March 17, 2020

Working with a Brazilian Hospital Holding Company to Enhance Value-based Care

Developing a system of accountable care


Cleveland Clinic recently entered an agreement with the Brazil-based Hospital Care holding company to help them enhance their model of care countrywide. Rogerio Melzi is CEO of Hospital Care, which operates regional centers for the healthcare management of the country’s population in cities throughout Brazil.


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“At Hospital Care we are focused on developing an integrated system of private healthcare,” Melzi explains. “We looked at several healthcare systems in the U.S. and found that Cleveland Clinic is able to provide what we need.”

Hospital Care is looking to Cleveland Clinic to help it create a value-based healthcare system that operationalizes care similar to an accountable care organization (ACO) where doctors, hospitals and all healthcare providers work together to coordinate high-quality care (in the U.S. this is for Medicare patients). The goal being to ensure the right care at the right time and preventing medical errors and duplication of services.

A meeting of the minds

The relationship started as a result of Melzi and fellow colleagues attending Cleveland Clinic events over the last two years, including the well-known Patient Experience and Innovation summits. Melzi and team have also attended a number of programs offered by Cleveland Clinic’s Global Executive Education team, including a three-day program in 2019 that was customized to meet their needs.

“We expressly designed a program for Hospital Care focused on our best practices,” says Aura Lopez, Senior Director of Cleveland Clinic Global Executive Education. “Our leaders serve as the faculty for our customized programs, and they provide information to help other healthcare teams look at things differently so they can return to their countries to innovate.”


Among the faculty during the three-day program was Cleveland Clinic’s Vice Chairman of Population Health Nirav Vakharia, MD, who explains: “With value-based care it comes down to providing the highest quality of care and achieving cost savings in the process, and we know that the marketplace in general is looking for more transparency. Consumers want to know about costs and quality and they absolutely have a right to that. It is our job is to produce that and to make sure it’s understandable and also reflects the complexity of care in populations that different providers might serve.”

“As we started analyzing and understanding [this],” Melzi says, “it became clear to us that finding a way between the extremes of pure fee-for-service and pure capitation – or full verticalization – could represent a favorable strategy and positioning for our company. In this context, as we looked to the U.S. to get ideas, we saw the ACO model as a winning proposition.”

During the training, Melzi noted that his team was impressed to learn that Cleveland Clinic’s success as an ACO resulted in $16.6 million in shared savings in 2015 and has continued to save millions every year since. Consequently, Melzi was eager to learn how Cleveland Clinic could assist his organization in Brazil in a more comprehensive way by helping him to establish an ACO network in his home country.

“We are very committed to bringing the concepts of bundles and primary care centers to the cities where we operate, knowing that these are fundamental pieces to build the concept,” says Melzi. “We are counting on Cleveland Clinic’s expertise in the ACO model…with access to its knowledge and the team behind the concept.”


In 2020, Cleveland Clinic’s International Operations will work with Hospital Cares executives on a year-long customized project that gives an in-depth look at operationalizing value-based care.

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