Deploying a large-scale hospital–community VBHC transformation

Context

In Spain, a leading university hospital, in partnership with a home healthcare provider, wanted to transform the care of patients with sleep apnoea.

The context was particularly demanding:

• strong growth in patient numbers
• major challenges around adherence and long-term follow-up
• the need to closely coordinate hospital care and home follow-up
• growing economic pressure on hospital resources

The shared ambition was clear: to structure a VBHC model capable of scaling up, while maintaining lasting team engagement, fine-grained clinical management and smooth coordination between stakeholders.

Our role

I supported this project for 18 months, as VBHC project lead, with end-to-end responsibility for:

• defining the VBHC strategy
• structuring the hospital / provider partnership
• managing the operational roll-out
• supporting the clinical and field teams
• securing the business case in relation to patient adherence

Approach and project timeline

1. Strategic VBHC framing (European level)

The project began by defining a common VBHC framework, shared between hospital management, the home healthcare provider, and the medical and operational teams. This framework aimed to:

• align clinical, organisational and economic objectives
• clarify the role of each stakeholder in the care pathway
• identify levers for improvement without a heavy overhaul of existing systems

2. Field roll-out on the sleep apnoea care pathway

The sleep apnoea care pathway served as the pilot to demonstrate the feasibility of the model. In 18 months, the number of patients followed rose from 200 to more than 7,000, in a coordinated hospital → home model, while maintaining robust clinical management.

The roll-out relied on:

• the gradual onboarding of hospital and field teams
• clarifying responsibilities between the hospital and the provider
• setting up weekly management rituals
• careful management of resources and of the ramp-up

3. Clinical management, adherence and business case

One of the project’s central challenges was to link patient adherence, clinical outcomes and the model’s economic balance. We worked on:

• clinical indicators that are genuinely useful to the teams
• assessing the business case according to levels of adherence
• continuously adjusting the organisation to support quality without reducing capacity

Data was used as a tool for decision-making and learning, not as mere reporting.

4. Hospital–community governance and coordination

The project required active governance to:

• align the expectations of the hospital and the provider
• decide on operational priorities
• secure the resources needed to scale up
• maintain team engagement over time

Governance was designed as a tool for ensuring the coherence of the care pathway, not as an additional layer.

Results achieved

• Successful scale-up: 200 → 7,000 patients followed
• Effective coordination between the university hospital and the home healthcare provider
• Fine-grained clinical management maintained despite the massive increase in volumes
• Lasting team engagement thanks to clear rituals and a shared vision
• Demonstrated ability to link patient adherence, organisation and economic performance