Hospital Clínic de Barcelona: before buying “on value”, they first bought… clarity

Most “innovative” procurement initiatives in healthcare miss the mark for one simple reason: they start with the solution.

Hospital Clínic de Barcelona did the opposite. And that is precisely what makes their case interesting.

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From the outset, the message is unambiguous: the point is not to buy innovation “for the sake of it” or to pile up innovative gadgets.

“It’s not about buying innovation. It’s about knowing how that innovation improves a care pathway and outcomes, for the patient, for society and for the health system.” (industry representative)

In other words: you are not procuring a product. You are procuring a capability to improve a care pathway and to demonstrate tangible effects.

1) Step 1: look at the real pathway, then get the right people around the table

On the hospital side, the trigger was not a procurement department looking for something original. It was a clinical drive: a committed lead cardiologist saw patients being “bounced around” the system and decided to tackle the problem at its root.

The key point: they did not start from an idea for a technology. They started from a dysfunctional care pathway.

A multidisciplinary team was set up (cardiologists, cardiac surgeons, nurses, geriatricians, etc.) and the pathway was mapped as it is actually experienced, from upstream (primary care) through to follow-up.

“We described the entire current pathway, identified the breaks, the bottlenecks, and the points where the system generates inefficiency.” (head of innovative procurement at the hospital)

The findings are familiar… but rarely treated as a system:

• underdiagnosis upstream (and auscultation not carried out systematically),
• poor coordination between primary care and the hospital,
• duplicated tests,
• delays before treatment,
• no “end-to-end” logic, particularly for long-term follow-up.

One organisational detail is telling: the heart team already existed, but without a geriatrician, even though most patients are elderly. Yet frailty assessment is decisive in choosing the best treatment option.

2) Step 2: turn the “gaps” into an action plan, not a catalogue of innovations

Once the breaking points had been identified, they did not produce a document of good intentions. They defined an operational plan, structured into actions, for example:

• referral criteria shared with GPs: when to refer, to whom, and how,
• education for citizens and GPs (short formats adapted to clinicians’ time),
• a single point of entry to the hospital: clear routing that everyone knows,
• “high-resolution” consultation (accelerated diagnosis and triage),
• multidisciplinary assessment with patient participation, including their preferences,
• prehabilitation: preparing the patient (education, nutrition, activity) before the procedure,
• digital support before and after (including an app) to make the return home safer, avoid unnecessary use of services and improve self-management,
• process manager: a cross-functional coordination role, essential if you really want to manage a care pathway,
• and a focus on palliative patients, who are better followed up, with a marked reduction in readmissions.

What this plan shows is that “value” is not limited to the technical procedure. It is built through organisation, pace, coordination, education and follow-up.

3) Step 3: only then comes procurement — but designed as a lever for transformation

The institutional context played its part: a European directive, European funds, the regional payer, an assessment agency and the hospital were all aligned. But the real breakthrough lies elsewhere: the call for tenders was designed around the care pathway.

“The call was aimed at a process, not a specific technology.” (head of innovative procurement at the hospital)

Above all, price became marginal in the decision. In this case, 4% of the score was based on price, 96% on quality.

“We are not used to weightings like 4% price and 96% quality.” (industry representative)

Procurement is no longer a hunt for the “cheapest”. It becomes an instrument for demanding quality, performance and value in use.

4) A smart contract: two lots, risk sharing, partly conditional payment

Three structuring choices make the exercise particularly instructive:

1) A market consultation before the tender

Objective: check feasibility, understand the strengths and limitations of the players, avoid unrealistic specifications, and organise a useful dialogue.

2) A refusal of the “single supplier that takes over everything”

The hospital wanted to remain in charge of the care pathway, not hand the transformation over to a contractor. So it chose to contract with two complementary companies.

“We wanted to remain leaders of the process. Not delegate, then evaluate.” (head of innovative procurement at the hospital)

3) Risk sharing and payment partly linked to performance

• Thresholds are defined: above them, the manufacturer covers part of the costs related to certain complications (pacemakers, leaks, strokes…).
• And part of the annual payment is conditional on meeting indicators.

“5% of the annual amount was linked to meeting indicators. If they are not met, we don’t pay that portion.” (head of innovative procurement at the hospital)

An important clarification is made explicit: these are management indicators (KPIs), distinct from clinical outcomes in the strict sense. But the intent is clear: to introduce a logic of shared responsibility, step by step.

5) Results: time saved, fewer complications and lower costs

The evaluation is observational (it is not a randomised trial), and the team says so. But the signals are clear:

• shorter referral times from primary care to the hospital,
• shorter internal time to treatment,
• fewer peri- and post-operative complications,
• shorter length of stay,
• lower costs: around 7% of total cost per patient per year,
• high patient and clinician satisfaction,
• and an overall result in favour of the new model in the cost-effectiveness analysis (with sensitivity analyses).

6) What this case teaches (and what it warns against)

What this case teaches:

1. You cannot “buy value” if you have not first defined the care pathway, its breaking points and its needs.
2. Value-based procurement works when the contract carries a concrete mechanism: quality weighting, risk sharing, indicators, governance.
3. Transforming a care pathway requires strong clinical leadership: without a committed leader, the model collapses.

“If you don’t have a strong leader, don’t go there: you will fail.” (head of innovative procurement at the hospital)

What this case warns against:

• the exercise is time-consuming: the hospital reports a significantly greater effort than for standard procurement, and so does the manufacturer.
• without a robust information system, measuring and applying contractual mechanisms (penalties, conditional payments) becomes very difficult.
• annual budgeting can make it impossible to smooth a “performance-based” payment from one year to the next, even when the intention is good.

Conclusion: the real shift is not “price → value”. It is “product → pathway”.

This case is not just the story of an unusual call for tenders. It shows a reversal: using public procurement as a lever for redesigning the care pathway, with an explicit definition of what is being improved, how it is measured, and how responsibility is shared.

And it is a reminder of a somewhat uncomfortable truth: if your “value-based procurement” starts with technology specifications, it is not value-based procurement. It is just shopping, made to look more serious on paper.

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Interested in a similar approach for your complex care pathways?

The Value Based HealthCare French Institute supports distributors and manufacturers in clarifying their role in patient journeys, structuring value-oriented partnerships, and moving beyond a purely product-based logic towards one of measurable impact.

Let’s talk.