Advancing Lung Cancer Care in Bulgaria: A Successful Implementation of Value-Based Healthcarе.

This project aims to assess the early impact of value-based healthcare (VBHC) implementation in a Bulgarian cancer center, focusing on lung cancer treatment, and to improve care coordination, expand capacity, and introduce outcome measurement through integrated practice units (IPUs), optimized pathways, and patient-reported outcome measures (PROMs). The approach included (i) 90 h of direct observation, (ii) structured stakeholder interviews, and (iii) time-driven activity-based costing (TDABC) to map resource use. Process maps guided workflow redesign. PROM implementation, based on the International Consortium for Health Outcomes Measurement lung cancer set, involved staff training and licensing. One year post-implementation, day hospital capacity doubled (50-100 patients/day). An external call center reduced physicians' administrative load. Interdisciplinary meetings and optimized referrals enhanced communication. PROMs now cover part of the lung cancer cohort. TDABC revealed opportunities for staff reallocation and streamlined diagnostics. Early results suggest VBHC is feasible in Eastern Europe, with measurable gains in efficiency. Future steps include PROM digitization, telemedicine expansion, and adapting the IPU model to other cancer types.