Search

Health savings accounts (HSAs), a creation of the 2003 Medicare Modernization Act, had become an integral part of the drive toward consumer-driven health care. Coupled with high-deductible health plans, HSAs allowed consumers to directly control a significant part of their annual health care spend, and the tax-advantaged nature of the accounts made them an attractive investment vehicle as well. Several thorny questions remained, however. For instance, would insurers and employers embrace the accounts for the customers they influenced? Would financial professionals see the relatively small accounts as a valuable component for their clients? In this context the mobile app HSA Coach was developed. The Health Savings Accounts case presents the challenges facing new innovations in mature sectors, with particular emphasis on technology and finance concerns of Prof. Herzlinger's Six Factors of the Innovating in Health Care framework.

Supplement to case 312029. Brazilian Managed Care Organization Amil faces a series of challenges while trying to redefine the terms of its relationship with hospitals and clinics and to implement a new health care model based on primary care and family medicine.

The B case documents developments in the Alzira model looking at the impact of new shareholder Centene, new programs and tools that have been developed, and changes in Spain's political environment that have impacted the model.

The CEO of Hebrew SeniorLife is contemplating how to scale his highly successful but asset-intensive continuing care retirement community for elders. Among the strategies he is considering is an expansion to China; virtual web-based care; providing continuing care in the home setting; and an expansionist model in the U.S. Hebrew SeniorLife is a mission-driven organization that is managed in a financially-prudent way. Those principles must guide his decision.

In 2016, Fitbit remained the world's leading producer of activity trackers-an increasingly crowded space-with over 21 million units sold that year. Fitbit's suite of products allowed users to track the number of steps taken, calories burned, and heart rate activity. Fitbit devices were marketed to individual consumers as well as corporate wellness programs and employers. Though Fitbit was primarily focused on wellness, should management consider evolving into a chronic disease management company?

This case should be distributed only after'Vitalia Franchise'(HBS Case No. 311-035) is distributed and discussed.

Case describes acquisition of Change Healthcare, which provides health care cost and quality information, by Emdeon, a health information exchange, and discusses health care transparency. Emdeon is a billion-dollar company that has grown through acquisitions; at its core, it transmits health insurance claims and payments between providers and insurers. The health care marketplace is becoming increasingly electronic, but this move comes with risks. Increased consumerism in health care is creating a need for information on cost and quality. Change Healthcare responds to this need and markets primarily to health insurers. The company has unique ways to drive enrollee engagement. However, the transparency space is becoming competitive, with entrants from public and private sources. In this shifting environment, Emdeon must decide how best to integrate Change.

This case focuses on Ac badem Healthcare Group's, Turkey's only premium nationwide hospital network, potential expansion strategies after it was acquired by International Healthcare Holdings Berhad (IHH) in 2011, the world's second-largest publicly listed health care group and a private hospital leader in Singapore and Malaysia. By providing perspectives on both Ac badem and IHH-Parkway-Pantai's operational models, growth aspirations, collaboration and synergies, as well as cultural and operational differences, the case allows students to discuss which expansion strategies would be best suited for Ac badem's operations--which geographic regions should initially be targeted, what business model is best suited for Ac badem's growth (specialized chain, public-partnership etc.) Also, students are encouraged to discuss how Ac badem should leverage its relationship with IHH and collaborate with Parkway-Pantai.

A medical device startup seeks to complete its clinical trials with very little startup funding and a small staff when compared to its competitors.

A medical device startup seeks to complete its clinical trials with very little startup funding and a small staff when compared to its competitors.

Bonitas, a South African medical scheme (i.e., health insurer), must navigate highly restrictive regulations that make it difficult for Bonitas to innovate, grow, and compete with market leader Discovery as well as providers of alternative insurance products. Bonitas (HBS No. 315-020) must also plan ahead for the rollout of national health insurance-a deeply politicized issue in a country with great disparities in health care quality and access. How can Bonitas compete today while positioning itself to thrive-and not lose relevance-under a universal public health insurance system?

MedCath is a horizontally integrated chain of heart hospitals that partners with local cardiologists. It claims that its focus leads to better and cheaper results than those of an everything-for-everybody general hospital. Community hospitals generally vehemently oppose their entry into a new area. What options does MedCath have?

This case, a follow-up to Cancer Treatment Centers of America (A), HBS No. 313-012, begins with the debate over New Hampshire's certificate-of-need (CON) law, which restricts hospital expansion. This debate ignited significant public criticism of Cancer Treatment Centers of America (CTCA), a for-profit chain of five cancer-focused hospitals that had previously won a CON exception in Georgia, over its for-profit status and low acceptance of government-insured patients. The case also introduces the controversy over CTCA's cancer treatment outcomes-reporting practices, as well as the disparities in outcomes-reporting practices by cancer treatment providers generally. By providing perspectives on both sides of the issues, the case allows students to debate and draw their own conclusions about whether organizations like CTCA should be granted CON exceptions and whether the criticisms of its patient-acceptance and outcomes-reporting practices are well founded.

MELA is a start-up medical device company looking to develop a novel technology to help physicians diagnose a deadly skin cancer, melanoma. The case reviews the FDA medical device development process, the development path pursued by MELA, and the regulatory and business trajectory of the firm. In the end, MELA raised $100 million for the development of this technology, and had $1 million in revenue after launch. The case offers opportunities to have discussions focused on device development, market assessment, regulatory strategy, and launch strategy.

Describes the challenges facing Dr. John Noseworthy, President and CEO, in implementing a long-term strategy for the growth of the Mayo Clinic-a leading academic medical center with a reputation for excellence in tertiary and quaternary health care. The case highlights the concurrent forces of regional and national competition and federal health care reform as factors complicating the plans of Mayo Clinic to grow through several channels. Students must ultimately decide whether Mayo Clinic should focus its future growth on its current areas of expertise (regional provision of integrated medical care and international provision of tertiary and quaternary care), new opportunities in a broader range of services and treatment channels (e.g., telemedicine, mobile health, enterprise learning and training for other health care systems), or some combination of these opportunities.

Hospital for Special Surgery, a focused factory for orthopedics and joint disease, is contemplating various growth options: further growth in the United Kingdom's National Health Services, management of hospitals in the United States, and/or hospital consulting. Reviews the issues surrounding growth of a nonprofit institution and the United Kingdom's socialized health care system.

The La Ribera case studies depict an innovative low cost/high quality privately financed hospital model struggling to achieve alignment with the Six Factors. It is reimbursed by the public sector in a Spanish environment whose Consumers, Structure, and Public Policy favor public health care. But the Accountability factor shows it to be the highest quality hospital in the region with 25% lower costs and Spain's Financing is weak. The A case (9-315-006) asks: What Business Model elements enabled La Ribera to achieve this level of value? How can it improve on its 1% profit margin and better align itself with the Six Factors? The hospital hired a consulting firm that presented four new options that could potentially increase returns. Which, if any, best fit with the ten elements of its Business Model? The B case (9-318-134) contains the d nouement for La Ribera.

This case is designed to support a discussion of the importance of outcomes evidence in empowering the public to make better health care decisions, the desired level of transparency and accountability for health care providers, and the issues with current measuring and reporting practices that undermine the quality and comparability of outcomes data. The case describes two approaches to measuring cancer treatment outcomes. First, it describes a prostate cancer outcomes study conducted by Radiotherapy Clinics of Georgia, a subsidiary of Vantage Oncology, including a senior Vantage Oncology executive's views on the distinctive merits of this study's design. Second, the case describes treatment outcomes research by Memorial Sloan-Kettering Cancer Center (MSKCC) that compares cancer survival rates and costs of MSKCC and various comparator groups. The case briefly introduces a third approach, taken by Cancer Treatment Centers of America, in an Appendix.

The management of Germany's Brainlab AG, a leading provider of software-driven oncology and surgery solutions, needs to evaluate strategic options for proceeding without an exclusive hardware partner in its most profitable business segment.

Fortis, India's largest for-profit hospital chain, must decide if its expensive expansion into the South East Asia market makes sense.

Companion note to'Amil and the Health Care System in Brazil,'Harvard Business School Case No. 312-029, January 2014.

Companion background note to AxSys.

AxSys, a Scottish health information exchange firm which can provide connectivity among the Electronic Medical Record systems of different vendors, must decide how best to enter the U.S. market.

Brazil's largest dental insurer, a successful and innovative firm, has saturated the corporate market and faces stiffer competition. It must decide whether to enter a new market in Brazil or to expand into other parts of Central and South America.

Aon Hewitt, a leading health insurance broker and consultant, is one of the first movers in forming exchanges to sell health insurance. What kinds of products should it offer on this exchange?

Contains the framework for the second-year Innovating in Health Care course. Delineates the role of six exogenous forces on new ventures: structure, financing, regulations, consumers, accountability, technology, and public policy. Also, presents the essential elements of business models for new health care ventures.

Through the lens of biopharmaceutical contract research organization (CRO) PAREXEL, this case traces the evolution of the firm as it reinvents itself in response to the transformation of the CRO sector from a small, secondary cluster of firms into a major player with essential capabilities for global drug development. The case begins as PAREXEL is pursuing an expensive globalization and IT strategy while many of its competitors focus on cost cutting. Over the prior 20 years, CEO Josef von Rickenbach had grown PAREXEL into a billion-dollar company by taking calculated risks and making bold investments based on anticipated industry trends and client demand. Now, despite slowing demand for CRO services, PAREXEL is betting that a global footprint and technology capabilities will become its key future competitive advantage. Near the end of the case, the timing transitions to a decade after Rickenbach made this strategic decision, describing the development of the industry and PAREXEL's place within it.

Shanghai Pharmaceuticals (SPH), a vertically integrated Chinese pharmaceutical conglomerate, was considering its strategic options in the context of a rapidly evolving industry, policy, and economic environment. The company-essentially a collection of subsidiaries operating under a unified management structure-was formed through the 2009 merger of several state-owned enterprises, part of a broad policy effort in China to streamline state assets, consolidate the fragmented pharmaceutical sector, and enhance the global competitiveness of domestic firms. As it competed with other large domestic firms to become one of the few national champions that the government hoped to create, SPH was also considering an acquisition in the U.S. or Europe. This case allows students to consider the broad trends sweeping China's pharmaceutical industry and health care sector and assess future opportunities there for domestic and foreign businesses.

Cancer Treatment Centers of America (CTCA), a U.S. network of four privately owned oncology focused factory hospitals, was weighing options for growth. CTCA was entirely cancer focused and specialized in treating patients with complex and advanced-stage cancers, who were reached through advertising its integrative, team-based approach to care. CEO Stephen Bonner needed to decide whether to focus future expansion on building additional full-scale hospitals or pursuing a hub-and-spoke model, in which numerous oncology outpatient centers would be built in the region of each CTCA hospital. His decision would be made in the context of CTCA's unique business model and treatment philosophy and the public policy landscape, including certificate-of-need laws and the advent of Accountable Care Organizations (ACOs) and bundled payments. CTCA's for-profit status and direct-to-consumer advertising made it a target, he knew.

The management of Germany's Brainlab AG, a leading provider of software-driven oncology and surgery solutions, needs to evaluate strategic options for proceeding without an exclusive hardware partner in its most profitable business segment.

This case compares and contrasts four different models for delivering cancer care in India and the US. Students are asked to select the best model in its alignment with the Six Forces in those two countries and Africa, to which one of the models is considering expansion, and intrinsic business characteristics. The Indian models are all focused factories, but one is a hub and spoke model, with a radiology hub and ambulatory spokes, while the other offers only ambulatory services. The U.S. models are all focused factory hospitals, one academic and the other a private, for-profit firm located on the grounds of teaching hospitals.

Would the advent of global payment models and ACOs create sufficient demand for a telemedicine offering covering the care continuum, from hospitals to the home? This was the decision facing Royal Philips Electronics (Philips), the Netherlands-based producer of lighting, consumer electronics, and health care products, in 2012. Philips already offered several remote monitoring systems for hospitals, including the eICU, which it obtained through the 1998 acquisition of Visicu. In the eICU model, patients in hospital ICUs were monitored using bedside devices, which transmitted patient data to a remote station from which clinicians monitored and directed care as needed. The model aimed to improve care quality by enabling early interventions and reducing adverse events, and to cut costs by allowing clinicians to care for a larger number of patients. Building on this and other offerings in its portfolio, including numerous home care devices, Philips could extend this model to create an integrated remote monitoring offering managed through a centralized clinician-staffed station. In doing so, it could gain a deep and early foothold with ACOs and position itself as a leader in telemedicine-enabled care. However, U.S. telemedicine adoption to date was slow, in part due to insufficient cost-effectiveness evidence, and ACOs-the likely target customer-remained underdeveloped. Philips would also contend with a complex selling process and numerous operational challenges. Was it too early to invest? And, if not, who were the ideal ACO beta sites?

This case asks students to price a new drug which is in Stage II of its clinical trials. It contains detailed estimates of the time required and costs for all the steps needed to commercialize a drug in the U.S.