Immersion Course

In January 2009, Professor Porter, together with Professor Elizabeth Olmsted Teisberg and other faculty, will teach for the second time time an intensive one week, full-time course on value-based health care delivery. This graduate-level course will be held at Harvard Business School for select Harvard MBA and MD students, others at Harvard pursuing health care-related courses of study, residents and junior physicians and clinicians at Boston area hospitals, and interested residents and clinicians from outside of Boston. The course utilizes case studies, guest protagonists, concept lectures, and other materials to present the fundamental principles of value-based competition and to examine organizations working to implement those principles in practice. See the course announcement for more information.

Cases

The Institute for Strategy and Competitiveness (ISC) at Harvard University is developing a growing body of case studies on health care delivery. These case studies, set in the United States and abroad, provide detailed examples of the strategic, organizational, or process choices involved in moving towards value-based care delivery models. These cases provide a rich understanding of how individual actors can drive change and improve patient outcomes.

Completed Case Studies

• ThedaCare: System Strategy
  Sachin H. Jain, Michael E. Porter
  Over the 1980s and 1990s, America's changing health care payer environment resulted in mergers of numerous community hospitals into hospital systems. Based in Appleton, Wisconsin, ThedaCare stood out among community hospital systems in its pursuit of service rationalization, clinical quality improvement, and value-based delivery. Driven by determined leadership, ThedaCare began site-based service line rationalization and introduced innovative care delivery models. ThedaCare is a metaphor for the challenges of transforming American community hospital systems. Can be used to teach: the evolution of structure, organization, and strategy of U.S.-based community hospital systems; integrated practice units and care cycles; management of health care quality improvement processes; challenges in diffusion of care delivery innovation; and cost transparency and quality measurement.

• The West German Headache Center: Integrated Migraine Care
  Michael E. Porter, Clemens Guth, Elisa Dannemiller
  Describes the joint efforts of the German health plan KKH and Essen University Hospital to develop an integrated practice unit (IPU), and the West German Headache Center's efforts to improve the quality of migraine care. Provides an overview of the German health care system detailing its provider, health plan, and reimbursement structure. Following new legislation in 2004, which allowed health plans and selected providers to contract outside of the regular group purchasing scheme, KKH and Dr. Deiner of Essen University Hospital developed a novel delivery structure for migraine care. Challenges and hurdles to implementation are described for both the health plan and the IPU. Provides detailed data to allow students to evaluate success, identify current challenges, and recommend improvements to the integrated care system.

• Commonwealth Care Alliance: Elderly and Disabled Care
  Michael E. Porter, Jennifer F. Baron
  Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the US. Commonwealth Care Alliance, a small nonprofit insurer and care delivery system in Massachusetts, operated under a public demonstration program designed to provide comprehensive coverage and care for the elderly dual eligible population. Led by Dr. Robert Master, Commonwealth Care Alliance worked with its contracted providers to implement and support a care delivery model that would allow as many members as possible to live independently outside of nursing homes. The case examines Commonwealth Care Alliance's insurance and care delivery approaches amidst a changing policy environment and various resource constraints.

• The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care
  Michael E. Porter, Sachin H. Jain
  In 2006, University of Texas MD Anderson Cancer Center was an internationally leading institution for cancer care, education, and research. Since 1996, it had successfully reorganized itself from a cancer hospital that was physically organized around clinical specialties into one what was organized into disease-based integrated practice units called multidisciplinary care centers. These units were supported by a new construction project that had created new disease-specific facilities and a widely-supported administrative plan in which physicians reported both to leadership of specialty-based academic departments and disease-based clinical centers.

• Brigham and Women's Hospital: Shapiro Cardiovascular Center
  Michael E. Porter, Robert S. Huckman, Jeremy L. Friese
  Considers the situation facing Gary Gottlieb, president of Brigham and Women's Hospital (BWH), prior to the opening of BWH's integrated cardiovascular center. This case allows students to develop an appreciation of the strategic, financial, organizational, clinical, and physical aspects of integrating health care delivery around specific categories of disease. It provides an opportunity to evaluate BWH's approach to integration along all of these dimensions and to identify the nature of the tradeoffs that hospitals--specifically, academic medical centers--face as they attempt to create disease-specific models of integrated care.

• In Vitro Fertilization: Outcomes Measurement
  Michael E. Porter, Saquib Rahim, Benjamin Tsai
  As of 2007, there were very few examples of widespread measurement and reporting of health outcomes, a critical quality measure. In-vitro fertilization clinics have been required to report their patient's health outcomes since 1995. The protagonist of the case, Dr. James Goldfarb, faces a number of challenges. As the medical director of a nationally-renowned fertility program at the Cleveland Clinic, he must run an efficient and effective practice that draws patients from both the surrounding area and from around the world. As a leader of the Society for Assisted Reproductive Technology, he must contribute toward the continuing evolution of the practice of in-vitro fertilization and ensure that the outcome measurement system is creating proper incentives and delivering timely, accurate, and useful information to patient, physicians, and researchers.

• Pitney Bowes: Employer Health Strategy
  Michael E. Porter, Jennifer F. Baron
  Pitney Bowes, a Fortune 500 mail and document management firm, offered its first health plans in the years following World War II. Over the ensuing decades, Pitney Bowes adapted its approach to employee health amid rising health care costs, shifting employer attitudes towards health benefits, and a rapidly changing policy environment. By 2008, the firm was widely regarded as an innovator in employee health, having dedicated substantial time and resources to its health benefits under the leadership of then CEO Michael Critelli and Corporate Medical Director Jack Mahoney. The case provides an overview of the history of employee health benefits in the U.S. and at Pitney Bowes. The range of health plans Pitney Bowes offered to employees in 2008, as well as the firm's contracting policies with commercial insurers and self-insured plan administrators, are examined in detail. Pitney Bowes health and wellness programs are also described, enabling an analysis of the firm's overall employee health strategy in 2008 and a discussion of where Pitney Bowes should focus its attention moving forward.

• The Cleveland Clinic: Growth Strategy 2008
  Michael E. Porter, Elizabeth O. Teisberg
  The Cleveland Clinic's health care services are internationally renowned for quality. In 2008, The Clinic is restructuring the organization into teams defined around patient needs, rather than traditional medical specialties. "Patients First!" takes shape as the teams measure and report outcomes, coordinate care and develop to support improving value for patients. In addition to restructuring care delivery in the hospitals and throughout northeastern Ohio, The Clinic has investments, facilities and staff in several other states in the U.S. as well as in Canada and Abu Dhabi. It is also considering initiatives in Austria, China and India. Students can explore strategy transformation, geographic expansion, the process of introducing new measurement approaches, alignment of activities with strategic goals, and issues in leading change both within a company and across an economic sector.

• Global Health Partner: Obesity Care
  Michael E. Porter, Zayed M. Yasin, Jennifer F. Baron
  Global Health Partner was founded in 2006 as a privately owned health care provider in Sweden serving both public and private paying patients. In contrast to most providers in the country, GHP organized around specific service lines where it saw the potential to provide the most value. This case details the GHP approach to both Spine Care and Obesity Care demonstrating the power of specialization for quality improvement as a basis for competitive advantage. Students will examine the organization of integrated multidisciplinary care, the impact of volume on learning and efficiency, and the importance of demonstrating quality through outcomes reporting. The case also provides a window into the Swedish Health Care System.

Near Completion

• Dartmouth-Hitchcock Medical Center: Spine Care
• Partners in Health: HIV Care in Rwanda
• The UCLA Health System Transplant Program
• Park Nicollet Health Services: Diabetes Care

In Process

• The Joslin Diabetes Center
• DaVita Dialysis Centers
• Koo Foundation Sun Yat-Sen Cancer Center: Breast Cancer Care in Taiwan
• Gastroenterology Care at Sweden's Highland Hospital
• Aetna: Health Insurance Strategy
• Children's Hospital of Philadelphia
• Novo Nordisk
• International Diabetes Center at Park Nicollet

Invitation to Health Care Faculty

We would be pleased to share our teaching materials and collaborate in studying and teaching value-based competition principles. To learn more about our curriculum and discuss how it might be used at your school, please contact Professor Porter (mporter@hbs.edu) or Institute Senior Researcher Jennifer Baron (jebaron@hbs.edu).