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• Article | JAMA, the Journal of the American Medical Association

  Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System

  Phillip Tseng, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah and Kevin A. Schulman

  The federal government mandated adoption of certified electronic health record systems (EHR), at least in part, to reduce administrative costs for physicians. This study used time-driven activity-based costing to determine the administrative costs associated with billing and insurance activities at a large academic health care center that had a certified EHR system. The center enjoyed economies of scale by concentrating its bill paying functions within a single, dedicated unit. The study found that costs for processing a single bill ranged from $20 for a primary care visit, about 20% of revenues, up to $215 for an inpatient surgical procedure. The high costs were not caused by wasteful, inefficient processes, duplicate or redundant tasks, or the inappropriate use of high-wage personnel to perform low-skilled tasks. Rather, they were driven by the heterogeneous payment requirements across the multiple payers and health plans contracting with the academic health center.

  Keywords: Health Care and Treatment; Cost Management; Insurance; Problems and Challenges;

  Citation:

  Tseng, Phillip, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah, and Kevin A. Schulman. "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System." JAMA, the Journal of the American Medical Association 319, no. 7 (February 20, 2018): 691–697.  View Details

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• Case | HBS Case Collection | February 2017 (Revised February 2018)

  Hebrew SeniorLife: Disseminating Excellence in Elder Care and Housing

  Regina E. Herzlinger, Carin-Isabel Knoop and Olivia Hull

  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.

  Keywords: continuing care; nursing home; rehabilitation; Assisted Living; elder care; entrepreneurial management; entrepreneurship; Health Care and Treatment; Entrepreneurship; Growth and Development Strategy; Health Industry; United States;

  Citation:

  Herzlinger, Regina E., Carin-Isabel Knoop, and Olivia Hull. "Hebrew SeniorLife: Disseminating Excellence in Elder Care and Housing." Harvard Business School Case 317-038, February 2017. (Revised February 2018.)  View Details

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• Case | HBS Case Collection | February 2018

  Health Savings Accounts: Enabling Consumer Participation

  Regina E. Herzlinger and James Wallace

  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.

  Keywords: health care; healthcare costs; health care and treatment; health insurance; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Health Industry; United States;

  Citation:

  Herzlinger, Regina E., and James Wallace. "Health Savings Accounts: Enabling Consumer Participation." Harvard Business School Case 318-110, February 2018.  View Details

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