Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare

Robert S. Kaplan; Mary L. Witkowski; Megan  Abbott; Alexis  Guzman; Laurence  Higgins; John  Meara; Erin  Padden; Apurva  Shah; Peter  Waters; Marco  Weidemeier; Samuel  Wertheimer; Thomas W. Feeley

Article | Journal of Healthcare Management | November–December 2014

Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare

by Robert S. Kaplan, Mary L. Witkowski, Megan Abbott, Alexis Guzman, Laurence Higgins, John Meara, Erin Padden, Apurva Shah, Peter Waters, Marco Weidemeier, Samuel Wertheimer and Thomas W. Feeley

Abstract

As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches.

Keywords: Value Creation; Activity Based Costing and Management; Health Care and Treatment; Health Industry; United States; Europe;

Format: Print

Find at Harvard

Citation:

Kaplan, Robert S., Mary L. Witkowski, Megan Abbott, Alexis Guzman, Laurence Higgins, John Meara, Erin Padden, Apurva Shah, Peter Waters, Marco Weidemeier, Samuel Wertheimer, and Thomas W. Feeley. "Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare." Journal of Healthcare Management 59, no. 6 (November–December 2014): 399–413.

Since its establishment in 2005, Hamburg’s Martini Klinik had single-mindedly focused on prostate cancer care with a commitment to measure long term health outcomes for every patient. A wholly owned subsidiary of the University Hospital Hamburg, Martini Klinik was a “hospital in a hospital” in close proximity to other medical departments and services. By 2019, Martini Klinik had become the largest prostate cancer treatment program in the world with 8,000 outpatient cases and more than 2,500 surgical cases annually. Patients came from all over Germany and from around the world. A new and expanded facility was under construction to have the capacity to manage more patients with prostate cancer.

Working Paper | HBS Working Paper Series | 2019

Intelligent Design of Inclusive Growth Strategies

Robert S. Kaplan, George Serafeim and Eduardo Tugendhat

Improving corporate engagement with society, as advocated in the Business Roundtable’s 2019 statement, should not be viewed as a zero-sum proposition where attention to new stakeholders detracts from delivering shareholder value. Corporate programs for sustainable and ethical sourcing practices, however, have fallen far short of solving the underlying causes of extreme poverty, extensive use of child labor, and threats to the environment and human health. We identify several causes to explain this disappointing shortfall in societal performance, including traditional company policies and incentives that inhibit the implementation of innovative, inclusive growth strategies. We propose the role for a new actor, a catalyst, to help companies forge new relationships with external funders, local intermediary companies, NGOs, and community leaders. The catalyst aligns the multiple stakeholders from multiple sectors into enduring, mutually beneficial relationships that produce more value than that currently produced when stakeholders connect only by transactional relationships. The catalyst attracts funding from public and private sources to invest in the new ecosystem, which can generate attractive financial returns while alleviating poverty and environmental degradation. Finally, the catalyst engages the multiple participants to collectively co-create explicit strategies and scorecards of metrics, which serve to motivate, create accountability, and enable an enduring governance model for a multi-stakeholder ecosystem.

Keywords: inclusion; sustainability; performance measures; Environmental Sustainability; Social Issues; Strategy; Governance; Corporate Social Responsibility and Impact; Business and Stakeholder Relations;

Citation:

Kaplan, Robert S., George Serafeim, and Eduardo Tugendhat. "Intelligent Design of Inclusive Growth Strategies." Harvard Business School Working Paper, No. 20-050, October 2019. View Details

Cite View Details SSRN Read Now

We applied a value (outcomes and cost) analysis to extracorporeal life support (ECLS), a relatively rare but very expensive ICU therapy with highly variable outcomes. To address the outcome component of the value approach, we created guidelines for ECLS delivery; to address the cost component, we applied time-driven activity-based costing to identify opportunities for more efficient care. We learned that patient and family preferences for more humane and sensitive end-of-life care, if respected, will lead to less intensive use of ICU resources. Patients will have outcomes concordant with their goals and preferences, and society incurs lower costs to help them achieve those preferences. Cost reduction can be achieved by increasing efficiencies in the delivery of care and minimizing care outside of locally developed appropriate use guidelines. Reducing ECLS demands on ICU resources allows these resources to be redeployed to patients who are more likely to benefit from them, which also helps the institution financially.

Faculty & Research

Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare

Abstract

Citation:

About the Authors

More from these Authors