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• Supplement | HBS Case Collection | June 2018

  Amil and the Health Care System in Brazil (B)

  Regina Herzlinger, Ana Maria Malik, Ruth Costas and Priscilla Zogbi

  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.

  Keywords: health care; Brazil; managed care; innovation; competitive strategy; health care industry; health; Health Care and Treatment; Health; Cost Management; Innovation and Invention; Competitive Strategy; Health Industry; Insurance Industry; Brazil;

  Citation:

  Herzlinger, Regina, Ana Maria Malik, Ruth Costas, and Priscilla Zogbi. "Amil and the Health Care System in Brazil (B)." Harvard Business School Supplement 318-149, June 2018.  View Details

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• Supplement | HBS Case Collection | May 2018

  La Ribera Health Department (B)

  Regina E. Herzlinger, Emer Moloney and Daniela Beyersdorfer

  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.

  Keywords: acquisition; business model; Business Plan; trends and opportunities; government; Government and Politics; health; Government programs; Acquisition; Business Model; Business Plan; Government and Politics; Health; Situation or Environment; Health Industry; Insurance Industry; Technology Industry; Spain;

  Citation:

  Herzlinger, Regina E., Emer Moloney, and Daniela Beyersdorfer. "La Ribera Health Department (B)." Harvard Business School Supplement 318-134, May 2018.  View Details

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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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