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• Article | Health Affairs

  Navy Medicine Introduces Value-Based Health Care

  Alee Hernandez, Robert S. Kaplan, Mary L. Witkowski, C. Forrest Faison III and Michael E. Porter

  In 2016 the newly appointed surgeon general of the Navy launched a value-based health care pilot project at Naval Hospital Jacksonville to explore whether multidisciplinary care teams (known as integrated practice units, or IPUs) and measurement of outcomes could improve the readiness of active duty personnel and lower the cost of delivering care to them, their dependents, and local retirees. This article describes the formation of the project’s leadership structure, the selection of four conditions to be treated (low back pain, osteoarthritis, diabetes, and high-risk pregnancy), the creation of the care team for each condition, outcomes and costs measured, and the near-term changes in outcomes during the twelve-month pilot period. Patient outcomes improved for three of the four conditions. We describe factors that contributed to the project’s success. After the pilot concluded, the Navy combined the back pain and osteoarthritis IPUs into a single musculoskeletal clinical unit and established a similar IPU at another naval hospital and its clinics. The diabetes IPU was continued, but the high-risk pregnancy IPU was not. We offer several observations on the elements that were key to the success of the project, explore challenges and opportunities, and suggest that the pilot described here could be taken to greater scale in the Military Health System and elsewhere.

  Keywords: military health system; Health Care and Treatment; Cost Management; Projects;

  Citation:

  Hernandez, Alee, Robert S. Kaplan, Mary L. Witkowski, C. Forrest Faison III, and Michael E. Porter. "Navy Medicine Introduces Value-Based Health Care." Health Affairs 38, no. 8 (August 2019): 1393–1400.  View Details

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• Article | JAMA Internal Medicine | July 2019

  Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements

  Derek A. Haas, Xiaoran Zhang, Robert S. Kaplan and Zirui Song

  In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. The paper analyzed Medicare costs for beneficiaries undergoing lower extremity joint replacement between April 1, 2016, through December 31, 2017. The introduction of the CJR was associated with reduced Medicare Part A spending ($582 per episode, a 2.5% savings) largely through lower post-acute spending in skilled nursing facilities. The CJR hospitals had no significant differences in hospital length of stay, readmissions, complications, 30- or 90-day mortality, volume of episodes, or patient characteristics relative to the non-CJR hospitals. We conclude that mandatory bundled payments may help to change clinicians’ and facilities’ behavior without harming quality.

  Keywords: Medicare; Medicaid; bundled payments; Health Care and Treatment; Cost Management; Performance Evaluation; Outcome or Result;

  Citation:

  Haas, Derek A., Xiaoran Zhang, Robert S. Kaplan, and Zirui Song. "Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements." JAMA Internal Medicine 179, no. 7 (July 2019): 924–931.  View Details

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• Case | HBS Case Collection | March 2019 (Revised May 2019)

  Fetchr: A New Way of Last Mile Delivery

  V.G. Narayanan and Eren Kuzucu

  By mid-2016, five years of aggressive growth had transformed Fetchr from a small logistics startup to a 1,000-employee, full-fledged last-mile delivery company operating across four countries in the Middle East and North Africa (MENA). Already beneficiaries of the largest Series A round to the Middle East from an American firm, CEO Idriss Al Rifai and the Fetchr team had ambitions of raising another $40 million in Series B and deliberated continuing international expansion. But first, Al Rifai and his team needed to address the operational efficiency and profitability issues that led their investors to threaten the discontinuation of funding and put the company’s future at stake. The case provides background information on the logistics sphere in the Middle East and the challenges companies face in the region. The case then takes the reader through Al Rifai’s journey of founding and growing Fetchr, backed with innovations like their patented GPS-based delivery technology. Finally, the case zooms in on Fetchr’s management team as they race against time to perform evaluations of their operational efficiency, weigh cost-cutting options, and explore strategies to improve profitability.

  Keywords: Startup; decision; financial strategy; UAE; KSA; MENA; Cost Accounting; Business Model; Business Startups; Transformation; Cost Management; Strategy; Disruptive Innovation; Technological Innovation; Growth and Development Strategy; Growth Management; Logistics; Service Delivery; Supply Chain Management; Performance Evaluation; Mathematical Methods; Mobile Technology; Transportation Networks; Middle East; United Arab Emirates; Dubai; Bahrain; Egypt; Saudi Arabia; North Africa;

  Citation:

  Narayanan, V.G., and Eren Kuzucu. "Fetchr: A New Way of Last Mile Delivery." Harvard Business School Case 119-018, March 2019. (Revised May 2019.)  View Details

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