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• Case | HBS Case Collection | March 2014 (Revised June 2019)

  Martini Klinik: Prostate Cancer Care

  Michael E. Porter, Jens Deerberg-Wittram, Thomas W. Feeley and Clifford M. Marks

  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 Hamburg University Hospital, Martini was a "hospital in a hospital" in close proximity to other hospital departments and services. By 2013, Martini Klinik had become the largest prostate cancer treatment program in the world with 5,000 outpatient cases and more than 2,200 surgical cases annually, with patients coming from all over Germany and from other countries. However, German private insurers were cutting reimbursement for prostate cancer by 15 percent, and denying extra payment for some new procedures, while reimbursement by public health plans was not covering costs. Dr. Hartwig Huland, Martini's founder and Medical Director, was considering how to respond.

  Keywords: health care; Michael Porter; Jens Deerberg-Wittram; Clifford Marks; prostate cancer; health care policy; value agenda; integrated practice units; outcomes measurement; Health Care and Treatment; Value; Health Disorders; Insurance; Medical Specialties; Outcome or Result; Measurement and Metrics; Business Processes; Insurance Industry; Health Industry; Germany;

  Citation:

  Porter, Michael E., Jens Deerberg-Wittram, Thomas W. Feeley, and Clifford M. Marks. "Martini Klinik: Prostate Cancer Care." Harvard Business School Case 714-471, March 2014. (Revised June 2019.)  View Details

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• Case | HBS Case Collection | February 2009 (Revised June 2019)

  Cleveland Clinic: Transformation and Growth 2015

  Michael E. Porter and Elizabeth O. Teisberg

  The Cleveland Clinic's health care services are internationally renowned for quality. In 2008, The Clinic began to restructure 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. Now in 2015, as the Clinic's domestic and international footprint continues to expand, its leadership is also focused in maintaining the Cleveland Clinic brand and providing optimal clinical care. 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.

  Keywords: health; health care operations; health care quality; health care; strategy and leadership; strategy development; Health Care and Treatment; Leading Change; Goals and Objectives; Growth and Development Strategy; Measurement and Metrics; Service Delivery; Organizational Change and Adaptation; Outcome or Result; Health Industry; Cleveland;

  Citation:

  Porter, Michael E., and Elizabeth O. Teisberg. "Cleveland Clinic: Transformation and Growth 2015." Harvard Business School Case 709-473, February 2009. (Revised June 2019.)  View Details

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• Article | Journal of Medical Economics | 2019

  Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance

  Robert S. Kaplan, Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell and Derek A. Haas

  Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.
  
  Methods: Time-Driven Activity-Based Costing (TDABC) was applied in a population-based cross-sectional study at Mayo Clinic’s warfarin anticoagulation clinic. The study measured the personnel and supplies costs to monitor and manage anticoagulation therapy for 5,526 patients.
  
  Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. For complex anticoagulation patients, the total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.
  
  Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.

  Keywords: Time-Driven Activity-Based Costing; Activity Based Costing and Management; Health Care and Treatment; Analysis;

  Citation:

  Kaplan, Robert S., Rohit A. Bobade, Richard A. Helmers, Thomas M. Jaeger, Laura J. Odell, and Derek A. Haas. "Time-Driven Activity-Based Cost Analysis for Outpatient Anticoagulation Therapy: Direct Costs in a Primary Care Setting with Optimal Performance." Journal of Medical Economics 22, no. 5 (2019): 471–477.  View Details

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