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- 2020
- Working Paper
Cutting the Gordian Knot of Employee Health Care Benefits and Costs: A Corporate Model Built on Employee Choice
By: Regina E. Herzlinger and Barak D. Richman
The U.S. employer-based health insurance tax exclusion created a system of employer-sponsored insurance (ESI) with limited insurance choices and transparency that may lock employed households into health plans that are costlier or different from those they prefer to...
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Keywords:
After-tax Income;
Consumer-driven Health Care;
Health Care Costs;
Health Insurance;
Income Inequality;
Tax Policy;
Health Care and Treatment;
Cost;
Insurance;
Employees;
Income;
Taxation;
Policy;
United States
Herzlinger, Regina E., and Barak D. Richman. "Cutting the Gordian Knot of Employee Health Care Benefits and Costs: A Corporate Model Built on Employee Choice." Duke Law School Public Law & Legal Theory Series, No. 2020-4, December 2019. (Revised January 2021.)
- November 2019
- Article
A Review of Bundled Payments in Total Joint Replacement
By: Olivia Manickas-Hill, Kevin J. Bozic and Thomas W. Feeley
The Bundled Payments for Care Improvement (BPCI) initiative, developed by the U.S. Center for Medicare & Medicaid Innovation, aims to reduce health care expenditures while maintaining or improving patient outcomes.
Several published reports evaluating the impact... View Details
Several published reports evaluating the impact... View Details
Manickas-Hill, Olivia, Kevin J. Bozic, and Thomas W. Feeley. "A Review of Bundled Payments in Total Joint Replacement." Journal of Bone and Joint Surgery Reviews 7, no. 11 (November 2019).
- Article
Mandate Outcomes Reporting
By: Robert S. Kaplan and Michael E. Porter
Currently, few health care providers measure and report their patient outcomes, which leads to several problems. Attempts to introduce price transparency without outcomes transparency could trigger a “race to the bottom.” Should Medicare coverage be expanded to...
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Keywords:
Outcomes Reporting;
Outcomes Measurement;
Medicare;
Medicaid;
Health Care and Treatment;
Outcome or Result;
Measurement and Metrics
Kaplan, Robert S., and Michael E. Porter. "Mandate Outcomes Reporting." Health Management, Policy and Innovation 4, no. 3 (December 2019).
- July 2019
- Article
Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements
By: 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...
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Keywords:
Medicare;
Medicaid;
Bundled Payments;
Health Care and Treatment;
Cost Management;
Performance Evaluation;
Outcome or Result
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.
- February 2019
- Article
Does It Matter If Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending
By: Leemore S. Dafny
There is limited empirical evidence about the impact of for-profit health insurers on various outcomes. I study the effects of conversions to for-profit status by Blue Cross Blue Shield (BCBS) affiliates in 11 states, spanning 28 geographic markets. I find both the...
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Keywords:
Health Insurance;
Medical Loss Ratio;
Blue Cross;
Corporate Governance;
Health;
Insurance;
For-Profit Firms;
Insurance Industry;
United States
Dafny, Leemore S. "Does It Matter If Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending." American Economic Journal: Economic Policy 11, no. 1 (February 2019): 222–265.
- August 2017
- Case
CareMore Health System
By: Robert S. Huckman and Brian W. Powers
CareMore Health System—a physician-founded care delivery system and health plan—had developed and refined an innovative care model for at-risk seniors enrolled in Medicare managed care (i.e., Medicare Advantage) plans. CareMore's President, Sachin Jain, and his...
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Keywords:
Health Care Delivery;
Health Insurance;
Medicare;
Medicaid;
Managed Care;
Extensivist;
Social Determinants Of Health;
Health Care and Treatment;
Insurance;
Business Model;
Growth and Development Strategy;
Decision Choices and Conditions;
Health Industry;
United States
Huckman, Robert S., and Brian W. Powers. "CareMore Health System." Harvard Business School Case 618-008, August 2017.
- August 2017
- Supplement
CareMore Health System (B)
By: Robert S. Huckman and Brian W. Powers
This supplement to “CareMore Health System (A)” discusses the company's early experience introducing its managed Medicaid model in the Des Moines, Iowa, market. It also provides an update on the Memphis program discussed in the (A) case.
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Keywords:
Health Care Delivery;
Health Insurance;
Medicare;
Medicaid;
Managed Care;
Extensivist;
Social Determinants Of Health;
Health Care and Treatment;
Insurance;
Business Model;
Growth and Development Strategy;
Health Industry;
United States
Huckman, Robert S., and Brian W. Powers. "CareMore Health System (B)." Harvard Business School Supplement 618-009, August 2017.
- May 2016
- Article
How the Affordable Care Act Has Affected Cancer Care in the United States: Has Value for Cancer Patients Improved?
By: Stephen M. Schleicher, Nancy M. Wood, Seohyun Lee and Thomas W. Feeley
The Patient Protection and Affordable Care Act (ACA), passed in 2010, contained a number of provisions with potential to directly or indirectly affect cancer care. Value for patients was widely discussed throughout the bill, and the Centers for Medicare and Medicaid...
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Schleicher, Stephen M., Nancy M. Wood, Seohyun Lee, and Thomas W. Feeley. "How the Affordable Care Act Has Affected Cancer Care in the United States: Has Value for Cancer Patients Improved?" Oncology 30, no. 5 (May 2016): 468–474.
- February 2015
- Background Note
A Note on the Affordable Care Act and the U.S. Health Care System
By: Joseph L. Bower and Michael Norris
This note provides an overview of the U.S. health care system as it stood in 2014, including an overview of hospitals, doctors, insurance companies, and other health care providers. It also discusses the major political actions on health care in the 20th century,...
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Keywords:
Health Care;
Health Care Policy;
Political Process;
Health Care and Treatment;
Health Industry;
United States
Bower, Joseph L., and Michael Norris. "A Note on the Affordable Care Act and the U.S. Health Care System." Harvard Business School Background Note 315-031, January 2015.
- February 2012 (Revised June 2013)
- Case
Moving to Universal Coverage: Health Care Reform in Massachusetts
By: Michael E. Porter and Jennifer F Baron
State health care reform in Massachusetts has involved a phased process, focusing first on coverage expansion and then turning to delivery system innovation and cost containment. In 2006, the state adopted an individual mandate to obtain health care coverage which,...
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Porter, Michael E., and Jennifer F Baron. "Moving to Universal Coverage: Health Care Reform in Massachusetts." Harvard Business School Case 712-466, February 2012. (Revised June 2013.)
- 20 May 2011
- Other Presentation
Value-Based Health Care Delivery
This presentation draws on Redefining Health Care: Creating Value-Based Competition on Results (with Elizabeth O. Teisberg), Harvard Business School Press, May 2006; ―A Strategy for Health Care Reform—Toward a Value-Based System, New England Journal of Medicine, June...
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Porter, Michael E. "Value-Based Health Care Delivery." Centers for Medicare & Medicaid Services, Baltimore, MD, May 20, 2011.
- 11 May 2011
- Other Presentation
Clinical Registries: The Opportunity for the Nation
Clinical Registries: The Opportunity for the Nation
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Porter, Michael E. "Clinical Registries: The Opportunity for the Nation." National Leadership Meeting, Centers for Medicare & Medicaid Services, May 11, 2011.
- 15 Dec 2010
- Other Presentation
Value-Based Health Care Delivery
This presentation draws on Redefining Health Care: Creating Value-Based Competition on Results (with Elizabeth O. Teisberg), Harvard Business School Press, May 2006; ―A Strategy for Health Care Reform—Toward a Value-Based System, New England Journal of Medicine, June...
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Porter, Michael E. "Value-Based Health Care Delivery." Medicaid Leadership Institute, Robert Wood Johnson Foundation, Boston, MA, December 15, 2010.
- 15 Sep 2009
- Other Presentation
Value-Based Health Care Delivery
This presentation draws on Michael E. Porter and Elizabeth Olmsted Teisberg: Redefining Health Care: Creating Value-Based Competition on Results, Harvard Business School Press, May 2006, and "How Physicians Can Change the Future of Health Care," Journal of the...
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Porter, Michael E. "Value-Based Health Care Delivery." Medicaid Leadership Forum, Princeton, NJ, September 15, 2009.
- April 2008
- Case
Ophthalmic Consultants of Boston and Dr. Bradford J. Shingleton (2004)
By: H. Kent Bowen and Marcelo Pancotto
Dr. Bradford Shingleton has developed some of the highest quality eye surgery techniques in the industry. He involves his nurses and technicians in creating a surgical service that is constantly improving. The case has many details about how Dr. Shingleton works with...
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Keywords:
Health Care and Treatment;
Independent Innovation and Invention;
Service Operations;
Performance Productivity;
Practice;
Problems and Challenges;
Health Industry;
Boston
Bowen, H. Kent, and Marcelo Pancotto. "Ophthalmic Consultants of Boston and Dr. Bradford J. Shingleton (2004)." Harvard Business School Case 608-151, April 2008.
- April 2008 (Revised May 2008)
- Case
Commonwealth Care Alliance: Elderly and Disabled Care
By: Michael E. Porter and Jennifer F Baron
Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the US. Commonwealth Care Alliance, a small nonprofit insurer and care delivery system in Massachusetts, operated under a public demonstration...
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Keywords:
Programs;
Public Sector;
Alliances;
Policy;
Age;
Service Delivery;
Value;
Health Care and Treatment;
Welfare;
Insurance Industry;
Health Industry;
Massachusetts
Porter, Michael E., and Jennifer F Baron. "Commonwealth Care Alliance: Elderly and Disabled Care." Harvard Business School Case 708-502, April 2008. (Revised May 2008.)
- Article
Cross Country: They'd Sooner Fix Medicaid
By: Tom Coburn and Regina Herzlinger
Coburn, Tom, and Regina Herzlinger. "Cross Country: They'd Sooner Fix Medicaid." Wall Street Journal (May 18, 2006).
- August 2, 2005
- Article
Medicine for Medicaid
By: R. E. Herzlinger
Herzlinger, R. E. "Medicine for Medicaid." Wall Street Journal (August 2, 2005), A10.
- July 1996 (Revised February 2021)
- Case
THG Management Services
By: Regina E. Herzlinger and D. Scott Lurding
The two entrepreneurial founders of a Medicaid managed-care firm are considering how and where to expand and whether they should manage risk for hospitals that want to enter the managed-care sector or own it.
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Keywords:
Managed Care;
Capitation;
Entrepreneurship;
Insurance;
Health Care and Treatment;
Risk Management;
Motivation and Incentives;
Expansion;
Health Industry;
Insurance Industry
Herzlinger, Regina E., and D. Scott Lurding. "THG Management Services." Harvard Business School Case 197-011, July 1996. (Revised February 2021.)