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Delays in receipt of necessary diagnostic and therapeutic medical procedures related to the timing of Medicare initiation at age 65 years have...
In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with but often...
- June 2, 2021
- Article
The CMS New Rule on Ambulatory Surgical Centers Earns Only Partial Credit
By: Junaid Nabi and Robert S. Kaplan
The Centers of Medicare and Medicaid Services (CMS) recently announced that it will be removing more...
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- March 2021 (Revised July 2021)
- Case
Aledade
By: Regina E. Herzlinger, Samyukta Mullangi and Nicholas Samonas
To truly supercharge growth, should Aledade take a step back and focus on product development?
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- 2020
- Working Paper
Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities
By: David Cutler, Leemore S. Dafny, David Grabowski, Steven S. Lee and Christopher Ody
The landscape of the U.S. healthcare industry is changing dramatically as healthcare providers expand both within and across markets. While federal antitrust agencies have mounted several challenges to same-market combinations, they have not challenged any...
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- 2020
- Working Paper
Hospital Allocation and Racial Disparities in Health Care
By: Amitabh Chandra, Pragya Kakani and Adam Sacarny
We develop a simple framework to measure the role of hospital allocation in racial disparities in health care and use it to study Black and white Medicare patients who are treated for heart attacks—a condition where virtually everyone receives care, hospital care is...
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- September 2, 2020
- Article
How to Pay for Public Option Without Tax Hike
By: Regina E. Herzlinger and Richard Boxer
A “Public Option” for health insurance that uses Medicare provider pricing and is administered by private insurers whose overall pricing conforms to GAAP will attain important, bi-partisan goals. For the Democrats, its lower costs will enable enrollment of the...
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- January 2, 2020
- Article
Changes in Quality of Care After Hospital Mergers and Acquisitions
By: Nancy Dean Beaulieu, Leemore S. Dafny, B. E. Landon, Jesse Dalton, Ifedayo Kuye and J. Michael McWilliams
Background: The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects...
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- January 2, 2020
- Article
Medicare for All or Public Option: Can Either Heal Health Care?
By: Regina E. Herzlinger and James Wallace
- Article
Economic Principles for Medicare Reform
By: Amitabh Chandra and Craig Garthwaite
In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but...
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- 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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- October 10, 2019
- Article
The Case for the Public Option Over Medicare for All
By: Regina E. Herzlinger and Richard Boxer
- 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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- March 2019
- Article
Evidence of Upcoding in Pay-for-Performance Programs
By: Hamsa Bastani, Joel Goh and Mohsen Bayati
Recent Medicare legislation seeks to improve patient care quality by financially penalizing providers for hospital-acquired infections (HAIs). However, Medicare cannot directly monitor HAI rates and instead relies on providers accurately self-reporting HAIs in claims...
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- February 2019
- Article
Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
By: David Cutler, Jonathan Skinner, Ariel Dora Stern and David Wennberg
There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician...
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- Article
Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated
By: Christopher Ody, Lucy Msall, Leemore S. Dafny, David Grabowski and David Cutler
Medicare’s Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a...
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- February 2018
- Case
Health Savings Accounts: Enabling Consumer Participation
By: Regina E. Herzlinger and James Wallace
Health savings accounts (HSAs), a creation of the 2003 Medicare Modernization Act, had become an integral part of the drive toward consumer-driven health care. Coupled with high-deductible health plans, HSAs allowed consumers to directly control a significant part of...
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- 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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- 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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- April 2017
- Supplement
Imprimis (B)
By: Ramon Casadesus-Masanell, Karen Elterman and Marc Appel
This case is a supplement to Imprimis (A). It describes the company’s decision to enter into the pharmaceutical compounding business in 2013–2014. Imprimis purchased a compounded ophthalmological medication called Dropless Therapy, which was injected into patients’...
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- November 2016 (Revised November 2016)
- Case
Radial Analytics Probes Post-Acute Care
By: Richard G. Hamermesh and Olivia Hull
Thaddeus Fulford-Jones and Eric Weiss, founders of healthcare technology startup Radial Analytics, have been busy developing a software program designed to save hospitals money and improve patient outcomes by producing customized care plans for patients leaving the...
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Keywords:
Electronic Medical Records;
Electronic Health Records;
Data Science;
Entrepreneurship;
Health Care and Treatment;
Business Model;
Business Startups;
Innovation and Invention;
Growth Management;
Marketing Strategy;
Product Launch;
Product Positioning;
Science-Based Business;
Business Strategy;
Health Industry;
Technology Industry;
Cambridge;
Massachusetts