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- February 2021
- Case
New England Baptist Hospital: Getting Paid for Value
By: Robert S. Kaplan, Mary Witkowski, Toby E. Emanuel and Syed S. Shehab
New England Baptist Hospital (NEBH), a national leader in adult orthopedic care, has the lowest rate of complications and 30-day readmissions in New England, but gets paid 30% less for its surgeries than nearby institutions. NEBH introduces, with several large...
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- Article
Want to See the Future of Digital Health Tools? Look to Germany
By: Ariel Dora Stern, Henrik Matthies, Julia Hagen, Jan B. Brönneke and Jörg F. Debatin
A new law will make it easier to introduce and determine the benefits of new tools. Perhaps its most important provisions are its formalization of “prescribable applications,” which include standard software, SaaS, and mobile as well as browser-based apps, and the...
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- Article
Using the Balanced Scorecard for Successful Health Care M&A Integration
By: Robert S. Kaplan
The failure of merged organizations to achieve stated goals is commonplace. In health care, the challenge is exacerbated by the industry’s third-party payer system and multiple stakeholders, especially the physicians in the merging entities. This article describes how...
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- Working Paper
Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.
By: Pragya Kakani, Michael Chernew and Amitabh Chandra
Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available and affect patient cost-sharing,...
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- January 2019 (Revised June 2019)
- Technical Note
U.S. Commercial Health Insurance Industry
By: Susanna Gallani, Mary Witkowski and Harry B. Wolberg
This note describes the role of commercial payers in the U.S. healthcare industry. We begin with a review of the historical evolution of commercial payers and their role in the market, from the beginning to the Affordable Care Act and beyond. Every wave of reforms in...
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- October 2018 (Revised August 2019)
- Case
Beth Israel Deaconess: Consolidating to Strengthen, or to Stave Off, Competition?
By: Leemore Dafny
In July 2017, CEO Kevin Tabb of Boston's Beth Israel Deaconess Medical Center announced his plan to consolidate 11 Massachusetts hospitals under a common management structure. These hospitals collectively generated $5 billion in patient revenue and 25% of...
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- Article
Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System
By: 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...
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- September 2017 (Revised December 2017)
- Case
Intermountain Healthcare: Pursuing Precision Medicine
By: Richard G. Hamermesh, Kathy E. Giusti, Robert S. Huckman and Julia Kelley
Headquartered in Salt Lake City, Intermountain Healthcare operates 23 hospitals and hundreds of clinics in Utah and Idaho and provides insurance to approximately 850,000 patients through its insurance arm, SelectHealth. In 2013, Intermountain, known for its commitment...
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- May 11, 2017
- Article
Good Riddance to Big Insurance Mergers
By: Leemore S. Dafny
Federal judges issued preliminary injunctions halting mergers of four of the five largest U.S. health insurers. These decisions provide more precedent to support challenges of mergers between competitors in health care markets—whether payers or providers.
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- Article
Time-Driven Activity-Based Costing for Surgical Episodes
By: Peter Najjar, Matt Strickland and Robert S. Kaplan
Health care costs related to surgical care account for 40% of all hospital and physician spending. Payers attempting to contain costs are replacing fee-for-service with value-based payment schemes that can encompass entire episodes of care, including physician services...
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- December 2016
- Article
Health Care Needs Real Competition
By: Leemore S. Dafny and Thomas H. Lee
The U.S. health care system is inefficient, unreliable, and crushingly expensive. There is no shortage of proposed solutions, but central to the best of them is the idea that health care needs more competition. In other sectors, competition improves quality and...
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- October 2015 (Revised July 2017)
- Case
OMV Petrom: Investment as Partnership—When It Takes Three to Tango
By: Dante Roscini, Emer Maloney and Daniela Beyersdorfer
Petrom was privatized by the Romanian state in 2004 and acquired by Austrian oil company OMV, with the state retaining a 20.6% stake in the company. The situation was particularly challenging for the foreign investor since the sector in which the company operated was...
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- March 2015
- Teaching Note
CVS Health: Promoting Drug Adherence
Email mking@hbs.edu for a courtesy copy.
This Teaching Note explains the theory of the case and teaching plan for the case: CVS Health: Promoting Drug Adherence (515010). The case finds Helena Foulkes, Executive... View Details
This Teaching Note explains the theory of the case and teaching plan for the case: CVS Health: Promoting Drug Adherence (515010). The case finds Helena Foulkes, Executive... View Details
Keywords:
Medication Adherence;
Affordable Care Act (ACA);
Marketing Strategy;
Communication Strategy;
Customer Value and Value Chain;
Decisions;
Health Care and Treatment;
Goals and Objectives;
Resource Allocation;
Marketing Communications;
Consumer Behavior;
Measurement and Metrics;
Service Delivery;
Behavior;
Motivation and Incentives;
Social Issues;
Information Technology;
Value Creation;
Health Industry;
Pharmaceutical Industry;
Insurance Industry;
Public Relations Industry;
Retail Industry;
United States
- Article
Better Accounting Transforms Health Care Delivery
By: Robert S. Kaplan and Mary L. Witkowski
The paper describes the theory and preliminary results for an action research program that explores the implications from better measurements of health care outcomes and costs. After summarizing Porter's outcome taxonomy (Porter 2010), we illustrate how to use process...
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- September 2011
- Article
How to Solve the Cost Crisis in Health Care
By: Robert S. Kaplan and Michael E. Porter
Existing health care costing systems have serious flaws that make it impossible to measure costs accurately at the individual patient and medical condition level. This gap has severely limited meaningful cost reduction throughout the system. The paper describes a new...
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- March 2011
- Article
What Do Dividends Tell Us About Earnings Quality
By: Douglas Skinner and Eugene F. Soltes
Over the past 30 years, there have been significant changes in the distribution of earnings (cross-sectional variation has increased, with increasing left skewness) as well as in corporate payout policy, with many fewer firms paying dividends and the emergence of stock...
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Keywords:
Distribution;
Business Earnings;
Change;
Policy;
Stocks;
Investment Return;
Performance Consistency;
Quality
- August 2010 (Revised March 2012)
- Case
The UCLA Medical Center: Kidney Transplantation
By: Michael E. Porter, Jennifer F Baron, Jacob Mathew Chacko and Robin Jian Tang
In 2010, organ transplantation remained among the few sets of medical conditions in the U.S. for which bundled payments were a dominant reimbursement model, and for which patient health outcomes were universally measured and reported. In 1986, UCLA Medical Center was...
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- 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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- 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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- November 2007 (Revised January 2010)
- Case
ThedaCare: System Strategy
By: Michael E. Porter and Sachin H. Jain
Over the 1980s and 1990s, America's changing health care payer environment resulted in mergers of numerous community hospitals into hospital systems. Based in Appleton, Wisconsin, ThedaCare stood out among community hospital systems in its pursuit of service...
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