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- 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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- 2021
- Working Paper
Which Markets (Don't) Drive Pharmaceutical Innovation? Evidence From U.S. Medicaid Expansions
By: Craig Garthwaite, Rebecca Sachs and Ariel Dora Stern
Pharmaceutical innovation policy involves managing a tradeoff between high prices for new products in the short-term and stronger incentives to develop products for the future. Prior research has documented a causal relationship between market size and pharmaceutical...
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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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- November 2020 (Revised April 2021)
- Case
Roll-Ups and Surprise Billing: Collisions at the Intersection of Private Equity and Patient Care
By: Trevor Fetter and Kira Seiger
This case describes the increasing investment by private equity (PE) firms in patient care and other healthcare services. The case focuses on investments in physician staffing firms and roll-up strategy investments in physician practice management (PPM). Included in...
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Keywords:
Business Ventures;
Acquisition;
Mergers and Acquisitions;
Business Model;
Change;
Disruption;
Fluctuation;
Trends;
Customers;
Customer Value and Value Chain;
Ethics;
Fairness;
Finance;
Equity;
Insurance;
Private Equity;
Geography;
Geographic Scope;
Health;
Health Care and Treatment;
Markets;
Demand and Consumers;
Supply and Industry;
Industry Structures;
Ownership;
Ownership Type;
Private Ownership;
Relationships;
Agency Theory;
Business and Community Relations;
Business and Shareholder Relations;
Business and Stakeholder Relations;
Networks;
Strategy;
Competition;
Consolidation;
Expansion;
Integration;
Horizontal Integration;
Vertical Integration;
Value;
Value Creation;
Health Industry;
Insurance Industry;
United States
- September 8, 2020
- Article
Allocation of COVID-19 Relief Funding to Disproportionately Black Counties
By: Pragya Kakani, Amitabh Chandra and Sendhil Mullainathan
This study describes correlations between the dollar amount of relief funding authorized by the US Congress to fund prevention, diagnosis, and treatment of coronavirus disease 2019 (COVID-19) and to reimburse health care entities for lost revenues, and county-level...
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- Article
Germany's Digital Health Reforms in the COVID-19 Era: Lessons and Opportunities for Other Countries
By: Sara Gerke, Ariel D. Stern and Timo Minssen
Reimbursement is a key challenge for many new digital health solutions, whose importance and value have been highlighted and expanded by the current COVID-19 pandemic. Germany’s new Digital Healthcare Act (Digitale–Versorgung–Gesetz or DVG) entitles all individuals...
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- June 30, 2020
- Article
Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option
By: Regina E. Herzlinger, Richard Boxer and James Wallace
A combination of health insurance initiatives by the presumptive 2020 Democratic and Republican presidential nominees could expand health care coverage and significantly reduce costs, without raising taxes. Along the way, the combination could revitalize private...
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- May–June 2020
- Article
The Agenda for the Next Generation of Health Care Information Technology
By: Thomas W. Feeley, Zachary Landman and Michael E. Porter
As the diffusion of value-based health care efforts accelerates globally, the need for interoperable information technology systems that support value-based care is essential. Such systems are needed to facilitate dramatic improvements in patient outcomes and...
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- 2019
- Working Paper
Thinking Outside the Box (12): The Benefits of Increased Transparency in Employer-Sponsored Health Insurance for the 180 Million Insured
By: Regina E. Herzlinger and Barak D. Richman
Economists have long noted that the tax exclusion of employer-sponsored insurance (ESI) caused workers to purchase health plans that differ in price and other characteristics from those they would otherwise choose for themselves. We explore the short-term and long-term...
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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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- 2019
- Chapter
Characterizing the Drug Development Pipeline for Precision Medicines
By: Amitabh Chandra, Craig Garthwaite and Ariel Dora Stern
BOOK ABSTRACT: Personalized and precision medicine (PPM)—the targeting of therapies according to an individual’s genetic, environmental, or lifestyle characteristics—is becoming an increasingly important approach in health care treatment and prevention. The advancement...
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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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- Article
Operational Efficiency and Effective Management in the Catheterization Laboratory
By: Grant W. Reed, Michael L. Tushman and Samir R. Kapadia
Operational efficiency is a core business principle in which organizations strive to deliver high-quality goods or services in a cost-effective manner. This concept has become increasingly relevant to cardiac catheterization laboratories, as insurers move away from...
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- May 2018 (Revised October 2020)
- Supplement
La Ribera Health Department (B): Epilogue
By: Regina E. Herzlinger, Emer Moloney and Daniela Beyersdorfer
The La Ribera case studies depict an innovative low cost/high quality privately financed hospital model struggling to achieve alignment with the Six Factors. It is reimbursed by the public sector in a Spanish environment whose Consumers, Structure, and Public Policy...
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- August 2017
- Case
RoboTech: Storming into the U.S. Market
By: Christopher A. Bartlett, Rachel Gordon and John J. Lafkas
This case describes the challenges facing the CEO of a small, Singapore-based industrial robotics company that decides to diversify away from its core industrial robot business by leveraging its expertise into the medical-devices industry. It launches an innovative...
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- January 2017
- Supplement
Intrapreneurship at DaVita HealthCare Partners: Cash Flow Tool
By: Joseph B. Fuller and Christopher Payton
DaVita Healthcare Partners Inc. (DaVita) is one of the U.S.'s leading dialysis providers, a process whereby persons with end-stage renal disease (ESRD) are connected to a machine that performs the functions of a healthy kidney. Kent Thiry, DaVita's CEO, has expanded...
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- Article
Adding Value by Talking More
By: Robert S. Kaplan, Derek A. Haas and Jonathan Warsh
The prevailing fee-for-service payment model has led health care administrators and physician practices to impose severe constraints on the time physicians spend talking, for which they are reimbursed poorly or not at all. New value-based reimbursement models, however,...
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- October 2016 (Revised March 2019)
- Case
Carrum Health: Scaling Bundled Payments
By: Robert S. Huckman and Sarah Mehta
Founded in 2014, Carrum Health helped self-insured employers located in three markets (San Diego, California; Seattle, Washington; and San Francisco, California) save money on their employees’ planned surgeries. It did so by contracting directly with top-quality...
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Keywords:
Health Financing;
Health Insurance;
Value-based Healthcare Reimbursements;
Bundled Payments;
Innovation;
Scale;
Health;
Health Care and Treatment;
Cost Management;
Growth and Development Strategy;
Decision Choices and Conditions;
Health Industry;
California;
San Francisco;
San Diego;
Seattle
- August 2016 (Revised August 2016)
- Teaching Note
Intrapreneurship at DaVita Healthcare Partners
By: Joseph B. Fuller and Matthew Preble
DaVita Healthcare Partners Inc. (DaVita) is one of the U.S.'s leading dialysis providers, a process whereby persons with end-stage renal disease (ESRD) are connected to a machine that performs the functions of a healthy kidney. Kent Thiry, DaVita's CEO, has expanded...
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- Article
Value-based Healthcare: Implications for Thyroid Cancer
By: A.K. Ying, T.W. Feeley and M. E. Porter
Today's delivery of care to thyroid cancer patients is complex, and costly, with uneven outcomes that can be improved. The incidence of thyroid cancer is rising and requires coordinated, multidisciplinary care with high volume centers that is not always available in...
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