Health Care

Health Care is a featured research topic and an initiative at Harvard Business School.
 
Over the past several decades, HBS has built a foundation in health care research, from Clayton Christensen's application of disruptive innovations and Regina Herzlinger's concept of consumer-driven health care to Michael Porter's use of competitive strategy principles. Today our research focuses on 
  • how management principles and best practices from other industries can be applied;
  • how the process of innovation can be improved;
  • how principles of strategy and consumer choice can be utilized;
  • how information technology can expand access, decrease costs, and improve quality;
  • how new approaches in developing nations can impact global health.

Featured Works

 

  1. Case | HBS Case Collection | February 2019

    Extend Fertility: Conceiving the Market for Egg Preservation (A)

    Debora L. Spar and Olivia Hull

    In April 2003, entrepreneur and MBA student Christy Jones was planning a new venture to help women preserve their fertility. Her company, Extend Fertility, would commercialize a technique known as egg freezing, in which a woman’s eggs were extracted and stored at low temperatures until she was ready to become a mother. To date, the emerging technology had mostly been used to preserve the fertility of cancer patients whose treatment course could damage their eggs. Jones’s business would target a massively broader population: healthy women wishing to postpone motherhood. Before Jones could launch Extend Fertility, she needed to answer two pressing questions. What, exactly, would an egg-freezing service be selling? And to whom?

    Keywords: Assisted reproduction; gender; strategy; entrepreneur; health and wellness; fertility; infertility; Women's health; Creating markets; egg freezing; fertility clinic; Strategy; Demographics; Entrepreneurship; Health Care and Treatment; Innovation and Invention; Marketing; Science; Technology; Innovation Strategy; Technological Innovation; Commercialization; Science-Based Business; Marketing Strategy; Business Plan; Product Marketing; Product Launch; Product Positioning; Mission and Purpose; Personal Development and Career; Social Issues; Integration; Health; Ethics; Health Industry; United States;

    Citation:

    Spar, Debora L., and Olivia Hull. "Extend Fertility: Conceiving the Market for Egg Preservation (A)." Harvard Business School Case 719-019, February 2019.  View Details
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  2. Article | American Economic Journal: Economic Policy | February 2019

    Does It Matter if Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending

    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 BCBS affiliate and its rivals increased premiums following conversions in markets where the converting affiliate had substantial market share. Medicaid enrollment rates also increased in these markets, a pattern consistent with "crowd in" of families who were formerly privately insured. The results suggest for-profit insurers are likelier than not-for-profit insurers to exercise market power when they possess it.

    Keywords: health insurance; medical loss ratio; Blue Cross; Corporate Governance; Health; Insurance; For-Profit Firms; Insurance Industry; United States;

    Citation:

    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.  View Details
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  3. Article | Health Affairs

    Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated

    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 concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups’ having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a system-wide reduction in readmissions that was roughly half as large as prior estimates have suggested.

    Keywords: readmission rates; Hospitals; acute care hospitals; Medicare; myocardial infarction; heart failure; Health Care and Treatment;

    Citation:

    Ody, Christopher, Lucy Msall, Leemore S. Dafny, David Grabowski, and David Cutler. "Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated." Health Affairs 38, no. 1 (January 2019): 36–43.  View Details
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  4. Case | HBS Case Collection | December 2018 (Revised December 2018)

    Associação Saúde Criança: Trying to Break the Cycle of Poverty and Illness at Scale

    Julie Battilana, Marissa Kimsey, Priscilla Zogbi and Johanna Mair

    Dr. Vera Cordeiro founded the NGO Associação Saúde Criança in 1991 to try to help poor families break the cycle of poverty and illness in Brazil. She and her team of employees and volunteers developed a holistic methodology to address the multidimensional sources of poverty based on the pillars of health, housing, citizenship, income, and education. After introducing the seeds of this approach, the case examines the evolution of the organization’s attempts to grow its social impact in Brazil and beyond—including a loose network of sister organizations, social franchising, licensing agreements, and government adoption.

    Keywords: social innovation; NGO; scaling; health; Social Enterprise; Social Entrepreneurship; Non-Governmental Organizations; Health Care and Treatment; Poverty; Health Industry; South America; Brazil;

    Citation:

    Battilana, Julie, Marissa Kimsey, Priscilla Zogbi, and Johanna Mair. "Associação Saúde Criança: Trying to Break the Cycle of Poverty and Illness at Scale." Harvard Business School Case 419-048, December 2018. (Revised December 2018.)  View Details
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  5. Article | NEJM Catalyst | November 8, 2018

    Transitioning Payment Models: Fee-for-Service to Value-Based Care

    Thomas W. Feeley and Namita Seth Mohta

    In a survey of the NEJM Catalyst Insights Council in July 2018, 42% of respondents say they think value-based reimbursement models will be the primary revenue model for U.S. health care. Indeed, this transition is already happening. Respondents report that a quarter of reimbursement at their organizations is based on value, on average. While three-quarters of their revenue remains fee-for-service, we see a remarkable change to a reimbursement system that was static for decades. In particular, survey respondents’ organizations are pursuing two value-based strategies: accountable care organizations, which often use capitated payments, and bundled payments. Nearly half (46%) of respondents say value-based contracts significantly improve the quality of care, and another 42% say value-based contracts significantly lower the cost of care. The survey identifies the leading barriers to implementing value-based reimbursement models. Infrastructure requirements, including information technology (indicated by 42% of respondents), and changing regulation/policy (34%) are the top two. There is strong consensus on the broad metrics that are most important for measuring value-based care. Outcome measures top the list, with 60% of respondents saying they are extremely important. This survey suggests that many in health care see value-based reimbursement as a real solution to the nation’s current health care crisis.

    Keywords: payment methods; value-based healthcare reimbursements; Health Care and Treatment; Value; Transformation;

    Citation:

    Feeley, Thomas W., and Namita Seth Mohta. "Transitioning Payment Models: Fee-for-Service to Value-Based Care." NEJM Catalyst (November 8, 2018).  View Details
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  6. Case | HBS Case Collection | November 2018

    David Hysong and SHEPHERD Therapeutics

    Ananth Raman, John Masko and Aldo Sesia

    In 2016, David Hysong, at age 27, found out he had a rare, incurable cancer. Rather than wait around to die, Hysong, a recent graduate of Harvard Divinity School, decided to launch a biotechnology company called Shepherd Therapeutics to development treatments for his’ and other rare cancers. Two years later, the company had several drugs in promising stages of development but were at least 3 to 5 years away from commercialization, if they made it through clinical trials successfully. Only about 4% of drugs that enter clinical trials receive U.S. FDA approval. It is October 2018, and Shepherd is running out of money. Hysong needs to raise $5 million to fund operations for 2019 and at least $20 million for the following few years. But the company is too early to attract the type of venture capital he needs. Even if he got financing, Hysong worried that the company’s mission could be compromised by investors more interested in a return on their investment than saving lives, and he worried about the scaling challenges ahead.

    Keywords: cancer; therapeutics; drugs; Health Care and Treatment; Business Startups; Product Development; Financing and Loans; Growth and Development Strategy; Problems and Challenges;

    Citation:

    Raman, Ananth, John Masko, and Aldo Sesia. "David Hysong and SHEPHERD Therapeutics." Harvard Business School Case 619-012, November 2018.  View Details
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  7. Article | Journal of the American College of Cardiology

    Operational Efficiency and Effective Management in the Catheterization Laboratory

    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 fee-for-service reimbursement and toward payment determined by quality measures bundled per episode of care. Accordingly, this review provides a framework for optimizing efficiency in the cardiac cath lab. The authors outline a management method based on the Nadler-Tushman Congruence Model, a commonly used business tool by which a company can assess whether its key elements are aligned with its strategy. Standardized metrics of cath lab efficiency are proposed, which can be used in public reports on this topic moving forward. Attention is paid to understanding balance sheets to track the financial health of the cath lab. Specific cost-saving measures are described, and examples of strategies used to save supply expenses are provided.

    Keywords: cath lab; catheterization laboratory; Health Care and Treatment; Performance Efficiency; Management; Performance Productivity; Cost Management; Health Industry;

    Citation:

    Reed, Grant W., Michael L. Tushman, and Samir R. Kapadia. "Operational Efficiency and Effective Management in the Catheterization Laboratory." Journal of the American College of Cardiology 72, no. 20 (November 20, 2018): 2507–2517.  View Details
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  8. Chapter | Innovation Policy and the Economy, Volume 19 | 2018

    The Orphan Drug Act at 35: Observations and an Outlook for the Twenty-First Century

    Nicholas Bagley, Benjamin Berger, Amitabh Chandra, Craig Garthwaite and Ariel Dora Stern

    On the 35th anniversary of the adoption of the Orphan Drug Act (ODA), we describe the enormous changes in the markets for therapies for rare diseases that have emerged over recent decades. The most prominent example is the fact that the profit-maximizing price of new orphan drugs appears to be greater today than it was in 1983. All else being equal, this should reduce the threshold for research and development (R&D) investment in an economically viable product. Further, the small size of patient populations for orphan drugs, together with the increasing prevalence of biologics among orphan drugs, have created a set of natural monopoly-like markets in which firms face little competition, even after the end of formal periods of patent protection and market exclusivity. Additionally, the evolving technologies of drug development—in particular, the increasingly common use of auxiliary endpoints in clinical trials and the use of biomarkers for patient selection for treatment—now allow manufacturers to target smaller populations. Taken together, these changes raise doubts about whether the ODA encourages the development of products that otherwise would not have been brought to market—or whether, instead, it simply rewards the producers of inframarginal products. After presenting empirical support for our claims of an evolving marketplace, we discuss the tradeoffs associated with reshaping the ODA for the 21st century.

    Keywords: Health Care and Treatment; Laws and Statutes; Research and Development; Investment; Markets; Monopoly;

    Citation:

    Bagley, Nicholas, Benjamin Berger, Amitabh Chandra, Craig Garthwaite, and Ariel Dora Stern. "The Orphan Drug Act at 35: Observations and an Outlook for the Twenty-First Century." Chap. 4 in Innovation Policy and the Economy, Volume 19, edited by Josh Lerner and Scott Stern, 97–137. University of Chicago Press, 2018.  View Details
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  9. Article | PLoS ONE | 2018

    Knowledge about Tuberculosis and Infection Prevention Behavior: A Nine City Longitudinal Study from India

    Sophie Huddart, Thomas Bossuroy, Vincent Pons, Siddhartha Baral, Madhukar Pai and Clara Delavallade

    Background
    Improving patients’ tuberculosis (TB) knowledge is a salient component of TB control strategies. Patient knowledge of TB may encourage infection prevention behaviors and improve treatment adherence. The purpose of this study is to examine how TB knowledge and infection prevention behaviors change over the course of treatment.
    Methods
    A matched patient-health worker dataset (n = 6,031) of publicly treated TB patients with NGO-provided treatment support health workers was compiled in nine Indian cities from March 2013 to September 2014. At the beginning and end of TB treatment, patients were asked about their knowledge of TB symptoms, transmission, and treatment and infection prevention behaviors.
    Results
    Patients beginning TB treatment (n = 3,424) demonstrated moderate knowledge of TB; 52.5% (50.8%, 54.2%) knew that cough was a symptom of TB and 67.2% (65.6%, 68.7%) knew that TB was communicable. Overall patient knowledge was significantly associated with literacy, education, and income, and was higher at the end of treatment than at the beginning (3.7%, CI: 3.02%, 4.47%). Infection prevention behaviors like covering a cough (63.4%, CI: 61.2%, 65.0%) and sleeping separately (19.3%, CI: 18.0%, 20.7%) were less prevalent. The age difference between patient and health worker as well as a shared language significantly predicted patient knowledge and adherence to infection prevention behaviors.
    Conclusions
    Social proximity between health worker and patients predicted greater knowledge and adherence to infection prevention behaviors but the latter rate remains undesirably low.

    Keywords: Health Disorders; Knowledge Dissemination; Behavior; India;

    Citation:

    Huddart, Sophie, Thomas Bossuroy, Vincent Pons, Siddhartha Baral, Madhukar Pai, and Clara Delavallade. "Knowledge about Tuberculosis and Infection Prevention Behavior: A Nine City Longitudinal Study from India." PLoS ONE 13, no. 10 (2018).  View Details
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  10. Case | HBS Case Collection | October 2018

    Fundraising at St. Camillus Hospital

    Srikant M. Datar and Caitlin N. Bowler

    St. Camillus is a fictional non-profit hospital in rural Maine facing a serious budget deficit. As Director of Marketing, Victoria Stern is building a team to modernize the hospital fundraising efforts. An interview with a promising candidate, who is also a digital native, forces her to confront shifting attitudes toward issues of data and privacy across generations against the backdrop of continued cybercrime and data breaches within the healthcare industry. Students grapple with the tension between data as "useful" or private within an organization. In this context they explore the ethical issues they will face around data security and data governance in their roles as managers.

    Keywords: data analysis; data privacy; data governance; non-profit; health care; fundraising; data security; Data and Data Sets; Safety; Governance; Ethics; Health Care and Treatment;

    Citation:

    Datar, Srikant M., and Caitlin N. Bowler. "Fundraising at St. Camillus Hospital." Harvard Business School Case 119-027, October 2018.  View Details
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    11.  
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Initiatives & Projects

  • Health Care

    The Health Care Initiative serves as a gateway for health care research, educational programs, and collaboration across all sectors of the health care industry.

  • Social Enterprise

    The Social Enterprise Initiative at HBS applies innovative business practices and managerial disciplines to drive sustained, high-impact social change.

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by Nitin Nohria
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by Srikant M. Datar and Caitlin N. Bowler

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