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Health Care

Health Care

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: Joseph L. Bower and Michael Norris

    In early 2009, the Obama administration and the Democratically-led Congress began working on what would eventually become the Affordable Care Act. The (A) case in this series discusses the legislative strategy in the House of Representatives, where three different committees each had jurisdiction over health care legislation.

    • February 2015
    • Supplement

    The Affordable Care Act (A): Legislative Strategy in the House of Representatives

    By: Joseph L. Bower and Michael Norris

    In early 2009, the Obama administration and the Democratically-led Congress began working on what would eventually become the Affordable Care Act. The (A) case in this series discusses the legislative strategy in the House of Representatives, where three different committees each had jurisdiction over health care legislation.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: Regina E. Herzlinger, Vasant Kumar, Kevin Schulman and Karen Staman

    Health care administration educators are at a crossroads: the health care sector is rife with inefficiencies, erratic quality, unequal access, and sky-high costs, complex problems which call for innovative solutions, and yet, according to our content analysis of top U.S. health administration schools and a recent article in the Lancet, our educational systems focus their curricula on isolated,theoretical subjects, such as analytics and quantitative problem solving, rather than the team-oriented, practical problem-solving skills required for innovation. All too often, when graduates of these programs enter the workforce, they find themselves unequipped to meet the challenges for innovation of 21st century health care.

    • Blog Post

    Innovation in Health Care Education: A Call to Action

    By: Regina E. Herzlinger, Vasant Kumar, Kevin Schulman and Karen Staman

    Health care administration educators are at a crossroads: the health care sector is rife with inefficiencies, erratic quality, unequal access, and sky-high costs, complex problems which call for innovative solutions, and yet, according to our content analysis of top U.S. health administration schools and a recent article in the Lancet, our...

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: Nava Ashraf, Oriana Bandiera and B. Kelsey Jack

    A substantial body of research investigates the effect of pay for performance in firms, yet less is known about the effect of non-financial rewards, especially in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents recruited by a public health organization to sell condoms are randomly allocated to four groups. Agents in the control group are hired as volunteers, whereas agents in the three treatment groups receive, respectively, a small monetary margin on each pack sold, a large margin, and a non-financial reward. The analysis yields three main findings. First, non-financial rewards are more effective at eliciting effort than either financial rewards or the volunteer contract and are also the most cost-effective of the four schemes. Second, non-financial rewards leverage intrinsic motivation and, contrary to existing laboratory evidence, financial incentives do not appear to crowd it out. Third, the responses to both types of incentives are stronger when their relative value is higher. Indeed, financial rewards are effective at motivating the poorest agents, and non-financial rewards are more effective when the peer group is larger. Overall, the findings demonstrate the power of non-financial rewards to motivate agents in settings where there are limits to the use of financial incentives.

    • December 2014
    • Article

    No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    By: Nava Ashraf, Oriana Bandiera and B. Kelsey Jack

    A substantial body of research investigates the effect of pay for performance in firms, yet less is known about the effect of non-financial rewards, especially in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents recruited by a public health organization to sell...

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: Clayton Christensen and Jeremy Dann

    After its spin-off from one of the world's largest ultrasound makers, Sonosite attempts to popularize a new kind of handheld ultrasound units. Sonosite needs to decide if it should focus on new markets that will value the portability and ease of use of its products, or if it should evolve its offerings so that they appeal to radiologists and cardiologists, the largest purchasers of ultrasound systems.

    • August 2001 (Revised January 2015)
    • Case

    SonoSite: A View Inside

    By: Clayton Christensen and Jeremy Dann

    After its spin-off from one of the world's largest ultrasound makers, Sonosite attempts to popularize a new kind of handheld ultrasound units. Sonosite needs to decide if it should focus on new markets that will value the portability and ease of use of its products, or if it should evolve its offerings so that they appeal to radiologists and...

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: John A. Quelch and Margaret L. Rodriguez

    In 2014, Yasuchika Hasegawa was orchestrating the transformation of Takeda from a Japanese pharmaceutical company with a global footprint into a global company with a Japanese heritage. A 33-year veteran of Takeda, Hasegawa-san was appointed president of Takeda in 2003 and chief executive in 2009. By 2013, Takeda was in the midst of implementing its new Vision 2020 plan, a strategic plan for the evolving global corporation, which included developing a global vaccine business.

    • March 2014 (Revised December 2014)
    • Case

    Vision 2020: Takeda and the Vaccine Business

    By: John A. Quelch and Margaret L. Rodriguez

    In 2014, Yasuchika Hasegawa was orchestrating the transformation of Takeda from a Japanese pharmaceutical company with a global footprint into a global company with a Japanese heritage. A 33-year veteran of Takeda, Hasegawa-san was appointed president of Takeda in 2003 and chief executive in 2009. By 2013, Takeda was in the midst of implementing...

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: Robert S. Kaplan and Jonathan Warsh

    Two groups of orthopedic surgeons form a joint venture with a community hospital to establish Hoag Orthopedic Institute, a for-profit hospital and two ambulatory service centers. By controlling and integrating all aspects of the patients' medical treatment, the physicians deliver superior outcomes, which they communicate with an annual public outcomes report. They also introduce bundled payment contracts with three insurers for orthopedic surgeries, and join a multi-hospital study for applying time-driven activity-based costing to identify process improvement and cost reduction opportunities. The case concludes with HOI leaders examining several options for expansion and growth.

    • August 2015 (Revised August 2015)
    • Case

    Hoag Orthopedic Institute

    By: Robert S. Kaplan and Jonathan Warsh

    Two groups of orthopedic surgeons form a joint venture with a community hospital to establish Hoag Orthopedic Institute, a for-profit hospital and two ambulatory service centers. By controlling and integrating all aspects of the patients' medical treatment, the physicians deliver superior outcomes, which they communicate with an annual public...

Initiatives & Projects

The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.
Health Care
Social Enterprise

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.

Initiatives & Projects

The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.

Health Care
Social Enterprise

Recent Publications

Health System Perspective on Cost for Delivering a Decision Aid for Prostate Cancer Using Time-Driven Activity-Based Costing

By: David R. Ho, Robert S. Kaplan, Jonathan Bergman, David F. Penson, Benjamin Waterman, Kristin C. Williams, Jefersson Villatoro, Lorna Kwan and Christopher S. Saigal
  • October 2023 |
  • Article |
  • Medical Care
Previsit decision aids (DAs) have been shown to improve decisional quality. But the cost to deploy a DA has not been previously estimated. We interviewed or observed relevant personnel at three institutions that had implemented DA programs for men with prostate cancer. We used time-driven activity-based costing to estimate cost. Total average costs (USD) per patient were $38 (UCLA), $60 (Olive View-UCLA), and $42 (Vanderbilt), respectively, with labor costs being the largest component. Electronic health record (EHR) integration streamlined DA delivery efficiency and produced substantial cost savings. DA use was also associated with shorter clinic visit length and high levels of decision quality.
Keywords: Time-Driven Activity-Based Costing; Health Care and Treatment; Cost Accounting; Health Industry
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Ho, David R., Robert S. Kaplan, Jonathan Bergman, David F. Penson, Benjamin Waterman, Kristin C. Williams, Jefersson Villatoro, Lorna Kwan, and Christopher S. Saigal. "Health System Perspective on Cost for Delivering a Decision Aid for Prostate Cancer Using Time-Driven Activity-Based Costing." Medical Care 61, no. 10 (October 2023): 681–688.

The Health Costs of Dirty Energy: Evidence from the Capacity Market in Colombia

By: Achyuta Adhvaryu, Theresa Molina, Anant Nyshadham, Jorge Tamayo and Nicholas Torres
  • September 2023 |
  • Article |
  • Journal of Development Economics
The health effects of “dirty” (fossil fuel driven) energy production are difficult to measure accurately due to the endogeneity of fuel choice. We exploit an electricity policy in Colombia that generates a price-based trigger for the use of thermal energy sources. Comparing municipalities near high versus low capacity plants, we first document that the activation of this trigger--which increased thermal energy production--led to significantly higher local pollution levels. This change increased cardiovascular-related ER mortality by 56% and respiratory-related morbidity by 9%. Our results translate to a cost of 996 million USD in terms of lives lost and higher healthcare costs.
Keywords: Pollution; Health Disorders; Energy Industry; Colombia
Citation
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Adhvaryu, Achyuta, Theresa Molina, Anant Nyshadham, Jorge Tamayo, and Nicholas Torres. "The Health Costs of Dirty Energy: Evidence from the Capacity Market in Colombia." Art. 103116. Journal of Development Economics 164 (September 2023).

Prospective Evaluation of the Cost of Performing Breast Imaging Examinations Using Time-Driven Activity-Based Costing Method: A Single Center Study

By: Aamir Ali, Jordana Phillips, Damir Ljuboja, Syed S. Shehab, Etta D. Pisano, Robert S. Kaplan and Ammar Sarwar
  • September–October 2023 |
  • Article |
  • Journal of Breast Imaging
We use time-driven activity-based costing (TDABC) to measure the cost of performing breast imaging using different modalities: full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), US and MRI exams, and stereotactic, US-guided and MRI-guided biopsies. Data on cost of equipment, personnel and supplies were collected for each exam type. The costs of screening using MRI, CEM, US, DBT, and FFDM costs were $249, $120, $83, $28, and $30, with personnel costs the highest contributor except for MRI where equipment cost was highest. The cost of diagnostic testing using MRI, CEM, US, and FFDM were $241, $123, $70, and $43, with personnel again the major contributor for all types except for MRI and equipment cost. Costs of MRI-guided, stereotactic, and US-guided biopsy were $1611, $826, and $356. Supplies contributed 40-50% and personnel contributed 31%–56% to the total cost of biopsies. Conclusion: TDABC enables costs and their principal contributors to be calculated for different breast screening, diagnostic, and biopsy exams and modalities. Clinical practices may use this methodology to understand costs and lower the cost of breast imaging.
Keywords: Time-Driven Activity-Based Costing; Health Care; Breast Cancer; Health Care and Treatment; Cost; Cost Accounting; Health Industry
Citation
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Ali, Aamir, Jordana Phillips, Damir Ljuboja, Syed S. Shehab, Etta D. Pisano, Robert S. Kaplan, and Ammar Sarwar. "Prospective Evaluation of the Cost of Performing Breast Imaging Examinations Using Time-Driven Activity-Based Costing Method: A Single Center Study." Journal of Breast Imaging 5, no. 5 (September–October 2023): 546–554.

Vanderbilt: Transforming an Academic Health Care Delivery System, 2020

By: Michael E. Porter, Robert S. Kaplan, Mary L. Witkowski and David N. Bernstein
  • August 2023 |
  • Case |
  • Faculty Research
Keywords: Health Care; Health Care Industry; Academic Medicine; Value-based Health Care; Value-based Healthcare; Health Care Delivery; Service Delivery; Transformation; Health Care and Treatment; Corporate Strategy; Leadership; Health Industry; Tennessee; United States
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Porter, Michael E., Robert S. Kaplan, Mary L. Witkowski, and David N. Bernstein. "Vanderbilt: Transforming an Academic Health Care Delivery System, 2020." Harvard Business School Case 724-373, August 2023.

Impact of Social Needs Case Management on Use of Medical and Behavioral Health Services: Secondary Analysis of a Randomized Controlled Trial

By: Mark D. Fleming, Crystal Guo, Margae Knox, Daniel M. Brown, Elizabeth A. Hernandez and Amanda L. Brewster
  • August 2023 |
  • Article |
  • Annals of Internal Medicine
Social needs case management is an increasingly common strategy used by health care organizations to address integrated health and social needs. These programs connect patients to resources such as food assistance, housing, transportation, or income benefits, in addition to facilitating access to health care and behavioral health services. One theory suggests these programs may benefit patients by increasing use of primary and preventive care and decreasing need for acute care. In 2017, Contra Costa Health Services in California implemented a large-scale, randomized study to evaluate the effect of social needs case management on acute care use. The trial showed an 11% reduction in hospitalizations among patients offered case management.
Keywords: Health Care and Treatment; Medical Specialties; Programs; Human Needs; Welfare; Health Industry; California
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Fleming, Mark D., Crystal Guo, Margae Knox, Daniel M. Brown, Elizabeth A. Hernandez, and Amanda L. Brewster. "Impact of Social Needs Case Management on Use of Medical and Behavioral Health Services: Secondary Analysis of a Randomized Controlled Trial." Annals of Internal Medicine 176, no. 8 (August 2023): 1139–1141.

No Mask, No Service: Customer Reaction to Walmart’s 2020 National Mask Mandate

By: Innessa Colaiacovo
  • 2023 |
  • Working Paper |
  • Faculty Research
Multi-location firms face a complex series of economic tradeoffs when deciding whether to implement standard processes or allow processes to vary across establishments. One element of this tradeoff is customer response. This paper explores customer reaction to a prominent standardized policy, Walmart’s national instore mask mandate during the COVID-19 pandemic. I find that, in the two weeks after Walmart’s corporate mask mandate was enacted, foot traffic at stores in counties with no government mask mandates declined by 1-2% relative to stores in other counties. This effect was driven by stores in heavily Republican counties, where the decline was approximately 5%. However, analysis of a spending panel suggests there was little impact on sales conducted via credit and debit cards. This study provides evidence about the scope for customer reaction in response to corporate policies which in turn informs decisions about the relative merits of standardization or variance of policies across establishments.
Keywords: Consumer Behavior; Geographic Location; Policy; Health Pandemics; Retail Industry; United States
Citation
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Colaiacovo, Innessa. "No Mask, No Service: Customer Reaction to Walmart’s 2020 National Mask Mandate." Harvard Business School Working Paper, No. 24-004, July 2023. (Revise and Resubmit to Journal of Economics and Management Strategy.)

Evidence from the First Shared Medical Appointments (SMAs) Randomised Controlled Trial in India: SMAs Increase the Satisfaction, Knowledge, and Medication Compliance of Patients with Glaucoma

By: Nazlı Sönmez, Kavitha Srinivasan, Rengaraj Venkatesh, Ryan W. Buell and Kamalini Ramdas
  • 2023 |
  • Article |
  • PLoS Global Public Health
In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients’ utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients’ satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 –July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017–0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057–0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients’ intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006–0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039–0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004–0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs.
Keywords: Health Care and Treatment; Customer Satisfaction; Outcome or Result; India
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Sönmez, Nazlı, Kavitha Srinivasan, Rengaraj Venkatesh, Ryan W. Buell, and Kamalini Ramdas. "Evidence from the First Shared Medical Appointments (SMAs) Randomised Controlled Trial in India: SMAs Increase the Satisfaction, Knowledge, and Medication Compliance of Patients with Glaucoma." e0001648. PLoS Global Public Health 3, no. 7 (2023).

Do Policies to Increase Access to Treatment for Opioid Use Disorder Work?

By: Eric Barrette, Leemore S. Dafny and Karen Shen
  • Summer 2023 |
  • Article |
  • American Journal of Health Economics
Even among commercially insured individuals, opioid use disorder is undertreated in the United States: nearly half receive no treatment within six months of a new diagnosis. Using a difference-in-differences specification exploiting the extension of insurance parity requirements for substance use disorder treatment to small-group enrollees in 2014, we find that parity increases utilization of residential treatment but decreases utilization of agonist medications, the standard of care. We find direct interventions to increase access to medication may be more promising: increases in the county-level share of physicians able to prescribe agonists are associated with substitution toward treatment that includes medication.
Keywords: Opioid Treatment; Medication-assisted Treatment; Substance Use Disorder; Private Insurance; Insurance; Health Care and Treatment
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Barrette, Eric, Leemore S. Dafny, and Karen Shen. "Do Policies to Increase Access to Treatment for Opioid Use Disorder Work?" American Journal of Health Economics 9, no. 3 (Summer 2023): 297–330.

Building the Business Case for an Inclusive Approach to Digital Health Measurement with a Web App (Market Opportunity Calculator): Instrument Development Study

By: Mitchell Tang, Yashoda Sharma, Jennifer C. Goldsack and Ariel Dora Stern
  • 2023 |
  • Article |
  • JMIR Formative Research
Background: The use of digital health measurement tools has grown substantially in recent years. However, there are concerns that the promised benefits from these products will not be shared equitably. Underserved populations, such as those with lower education and income, racial and ethnic minorities, and those with disabilities, may find such tools poorly suited for their needs. Because underserved populations shoulder a disproportionate share of the U.S. disease burden, they also represent a substantial share of digital health companies’ target markets. Incorporating inclusive principles into the product development process can help ensure that the resulting tools are broadly accessible and effective. In this context, inclusivity not only maximizes societal benefit but also leads to greater commercial success.

Objective: A critical element in fostering inclusive product development is building the business case for why it is worthwhile. The Digital Health Measurement Collaborative Community (DATAcc) Market Opportunity Calculator was developed as an open-access resource to enable digital health measurement product developers to build a business case for incorporating inclusive practices into their research and development processes.

Methods: The DATAcc Market Opportunity Calculator combines data on population demographics and disease prevalence and health status from the U.S. Census Bureau and the U.S. Centers for Disease Control and Prevention (CDC). Together, these data are used to calculate the share of U.S. adults with specific conditions (e.g., diabetes) falling into various population segments along key “inclusion vectors” (e.g., race and ethnicity).

Results: A free and open resource, the DATAcc Market Opportunity Calculator can be accessed from the DATAcc website. Users first select the target health condition addressed by their product, and then an inclusion vector to segment the patient population. The calculator displays each segment as a share of the overall U.S. adult population and its share specifically among adults with the target condition, quantifying the importance of underserved patient segments to the target market. The calculator also estimates the value of improvements to product inclusivity by modeling the downstream impact on the accessible market size. For example, simplifying prompts on a hypertension-focused product to make it more accessible for adults with lower educational attainment is shown by the calculator to increase the target market by 2 million people and the total addressable market opportunity by U.S. $200 million.

Conclusions: Digital health measurement is still in its infancy. Now is the time to establish a precedent for inclusive product development to maximize societal benefit and build sustainable commercial returns. The Market Opportunity Calculator can help build the business case for “why”—showing how inclusivity can translate to financial opportunity. Once the decision has been made to pursue inclusive design, other components of the broader DATAcc toolkit for inclusive product development can support the “how.”
Keywords: Demographics; Product Development; Health Care and Treatment; Medical Devices and Supplies Industry
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Tang, Mitchell, Yashoda Sharma, Jennifer C. Goldsack, and Ariel Dora Stern. "Building the Business Case for an Inclusive Approach to Digital Health Measurement with a Web App (Market Opportunity Calculator): Instrument Development Study." JMIR Formative Research 7 (2023).

How to Tap the Full Potential of Telemedicine

By: Mitchell Tang, Louise Short, Ryan June, Matthew Dowling and Ateev Mehrotra
  • June 5, 2023 |
  • Article |
  • Harvard Business Review (website)
Telemedicine visits in the United States have fallen sharply since April 2020, but the end of the pandemic should not spell the end of telemedicine. It can play a valuable role in the delivery of health care. The key to tapping its potential is to bring many elements of the clinic to the patient. An array of new technologies and services is making that possible.
Keywords: Health Care and Treatment; Technological Innovation
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Tang, Mitchell, Louise Short, Ryan June, Matthew Dowling, and Ateev Mehrotra. "How to Tap the Full Potential of Telemedicine." Harvard Business Review (website) (June 5, 2023).
More Publications

Faculty

Michael E. Porter
Regina E. Herzlinger
Robert S. Kaplan
Robert S. Huckman
Ariel D. Stern
Amy C. Edmondson
Richard G. Hamermesh
John A. Quelch
Alvin E. Roth
Leemore S. Dafny
Amitabh Chandra
James E. Austin
→See All

HBS Working Knowlege

    • 26 Sep 2023

    The PGA Tour and LIV Golf Merger: Competition vs. Cooperation

    Re: Alexander J. MacKay
    • 26 Sep 2023

    Unpacking That Icky Feeling of 'Shopping' for Diverse Job Candidates

    Re: Summer R. Jackson
    • 26 Sep 2023

    Digital Strategy: A Handbook for Managing a Moving Target

    Re: Feng Zhu
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Harvard Business Publishing

    • December 9, 2020
    • Article

    Give Employees Cash to Purchase Their Own Insurance

    By: Regina E. Herzlinger and Barak D. Richman
    • August 2023
    • Case

    Vanderbilt: Transforming an Academic Health Care Delivery System, 2020

    By: Michael E. Porter, Robert S. Kaplan, Mary L. Witkowski and David N. Bernstein
→More Harvard Business Publishing
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