Health Care
Health Care
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 CareSocial EnterpriseRecent 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.
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.
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.
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
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.
No Mask, No Service: Customer Reaction to Walmart’s 2020 National Mask Mandate
- 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.
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.
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.
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.”
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.”
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.