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 | June 2018

    Innovation at Insigne Health

    Srikant M. Datar, Linda A. Cyr and Caitlin N. Bowler

    Insigne Health is a fictional for-profit, integrated health insurer/health care provider whose leadership believes that by shifting members’ focus from “sickness” to “well-being” it could increase the overall health of its insured population and decrease the resources it spent each year on delivering care.
    The case puts students in the role of design researcher charged with understanding the member segment about which Insigne Health leadership is most concerned: The “silent middle.” This cohort represents 70% of membership. They are “neither sick nor well,” and may, without changes in a range of behaviors, be quietly developing conditions that will evolve into costly chronic diseases.
    From interviews included in the case, students uncover insights into member behavior and, based on these insights, generate and develop concepts to help members change behaviors and lead healthier lives.

    Keywords: design thinking; behavior change; chronic disease; health care; Health Care and Treatment; Design; Behavior; Change; Innovation and Management;

    Citation:

    Datar, Srikant M., Linda A. Cyr, and Caitlin N. Bowler. "Innovation at Insigne Health." Harvard Business School Case 118-042, June 2018.  View Details
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  2. Article | Journal of Personality and Social Psychology

    Enacting Rituals to Improve Self-control

    D. A. Tian, J. Schroeder, G. Haubl, J. Risen, M. I. Norton and F. Gino

    Rituals are predefined sequences of actions characterized by rigidity and repetition. We propose that enacting ritualized actions can enhance subjective feelings of self-discipline, such that rituals can be harnessed to improve behavioral self-control. We test this hypothesis in six experiments. A field experiment showed that engaging in a pre-eating ritual over a 5-day period helped participants reduce calorie intake (Experiment 1). Pairing a ritual with healthy eating behavior increased the likelihood of choosing healthy food in a subsequent decision (Experiment 2), and enacting a ritual prior to a food choice (i.e., without being integrated into the consumption process) promoted the choice of healthy food over unhealthy food (Experiments 3a and 3b). The positive effect of rituals on self-control held even when a set of ritualized gestures enacted were not explicitly labeled as a ritual, and in other domains of behavioral self-control (i.e., prosocial decision-making; Experiments 4 and 5). Furthermore, Experiments 3a, 3b, 4, and 5 provided evidence for the psychological process underlying the effectiveness of rituals: heightened feelings of self-discipline undergirded the facilitative effect of rituals on behavioral self-control. Finally, Experiment 5 showed that the absence of a self-control conflict eliminated the effect of rituals on behavior, demonstrating that rituals affect behavioral self-control specifically because they alter responses to self-control conflicts.

    Keywords: Behavior; Perception; Personal Characteristics; Health;

    Citation:

    Tian, D. A., J. Schroeder, G. Haubl, J. Risen, M. I. Norton, and F. Gino. "Enacting Rituals to Improve Self-control." Journal of Personality and Social Psychology 114, no. 6 (June 2018): 851–876.  View Details
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  3. Case | HBS Case Collection | May 2018

    The Multiple Myeloma Research Foundation's Answer Fund

    Richard G. Hamermesh and Matthew G. Preble

    Keywords: Data Analytics; Customer Focus and Relationships; Customer Relationship Management; Cost vs Benefits; Investment Return; Health Care and Treatment; Innovation Leadership; Intellectual Property; Knowledge Sharing; Knowledge Dissemination; Leadership; Leading Change; Resource Allocation; Goals and Objectives; Marketing Communications; Performance; Programs; Projects; Business and Community Relations; Business and Stakeholder Relations; Networks; Partners and Partnerships; Research and Development; Genetics; Behavior; Motivation and Incentives; Social and Collaborative Networks; Nonprofit Organizations; Strategy; Health Industry; Pharmaceutical Industry; Biotechnology Industry; United States;

    Citation:

    Hamermesh, Richard G., and Matthew G. Preble. "The Multiple Myeloma Research Foundation's Answer Fund." Harvard Business School Case 818-045, May 2018.  View Details
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  4. Case | HBS Case Collection | May 2018

    Kaiser Permanente Colorado: Primary Care Plus

    Robert S. Kaplan and Mahek A. Shah

    A gerontologist in Kaiser Permanente’s Colorado region is concerned with the high and growing cost of treating the elderly population. She introduces a new care model, Primary Care Plus, using an interdisciplinary team of a primary care doctor, palliative care specialist, nurse coordinator, clinical pharmacy specialist, and behavioral and social service specialists. The team focuses on the highest-risk patients to see if the new, pro-active care model can improve patient, family, and provider satisfaction and lower Kaiser Permanente’s total cost of care for this patient segment.

    Keywords: primary health care; elderly patients; integrated practice unit; interdisciplinary care; Health Care and Treatment; Age; Cost Management; Performance Improvement; Health Industry; United States; Colorado;

    Citation:

    Kaplan, Robert S., and Mahek A. Shah. "Kaiser Permanente Colorado: Primary Care Plus." Harvard Business School Case 118-053, May 2018.  View Details
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  5. Article | Operations Research | May–June 2018

    Data Uncertainty in Markov Chains: Application to Cost-Effectiveness Analyses of Medical Innovations

    Joel Goh, Mohsen Bayati, Stefanos A. Zenios, Sundeep Singh and David Moore

    Cost-effectiveness studies of medical innovations often suffer from data inadequacy. When Markov chains are used as a modeling framework for such studies, this data inadequacy can manifest itself as imprecision in the elements of the transition matrix. In this paper, we study how to compute maximal and minimal values for the discounted value of the chain (with respect to a vector of state-wise costs or rewards) as these uncertain transition parameters jointly vary within a given uncertainty set. We show that these problems are computationally tractable if the uncertainty set has a row-wise structure. Conversely, we prove that the row-wise structure is necessary for tractability. Without it, the problems become computationally intractable (strongly NP-hard). We apply our model to assess the cost effectiveness of fecal immunochemical testing (FIT), a new screening method for colorectal cancer. Our results show that despite the large uncertainty in FIT's performance, it could be cost-effective relative to the prevailing screening method of colonoscopy.

    Keywords: Markov Chains; cost effectiveness; medical innovations; Colorectal Cancer; Health Care and Treatment; Cost vs Benefits; Innovation and Invention; Mathematical Methods; Health Industry;

    Citation:

    Goh, Joel, Mohsen Bayati, Stefanos A. Zenios, Sundeep Singh, and David Moore. "Data Uncertainty in Markov Chains: Application to Cost-Effectiveness Analyses of Medical Innovations." Operations Research 66, no. 3 (May–June 2018): 697–715. (Winner, 2014 INFORMS Health Applications Society Pierskalla Award & Finalist, 2014 INFORMS George E. Nicholson student paper competition.)  View Details
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  6. Case | HBS Case Collection | March 2018

    University Hospitals Cleveland Medical Center: Managing Capacity in Neurology

    Joel Goh, Robert S. Huckman and Nikhil Sahni

    In December 2014, Dr. Anthony Furlan, chair of the Department of Neurology at University Hospitals Cleveland Medical Center (UH), faced a mandate from the hospital’s executive leadership team. Specifically, all UH departments were directed to take steps within six months to reduce the waiting time for outpatient appointments—measured as the time to first available outpatient appointment—to no more than 15 days. For Furlan and his colleagues in neurology, achieving this target was a significant challenge, as the department’s current time to first available appointment was 93 days. The case considers several alternatives for reducing waiting time in outpatient neurology without increasing the total clinical staff. The case allows students to evaluate opportunities for expanding the effective capacity of a complex service operation and to understand the tradeoffs between customer service and labor utilization.

    Keywords: health care; Hospitals; capacity planning; scheduling; Health Care and Treatment; Service Operations; Performance Capacity; Health Industry; North America; United States; Ohio; Cleveland;

    Citation:

    Goh, Joel, Robert S. Huckman, and Nikhil Sahni. "University Hospitals Cleveland Medical Center: Managing Capacity in Neurology." Harvard Business School Case 618-062, March 2018.  View Details
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  7. Article | JAMA, the Journal of the American Medical Association

    Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System

    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 billing and insurance activities at a large academic health care center that had a certified EHR system. The center enjoyed economies of scale by concentrating its bill paying functions within a single, dedicated unit. The study found that costs for processing a single bill ranged from $20 for a primary care visit, about 20% of revenues, up to $215 for an inpatient surgical procedure. The high costs were not caused by wasteful, inefficient processes, duplicate or redundant tasks, or the inappropriate use of high-wage personnel to perform low-skilled tasks. Rather, they were driven by the heterogeneous payment requirements across the multiple payers and health plans contracting with the academic health center.

    Keywords: Health Care and Treatment; Cost Management; Insurance; Problems and Challenges;

    Citation:

    Tseng, Phillip, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah, and Kevin A. Schulman. "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System." JAMA, the Journal of the American Medical Association 319, no. 7 (February 20, 2018): 691–697.  View Details
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  8. Case | HBS Case Collection | February 2018 (Revised April 2018)

    Yunnan Baiyao: Transforming a Chinese State-Owned Enterprise

    Michael Chu, William C. Kirby, Nancy Hua Dai and Yuanzhuo Wang

    This case tells the story of how Wang Minghui, Chairman of Yunnan Baiyao Group since 1999, transformed a single-product traditional Chinese medicine (TCM) state-owned enterprise (SOE) into a major diversified consumer health player in China's highly competitive fast-moving consumer goods market. The case also traces the development of the company from a private business to a SOE and then to a SOE under mixed state-private ownership.

    Keywords: state-owned enterprise (SOE); competition; traditional chinese medicine; Yunnan; Yunnan Baiyao; consumer health; enterprise transformation; Transformation; Health; Business History; State Ownership; Private Ownership; Business Strategy; Commercialization; Competition; Consumer Products Industry; Health Industry; Pharmaceutical Industry; China;

    Citation:

    Chu, Michael, William C. Kirby, Nancy Hua Dai, and Yuanzhuo Wang. "Yunnan Baiyao: Transforming a Chinese State-Owned Enterprise." Harvard Business School Case 318-078, February 2018. (Revised April 2018.)  View Details
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  9. Case | HBS Case Collection | February 2018

    Health Savings Accounts: Enabling Consumer Participation

    Regina E. Herzlinger and James Wallace

    Health savings accounts (HSAs), a creation of the 2003 Medicare Modernization Act, had become an integral part of the drive toward consumer-driven health care. Coupled with high-deductible health plans, HSAs allowed consumers to directly control a significant part of their annual health care spend, and the tax-advantaged nature of the accounts made them an attractive investment vehicle as well. Several thorny questions remained, however. For instance, would insurers and employers embrace the accounts for the customers they influenced? Would financial professionals see the relatively small accounts as a valuable component for their clients? In this context the mobile app HSA Coach was developed. The Health Savings Accounts case presents the challenges facing new innovations in mature sectors, with particular emphasis on technology and finance concerns of Prof. Herzlinger’s Six Factors of the Innovating in Health Care framework.

    Keywords: health care; healthcare costs; health care and treatment; health insurance; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Health Industry; United States;

    Citation:

    Herzlinger, Regina E., and James Wallace. "Health Savings Accounts: Enabling Consumer Participation." Harvard Business School Case 318-110, February 2018.  View Details
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  10. Article | Journal of Oncology Practice | February 2018

    Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program

    Tracy Spinks, Alexis Guzman, Beth M. Beadle, Seohyun Lee, Ron Walters, Jim Incalcaterra, Ehab Hanna, Amy Hessel, Randal Weber, Sandra Denney, Lee Newcomer and Thomas W. Feeley

    Purpose: Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers.

    Methods: Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively identified and enrolled, and bundled payments were made at treatment start. Operational metrics tracked incremental effort for pilot processes and average payment cycle time compared with fee-for-service (FFS) payments.

    Results: This pilot confirmed the feasibility of a 1-year prospective bundled payment for head and neck cancers. Between November 2014 and October 2016, 88 patients were enrolled successfully with prospective bundled payments. Through September 2017, 94% of patients completed the pilot with 6% still enrolled. Manual pilot processes required more effort than anticipated; claims processing was the most time-consuming activity. The production of a bundle bill took an additional 15 minutes versus FFS billing. The average payment cycle time was 37 days (range, 15 to 141 days) compared with a 15-day average under FFS.

    Conclusion: Prospective bundled payments were successfully implemented in this pilot. Additional pilots should study this payment method in higher-volume cancers. Robust systems are needed to automate patient identification, enrollment, billing, and payment along with policies that reduce administrative burden and allow for the introduction of novel cancer therapies.

    Keywords: Health Care and Treatment; Cost Management;

    Citation:

    Spinks, Tracy, Alexis Guzman, Beth M. Beadle, Seohyun Lee, Ron Walters, Jim Incalcaterra, Ehab Hanna, Amy Hessel, Randal Weber, Sandra Denney, Lee Newcomer, and Thomas W. Feeley. "Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program." Journal of Oncology Practice 14, no. 2 (February 2018): e103–e121.  View Details
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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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Faculty

HBS Working Knowledge

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re Joshua Lev Krieger
Pharmaceutical companies are criticized for not producing more breakthrough drugs. But new research by Joshua Krieger and colleagues shows that, given a financial windfall, drug giants turn on the in
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re Michael W. Toffel
Basic tweaks to the schedules of food safety inspectors could prevent millions of foodborne illnesses, according to new behavioral science research by Maria Ibáñez and Michael Toffel.
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re Ariel D. Stern
Ariel Stern discusses her recent case study about creating a new type of clinical trial designed to deliver life-enhancing drugs to patients more quickly.

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Harvard Business Publishing

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by Nitin Nohria
Case
by Robert S. Kaplan and Mahek A. Shah

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