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. 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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  2. 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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  3. 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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  4. Chapter | Handbook of Healthcare Analytics | 2018

    Competing Interests

    Joel Goh

    Book Abstract: The editors, aided by a team of internationally acclaimed experts, have curated this timely volume to help newcomers and seasoned researchers alike to rapidly comprehend a diverse set of thrusts and tools in this rapidly growing cross-disciplinary field. The Handbook covers a wide range of macro-, meso- and micro-level thrusts—such as market design, competing interests, global health, personalized medicine, residential care, and concierge medicine, among others—and structures what has been a highly fragmented research area into a coherent scientific discipline. The Handbook also provides an easy-to-comprehend introduction to five essential research tools—Markov decision process, game theory and information economics, queueing games, econometric methods, and data science—by illustrating their uses and applicability on examples from diverse healthcare settings, thus connecting tools with thrusts. The primary audience of the Handbook includes analytics scholars interested in healthcare and healthcare practitioners interested in analytics.

    Keywords: healthcare; analytics; Health Care and Treatment; Research; Competition;

    Citation:

    Goh, Joel. "Competing Interests." Chap. 4 in Handbook of Healthcare Analytics: Theoretical Minimum for Conducting 21st Century Research on Healthcare Operations, edited by Tinglong Dai and Sridhar Tayur, 51–78. John Wiley & Sons, 2018.  View Details
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  5. 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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  6. Case | HBS Case Collection | September 2018 (Revised November 2018)

    Zebra Medical Vision

    Shane Greenstein and Sarah Gulick

    An Israeli startup founded in 2014, Zebra Medical Vision developed algorithms that produced diagnoses from X-rays, mammograms, and CT-scans. The algorithms used deep learning and digitized radiology scans to create software that could assist doctors in making diagnoses. By July 2018, Zebra had developed seven algorithms to analyze scans for emphysema, liver density, compression fractures, bone density, brain bleeds, breast cancer, and a calcium score used to detect calcified plaque in coronary arteries. For each scan analyzed, Zebra charged hospitals $1. By 2018 Zebra found itself in a race with its competitors to perfect these algorithms, create software tools, distribute the tools to physician partners, and create a market. Zebra already had several partners in the U.S. and Europe who gave feedback on its development. Management had to answer the following questions: What should they do next at Zebra? Should they work on the accuracy of the already developed algorithms or continue to develop many new tools? If they chose to develop new products, which applications should they address? And how should they go to market?

    Keywords: radiology; Machine learning; X-ray; CT scan; medical technology; probability; FDA 510(k); diagnosis; Health Testing and Trials; Technology; Competitive Strategy; Product Development; Commercialization; Decision Choices and Conditions; Israel;

    Citation:

    Greenstein, Shane, and Sarah Gulick. "Zebra Medical Vision." Harvard Business School Case 619-014, September 2018. (Revised November 2018.)  View Details
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  7. Article | NEJM Catalyst | August 23, 2018

    Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost

    Katy French, Barbra Bryce Speer, Alexis B. Guzman, Tayab Andrabi, Iris Recinos, Keith A. Shook, James R. Incalcaterra, John C. Frenzel and Thomas W. Feeley

    Patients and providers are frustrated with seemingly endless data entry. We used our patients’ vested interest in their own health care by actively engaging them in the entry of their own medical information into the EHR. Prior to the implementation of the new EHR we to developed an electronic version of a patient questionnaire that had been designed and vetted by a group of subspecialty experts. We integrated that survey into our EHR. To assess the effects of our new EHR system and the new process flow for patients, we utilized time-driven activity-based costing (TDABC). One year after the implementation of the new system, TDABC analysis demonstrated cost savings of 19% and a 10-minute decrease in provider data-entry time. Any EHR system that allows the patient to input data is useful in that it can save patients and providers time and frustration, can allow for advanced care planning, and can help to ensure transparency of patient information throughout the institution.

    Keywords: Health Care and Treatment; Data and Data Sets; Performance Efficiency; Cost Management;

    Citation:

    French, Katy, Barbra Bryce Speer, Alexis B. Guzman, Tayab Andrabi, Iris Recinos, Keith A. Shook, James R. Incalcaterra, John C. Frenzel, and Thomas W. Feeley. "Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost." NEJM Catalyst (August 23, 2018).  View Details
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  8. Article | Proceedings of the National Academy of Sciences of the United States of America | August 21, 2018

    Patient–Physician Gender Concordance and Increased Mortality Among Female Heart Attack Patients

    Brad Greenwood, Seth Carnahan and Laura Huang

    We examine patient gender disparities in survival rates following acute myocardial infarctions (i.e., heart attacks) based on the gender of the treating physician. Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, we find higher mortality among female patients who are treated by male physicians. Male patients and female patients experience similar outcomes when treated by female physicians, suggesting that unique challenges arise when male physicians treat female patients. We further find that male physicians with more exposure to female patients and female physicians have more success treating female patients.

    Keywords: Health Disorders; Health Care and Treatment; Gender; Outcome or Result;

    Citation:

    Greenwood, Brad, Seth Carnahan, and Laura Huang. "Patient–Physician Gender Concordance and Increased Mortality Among Female Heart Attack Patients." Proceedings of the National Academy of Sciences of the United States of America 115, no. 34 (August 21, 2018).  View Details
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  9. Article | NEJM Catalyst | August 8, 2018

    Hospital-based ACOs Face Challenges in Tracking Performance Indicators

    Christiana Beveridge, Sofia Warner, Greg Leya and Thomas W. Feeley

    Given that accountable care organizations (ACOs) have not achieved the degree of cost reductions and quality improvements initially hoped for, we sought to better understand the underlying reasons for their limited success. Our analysis of American Hospital Association (AHA) data on hospital-based ACOs found that many organizations do not have the capability to track and share performance metrics, including financial metrics, and those that do are more likely to have taken on more financial risk. Our findings highlight the challenges of using ACOs as a mechanism to achieve financial cost savings. Bundled payments, which focus on narrower episodes of care, may involve fewer operational complexities and be better structured for financial success.

    Keywords: ACOs; Health Care and Treatment; Cost Management; Performance; Measurement and Metrics;

    Citation:

    Beveridge, Christiana, Sofia Warner, Greg Leya, and Thomas W. Feeley. "Hospital-based ACOs Face Challenges in Tracking Performance Indicators." NEJM Catalyst (August 8, 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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Faculty

HBS Working Knowledge

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re Robert S. Kaplan
The cost of healthcare in rural Haiti was found to vary widely, even inside the same health organization. A pioneering cost accounting system co-developed by Robert Kaplan was called in to determine
Pic
re Laura Huang
Roughly one in 66 women has a better chance of leaving the hospital alive if their doctor is also a woman, according to research by Laura Huang and colleagues.
This analysis examines how a surge in liability risk faced by upstream suppliers of general purpose technologies (polymers) affected downstream innovation in implant technologies. Implant patenting d

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

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