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
Medicare’s 2026–2030 Transforming Episode Accountability Model (TEAM): Implications for Anesthesiologists
By: Anjali K. Ghoshal, Robert S. Kaplan, Angela M. Bader and David L. Hepner
- October 2026 |
- Article |
- Anesthesiology
Medicare’s Transforming Episode Accountability Model (TEAM) represents a significant shift in surgical care reimbursement. TEAM’s bundled payment introduces episode-level accountability for cost and outcomes, replacing fee-for-service for discrete activities. TEAM’s risk-sharing payments will reshape the clinical and financial environment in which anesthesiologists practice, as their reimbursement is included within the bundle. Their role in perioperative decision-making can strongly influence the performance of hospitals operating under TEAM’s risk-sharing arrangements. This article outlines TEAM’s structure and examines how episode-based payment models elevate aspects of anesthesiology practice that have traditionally been undervalued under fee-for-service reimbursement. The article also describes the expanded roles for anesthesiologists to prevent complications and to optimize perioperative care. Finally, the article discusses the growing need for anesthesiologists to define, measure, and report outcomes that reflect their contribution to patient recovery and resource utilization. As payment models evolve, aligning anesthesiology practice with episode-level metrics will demonstrate its value for delivering accountable surgical care.
Chastity-Guarding Practices
By: Anke Becker and Lindsey Novak
- 2026 |
- Working Paper |
- Faculty Research
Across societies and throughout history, concerns over women’s chastity have given rise to a wide range of practices that aim to keep women from having extramarital sex – from female genital cutting to restrictions on women’s mobility to child marriage to veiling to honor cultures. In this article, we review the state of the literature on these chastity-guarding practices. We organize our discussion around the following questions: Why do concerns about chastity arise and center on women? Which practices count as chastity-guarding and through which mechanisms do they operate? Which costs and benefits are associated with them and who do they accrue to? Why does their presence and intensity vary across societies? What explains their persistence and under which conditions do they change? We also highlight open questions about the origins, impacts, persistence, and malleability of chastity-guarding practices.
Marvin AI: Behavioral Health by Clinicians, for Clinicians
- August 2026 |
- Case |
- Faculty Research
More than one third of Americans were said to suffer some type of behavioral health ailment at some point in their lifetime, with many people requiring chronic therapy or intervention. Despite significant clinical needs, access to reliable treatment has been difficult due to shortage of providers, stigma, and poor reimbursement, especially for medical clinicians who were placed under enormous stress during the peak of the COVID-19 epidemic and whose professional culture does not encourage acknowledgement of mental health pressure.
Marvin’s primary offering was online teletherapy via video chat with licensed mental health professionals, including psychologists, psychiatrists, and licensed clinical social workers. One major draw for providers was Marvin’s handling all scheduling and rescheduling, saving providers’ time. Their main priority was to build and implement machine learning (ML) tools to offer more targeted, personalized mental health care to physicians. They were building a ML matching algorithm that could classify users’ moods based on their facial expressions and other data, such as vocal, chat, and text interactions. Marvin could use this algorithm to track users’ moods and suggest targeted exercises (e.g., meditations).
Marvin’s primary offering was online teletherapy via video chat to medical clinicians. Its founders hoped to bring Marvin’s solution to a wider audience and thought that the race belonged to the swift. As they considered the market opportunity and the complex landscape of digital mental health, they wondered what to do next?
Sutter Health: Soul Searching
By: Ranjay Gulati and Sarah Sasso
- August 2026 |
- Case |
- Faculty Research
In November 2022, when Warner Thomas stepped in as CEO at Sutter Health, which served more than 3.5 million patients across Northern California, he walked into a non-profit healthcare system whose financial performance had been flat for several years running, and was operationally and culturally disjointed. Years of regulatory pressures, litigation, leadership turnover, and repeated cost-cutting had stalled growth and eroded trust. Employees described the system as siloed, bureaucratic, fearful, even toxic. Rather than cutting further, Sutter sought to grow its way out of stagnation. They rebuilt the organization around five core capabilities: internal talent, patient access, operational excellence, whole-person health, and community health. At the center was what leaders began calling the “Sutter Way”—a rigorous operating cadence grounded in transparency, disciplined workflows, strategic capital allocation, talent development, and governance oversight. The goal was not simply to become “One Sutter,” but to institutionalize a repeatable way of leading and executing. By March 2026, after expansion and renewed growth, Sutter faced new questions: could it reclaim its “soul,” and was its transformation situational, or could the Sutter Way scale?
Keywords: Transformation; Talent and Talent Management; Financial Management; Financial Strategy; Corporate Governance; Health Care and Treatment; Leading Change; Growth Management; Resource Allocation; Organizational Change and Adaptation; Organizational Culture; Organizational Design; Nonprofit Organizations; Expansion; Health Industry; California
AI-powered Early Intervention for Depression and Anxiety: A Randomized Clinical Trial
By: Julie Y.A. Cachia, Xuan Zhao, Wenxi Pu, Chi Liao, Merel Keijsers, Julian De Freitas and Rebecca Fortgang
- 2026 |
- Working Paper |
- Faculty Research
Importance: Depression and anxiety are prevalent and disabling, yet most individuals receive inadequate or no care. Purpose-built generative AI platforms may offer scalable first-line support, though large-trial evidence remains limited.
Objective: To determine whether Flourish, an AI-powered mental health platform, prevents and reduces depression and anxiety symptoms compared with care-as-usual.
Design: Preregistered, parallel-group, superiority randomized clinical trial conducted in 2025, with assessments at weeks 0, 2, 4, and 6. Setting: A large North American university.
Participants: A total of 1,137 college students aged 18 years or older was recruited through a research participation system without symptom-based screening and randomized to treatment or care-as-usual. 850 participants (74.6%) completed the final Week 6 follow-up.
Intervention: Participants assigned to treatment received Flourish, which offered self-guided support informed by cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy, positive psychology, and motivational interviewing, and were instructed to use it at least twice weekly. Participants assigned to care-as-usual retained access to usual mental health resources.
Main Outcomes and Measures: Preregistered primary outcomes were depression (Patient Health Questionnaire-2) and anxiety symptoms (Generalized Anxiety Disorder-2), assessed biweekly.
Results: Among 1,137 participants, mean (SD) age was 20.77 (5.34) years, and 853 (75.0%) were female. Symptom trajectories were more favorable in treatment (vs control) for depression (condition × time: β = −0.03; 95% CI, −0.05 to −0.01; P = .006) and anxiety (β = −0.04; 95% CI, −0.06 to −0.01; P = .001). Among participants with elevated baseline symptom severity, treatment increased rates of meaningful change for depressive symptoms (52.3% vs 31.7%; risk ratio [RR], 1.65 [95% CI, 1.16-2.34]; number needed to treat [NNT], 4.9 [95% CI, 2.9-14.8]) and anxiety symptoms (50.6% vs 38.1%; RR, 1.33 [95% CI, 1.05-1.68]; NNT, 8.0 [95% CI, 4.4-44.5]). Participants with low baseline symptoms showed less symptom worsening at 6 weeks. No adverse events attributable to the intervention were identified.
Conclusions and Relevance: This trial demonstrates that a purpose-built generative AI platform can serve as a scalable first-line mental health tool, effective for prevention and early intervention of depression and anxiety symptoms in an unscreened general population.
Objective: To determine whether Flourish, an AI-powered mental health platform, prevents and reduces depression and anxiety symptoms compared with care-as-usual.
Design: Preregistered, parallel-group, superiority randomized clinical trial conducted in 2025, with assessments at weeks 0, 2, 4, and 6. Setting: A large North American university.
Participants: A total of 1,137 college students aged 18 years or older was recruited through a research participation system without symptom-based screening and randomized to treatment or care-as-usual. 850 participants (74.6%) completed the final Week 6 follow-up.
Intervention: Participants assigned to treatment received Flourish, which offered self-guided support informed by cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy, positive psychology, and motivational interviewing, and were instructed to use it at least twice weekly. Participants assigned to care-as-usual retained access to usual mental health resources.
Main Outcomes and Measures: Preregistered primary outcomes were depression (Patient Health Questionnaire-2) and anxiety symptoms (Generalized Anxiety Disorder-2), assessed biweekly.
Results: Among 1,137 participants, mean (SD) age was 20.77 (5.34) years, and 853 (75.0%) were female. Symptom trajectories were more favorable in treatment (vs control) for depression (condition × time: β = −0.03; 95% CI, −0.05 to −0.01; P = .006) and anxiety (β = −0.04; 95% CI, −0.06 to −0.01; P = .001). Among participants with elevated baseline symptom severity, treatment increased rates of meaningful change for depressive symptoms (52.3% vs 31.7%; risk ratio [RR], 1.65 [95% CI, 1.16-2.34]; number needed to treat [NNT], 4.9 [95% CI, 2.9-14.8]) and anxiety symptoms (50.6% vs 38.1%; RR, 1.33 [95% CI, 1.05-1.68]; NNT, 8.0 [95% CI, 4.4-44.5]). Participants with low baseline symptoms showed less symptom worsening at 6 weeks. No adverse events attributable to the intervention were identified.
Conclusions and Relevance: This trial demonstrates that a purpose-built generative AI platform can serve as a scalable first-line mental health tool, effective for prevention and early intervention of depression and anxiety symptoms in an unscreened general population.
Estimating the Global Inventory of Deprioritized Clinical-stage Drug Development Programs: Toward a Market for Shelved Assets
By: Annette Bakker, Tanisha Carino, Joonhyuk Cho, Mosab Hammoudeh, Joshua L. Krieger, Freda Lewis-Hall, Andrew W. Lo and Richard T. Thakor
- July 2026 |
- Article |
- Drug Discovery Today
We propose a set of algorithms to identify ‘shelved asset candidates’ in drug development—drug candidates for which development was discontinued for reasons other than safety or efficacy. Using a variety of microdata sources and classification algorithms, we identify 5523 drug-development programs that appear to have been deprioritized after entering human clinical trials. While many of these assets were likely discontinued for scientifically valid reasons that are not fully observable in public data, the analysis suggests that a subset could retain scientific or commercial option value under alternative development strategies. These estimates provide a starting point for building a systematic catalog of discontinued assets and for facilitating collaboration among industry sponsors, nonprofit organizations and new developers interested in repositioning or advancing these compounds.
AI for Proactive Mental Health: A Multi-Institutional, Longitudinal, Randomized Controlled Trial
By: Julie Y.A. Cachia, Xuan Zhao, John Hunter, Delancy Wu, Eta Lin and Julian De Freitas
- August 2026 |
- Article |
- New England Journal of Medicine AI
Young adults today face unprecedented mental health challenges, yet many hesitate to seek support due to barriers such as accessibility, stigma, and time constraints. Bite-sized well-being interventions offer a promising solution to preventing mental distress before it escalates to clinical levels, but have not yet been delivered through personalized, interactive, and scalable technology. We conducted the first multi-institutional, longitudinal, preregistered randomized controlled trial of a generative AI-powered mobile app (“Flourish”) designed to address this gap. Over six weeks in Fall 2024, 486 undergraduate students from three U.S. institutions were randomized to receive app access or to a care-as-usual control condition. Participants instructed to use the Flourish app twice per week reported significantly greater positive affect, resilience, and social well-being (i.e., increased belonging, closeness to community, and reduced loneliness) and were buffered against declines in mindfulness and flourishing. These findings suggest that, with purposeful and ethical design, generative AI can deliver proactive, population-level well-being interventions that produce measurable benefits.
Experiential and Social Learning
By: Agha A. Akram, Gabriella Fleischman, Reshmaan N. Hussam and Akib Khan
- 2026 |
- Working Paper |
- Faculty Research
How does a person’s own learning experience affect their ability to learn from others? We conduct a field experiment on chlorination in Pakistan, where randomized “learning-arm” households use a tool to track their children’s diarrhea before and after chlorine distribution. Learning-arm households with learning-arm neighbors chlorinate significantly more one year after the withdrawal of the tool, with children’s health improving by 0.08 SD relative to all other households receiving chlorine. Neither learning households without learning-arm neighbors, nor non-learning households with learning-arm neighbors, exhibit sustained behavior change, results which have significant implications for intervention and evaluation design.
Breaking Up Health Care Conglomerates—The Right Fix Right Now?
By: Leemore S. Dafny
- June 23, 2026 |
- Article |
- JAMA, the Journal of the American Medical Association
The Break Up Big Medicine Act (BUBMA) would prohibit vertical integration across the health care supply chain, specifically common ownership of a medical service provider, such as a physician practice or pharmacy, and an insurer, pharmacy benefit manager (PBM), or drug or device wholesaler. While some empirical evidence supports concerns about foreclosure and margin gaming by integrated conglomerates, vertical integration can also align incentives and enable investments that fragmented ownership would not support. The BUBMA's categorical prohibition—requiring breakups within one year—is a blunt instrument that ignores competitive context and would disrupt organizations of all sizes. Strengthened antitrust enforcement and reforms targeting the underlying incentives that make consolidation attractive, particularly the tax treatment of employer-sponsored insurance, would accomplish more with less collateral damage.
Optimal Medical Liability for AI
By: Alex Chan
- 2026 |
- Working Paper |
- Faculty Research
I study medical liability when artificial intelligence acts as a doctor rather than as a passive clinical tool. The central object is the legally usable medical record: the inputs, logs, warnings, prescriptions, follow-up instructions, and outcomes on which courts, contracts, insurers, and regulators can condition responsibility. I show that AI medical liability is an institutional design problem under imperfect legal information. If the record separates AI-controllable error from patient nonadherence and natural disease progression, high-powered AI-fault liability implements the standard accident-law ideal. If the record is coarse, the first best may be infeasible: the same transfer that disciplines the AI also insures the patient’s hidden action. With joint causation, the relevant object is a marginal-responsibility score rather than a posterior cause label. I characterize the feasible set of liability incentives generated by the record and show when the optimal rule is no liability, strict liability, negligence, a safe harbor, comparative fault, or a continuous warranty. I then study algorithmic defensive design, through which AI developers can design not only medical recommendations but also the record on which future liability depends. Adoption, learning, enterprise liability, insurance, no-fault compensation, and regulation enter as ways to change the record, the liable entity, or the financing of compensation. The framework yields conditional implications rather than a one-size-fits-all rule.