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April 2006
Case

Finance Leadership in Novartis Consumer Health Businesses

By: Boris Groysberg and Ingrid Vargas

Describes and contrasts the roles and challenges of three high-performing finance heads at Novartis Consumer Health businesses in Australia, Japan, and Venezuela. All three faced tremendous pressures in terms of managing time and limited resources, but the particular... View Details

Keywords: Finance; Financial Management; Multinational Firms and Management; Leadership Style; Health Industry; Japan; Australia; Venezuela

September 2014 (Revised March 2021)
Case

La Ribera Health Department (A)

By: Regina E. Herzlinger, Emer Moloney and Daniela Beyersdorfer

The La Ribera case studies depict an innovative low cost/high quality privately financed hospital model struggling to achieve alignment with the Six Factors. It is reimbursed by the public sector in a Spanish environment whose Consumers, Structure, and Public Policy... View Details

Keywords: Health Care; Health Care Financing; Health Care Industry; Health Care Operations; Health Care and Treatment; Operations; Business Model; Government and Politics; Programs; Innovation Strategy; Vertical Integration; Health Industry; Europe; Spain

January 2023
Exercise

Identify the Health Care Venture

By: Regina E. Herzlinger and James Wallace

This case enables rapid learning of the key financial characteristics of many types of health care organizations and to diagnose their financial status. It is a surprisingly fun exercise (see the Teaching Note) accomplished by organizing groups of students that compete... View Details

Keywords: Health Care; Health Care Spending; Health Care Financing; Health Care Industry; Health Care Operations; Health Care Delivery; Health Care and Treatment; Financial Condition; Health Industry

December 2007
Article

Regional Health Information Organizations: Current Activities and Financing

Electronic clinical data exchange promises substantial financial and societal benefits, but it is unclear whether and when it will become widespread. In early 2007 we surveyed 145 regional health information organizations (RHIOs), the U.S. entities working to establish... View Details

Keywords: Information Technology; Financing and Loans; Health Care and Treatment; Information Management; Health Industry; United States

January 2023
Teaching Note

Identify the Health Care Venture

By: Regina E. Herzlinger and James Wallace

Teaching Note for HBS Exercise No. 323-061. View Details

Keywords: Health Care; Health Care Delivery; Health Care Financing; Health Care Industry; Health Care Services

February 2018
Case

Health Savings Accounts: Enabling Consumer Participation

By: 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... View Details

Keywords: Health Care; Healthcare Costs; Health Insurance; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Health Industry; United States

August 2003 (Revised September 2008)
Background Note

Note on Financing of the U.S. Health Care Sector

By: Regina E. Herzlinger and Jeff Grahling

This course describes the public and private sources of financing of the U.S. health-care sector,and identifies the characteristics of insurance policies, their costs, the structure of the insurance industry, and the role of consultants and brokers. The insurance... View Details

Keywords: Economic Sectors; Financing and Loans; Insurance; Industry Structures; Health Industry; Health Industry; United States

August 2017
Case

CareMore Health System

By: Robert S. Huckman and Brian W. Powers

CareMore Health System—a physician-founded care delivery system and health plan—had developed and refined an innovative care model for at-risk seniors enrolled in Medicare managed care (i.e., Medicare Advantage) plans. CareMore's President, Sachin Jain, and his... View Details

Keywords: Health Care Delivery; Health Insurance; Medicare; Medicaid; Managed Care; Extensivist; Social Determinants Of Health; Health Care and Treatment; Insurance; Business Model; Growth and Development Strategy; Decision Choices and Conditions; Health Industry; United States

August 2017
Supplement

CareMore Health System (B)

By: Robert S. Huckman and Brian W. Powers

This supplement to “CareMore Health System (A)” discusses the company's early experience introducing its managed Medicaid model in the Des Moines, Iowa, market. It also provides an update on the Memphis program discussed in the (A) case. View Details

Keywords: Health Care Delivery; Health Insurance; Medicare; Medicaid; Managed Care; Extensivist; Social Determinants Of Health; Health Care and Treatment; Insurance; Business Model; Growth and Development Strategy; Health Industry; United States

June 30, 2020
Article

Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option

By: Regina E. Herzlinger, Richard Boxer and James Wallace

A combination of health insurance initiatives by the presumptive 2020 Democratic and Republican presidential nominees could expand health care coverage and significantly reduce costs, without raising taxes. Along the way, the combination could revitalize private... View Details

Keywords: Health Care Financing; Public Option; Health Reimbursement Arrangement (HRA); Health Care and Treatment; Insurance; Cost Management

June 15, 2021
Article

Cutting the Gordian Knot of Employee Health Care Benefits and Costs: A Corporate Model Built on Employee Choice

By: Regina E. Herzlinger and Barak D. Richman

President Joe Biden’s promise to give every American access to affordable health insurance is well-intentioned, but his plan’s policy elements—a public option, a permanent expanded tax credit—require congressional approval and would expend significant political and... View Details

Keywords: Health Insurance; Health Insurance Marketplaces; Health Care Delivery; Health Care Financing; Health Care Industry; Health Care and Treatment; Insurance; Service Delivery; Cost Management; Health Industry; United States

Winter 2019
Article

Value-based Health Care: Lessons for the Anesthesiologist

By: J.A. Martin, B.L. Potter, T.F. Flanagan and T.W. Feeley

At one point or another in our life, we all become consumers of the health care industry. Indeed, health care affects everyone and encompasses a diverse set of services from childbirth, to illness prevention, to the management of chronic disease and end-of-life care.... View Details

Keywords: Value-based Health Care; Anesthesiologists; Health Care and Treatment; Value; Cost Management; Problems and Challenges; Health Industry; United States

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August 2012 (Revised December 2023)
Background Note

Note on Health Insurance Coverage, Coding, and Payment

By: Regina E. Herzlinger and Jo Ellen Slurzberg

This note explains how health care technology and service innovators receive payment from government insurers, in the U.S. and abroad, and from private insurers. It describes each of the three steps needed to obtain reimbursement: coverage, coding, and payment. It also... View Details

Keywords: Health Care Delivery; Health Care Costs; Health Insurance; Health Insurance Marketplaces; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Private Sector; Public Sector; Decision Making; Information Technology; Health Industry; Health Industry

Article

Navy Medicine Introduces Value-Based Health Care

By: Alee Hernandez, Robert S. Kaplan, Mary L. Witkowski, C. Forrest Faison III and Michael E. Porter

In 2016 the newly appointed surgeon general of the Navy launched a value-based health care pilot project at Naval Hospital Jacksonville to explore whether multidisciplinary care teams (known as integrated practice units, or IPUs) and measurement of outcomes could... View Details

Keywords: Military Health System; Health Care and Treatment; Cost Management; Projects

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February 2014 (Revised July 2016)
Case

Iora Health

By: William A. Sahlman and Vineeta Vijayaraghavan

The Iora Health case looks at a new approach to the management and delivery of primary care. Instead of having a doctor, half a nurse and two accountants, Iora deploys a doctor, a nurse and several health coaches, all operating as an integrated team. Iora focuses on... View Details

Keywords: Management; Service Delivery; Groups and Teams; Financing and Loans; Health Care and Treatment; Health Industry

June 2018
Supplement

Amil and the Health Care System in Brazil (B)

By: Regina Herzlinger, Ana Maria Malik, Ruth Costas and Priscilla Zogbi

Brazilian Managed Care Organization Amil faces a series of challenges while trying to redefine the terms of its relationship with hospitals and clinics and to implement a new health care model based on primary care and family medicine. View Details

Keywords: Health Care; Brazil; Managed Care; Innovation; Health Care Industry; Health Care and Treatment; Health; Cost Management; Innovation and Invention; Competitive Strategy; Health Industry; Health Industry; Brazil

January 2017 (Revised March 2017)
Case

SIN Capital and the Fullerton Health IPO

By: Josh Lerner and Ann Leamon

In early 2016, David Sin, founder of the Singapore-based private equity group SIN Capital and chairman of its primary holding, Fullerton Health, was deeply involved in preparations for taking Fullerton public on the Singapore stock exchange. Three years after SIN... View Details

Keywords: Healthcare; Asia; IPO; Financing; Singapore; Growth; Health Care and Treatment; Private Equity; Initial Public Offering; Financing and Loans; Strategy; Value Creation; Growth and Development Strategy; Health Industry; Singapore

November 2013
Case

Choosing Health Insurance Coverage under the Affordable Care Act (ACA)

By: Robert C. Pozen, Katherine Brooks and Iwan Djanali

Keywords: Health Care; Health Care Industry; Insurance; Laws and Statutes; Health Care and Treatment; Policy; Health Industry; Health Industry; United States

January 2001 (Revised July 2003)
Case

Pharmacyclics: Financing Research & Development

By: Malcolm P. Baker, Richard S. Ruback and Aldo Sesia

Pharmacyclics (NASDAQ: PCYC), a pharmaceutical company that manufactures products that will improve existing therapeutic treatments for cancer, arteriosclerosis, and retinal disease, was considering a $60 million private placement in February 2000. The company had more... View Details

Keywords: Valuation; Cash Flow; Financing and Loans; Business Startups; Financial Strategy; Health Industry; Health Industry; Health Industry

February 2000
Case

E2M Health Services

By: Richard M.J. Bohmer and Naomi Atkins

Outlines the growth of an innovative diabetes disease management organization from 1994-99. Having demonstrated the success of their model in managing diabetes populations in Texas and New York State, the CEO and president must decide the future strategy of the company... View Details

Keywords: Business Model; Customer Focus and Relationships; Decision Choices and Conditions; Financial Markets; Revenue; Innovation and Invention; Business or Company Management; Marketing Strategy; Internet; Health Industry

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