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- All HBS Web
(168)
- News (46)
- Research (105)
- Multimedia (6)
- Faculty Publications (60)
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- September 2022
- Article
Giving a Buck or Making a Buck? Donations by Pharmaceutical Manufacturers to Independent Patient Assistance Charities
By: Leemore Dafny, Christopher Ody and Teresa Rokos
The federal Anti-Kickback Statute prohibits biopharmaceutical manufacturers from directly covering Medicare enrollees’ out-of-pocket spending for the drugs they manufacture, but manufacturers may donate to independent patient assistance charities and earmark donations... View Details
Keywords: Cost Sharing; Prescription Drugs; Drug Spending; Medicare; Dual Eligibility; Cost; Health Care and Treatment; Philanthropy and Charitable Giving; Pharmaceutical Industry
Dafny, Leemore, Christopher Ody, and Teresa Rokos. "Giving a Buck or Making a Buck? Donations by Pharmaceutical Manufacturers to Independent Patient Assistance Charities." Health Affairs 41, no. 9 (September 2022).
- 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
Huckman, Robert S., and Brian W. Powers. "CareMore Health System." Harvard Business School Case 618-008, August 2017.
- Article
Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated
By: Christopher Ody, Lucy Msall, Leemore S. Dafny, David Grabowski and David Cutler
Medicare’s Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a... View Details
Keywords: Readmission Rates; Hospitals; Acute Care Hospitals; Medicare; Myocardial Infarction; Heart Failure; Health Care and Treatment
Ody, Christopher, Lucy Msall, Leemore S. Dafny, David Grabowski, and David Cutler. "Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated." Health Affairs 38, no. 1 (January 2019): 36–43.
- 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
Huckman, Robert S., and Brian W. Powers. "CareMore Health System (B)." Harvard Business School Supplement 618-009, August 2017.
- October 2013 (Revised October 2016)
- Case
Steward Health Care System
By: Robert F. Higgins and Noah Fisher
Steward Health has raised private equity and has converted from not-for-profit to for-profit. The case describes its Accountable Care Organization (ACO) and asks whether it should continue this experiment. View Details
Keywords: Accountable Care Organization; ACO; Medicare; Medicaid; Medical Services; Cerberus; Caritas; Health Care Policy; Health Care Industry; Provider Organizations; Health Care and Treatment; Health Industry; United States
Higgins, Robert F., and Noah Fisher. "Steward Health Care System." Harvard Business School Case 814-029, October 2013. (Revised October 2016.)
- March 2021 (Revised July 2021)
- Case
Aledade
By: Regina E. Herzlinger, Samyukta Mullangi and Nicholas Samonas
To truly supercharge growth, should Aledade take a step back and focus on product development? View Details
- January 2011 (Revised September 2011)
- Case
Caterpillar, Inc. (A)
By: David F. Hawkins
2010 Healthcare Reform Act eliminates Medicare Part D subsidy and Caterpillar recognizes a $100 million change. View Details
Keywords: Information Infrastructure; Governing Rules, Regulations, and Reforms; Employment; Cost vs Benefits; Forecasting and Prediction; Change Management; Asset Management; Financial Strategy; Activity Based Costing and Management; Business or Company Management; Technology Industry; Manufacturing Industry; United States
Hawkins, David F. "Caterpillar, Inc. (A)." Harvard Business School Case 111-031, January 2011. (Revised September 2011.)
- August 2003 (Revised August 2006)
- Case
HealthSouth Corporation
By: Regina E. Herzlinger and Ivan Cheung
Delineates how a for-profit health services business was created. Focuses on sources of financing, the impact of Medicare reimbursement, and Stark laws against fraud and abuse. View Details
Herzlinger, Regina E., and Ivan Cheung. "HealthSouth Corporation." Harvard Business School Case 304-006, August 2003. (Revised August 2006.)
- August 2022 (Revised January 2023)
- Case
Icario Health: AI to Drive Health Engagement
By: David C. Edelman
Icario Health has built a market-leading artificial intelligence (AI) engine to help health insurers drive better health behaviors for their members, enabling the insurers to improve their Medicare performance. View Details
Keywords: Marketing; Health Care and Treatment; AI and Machine Learning; Health Industry; United States
Edelman, David C. "Icario Health: AI to Drive Health Engagement." Harvard Business School Case 523-025, August 2022. (Revised January 2023.)
- 08 Jun 2015
- Working Paper Summaries
Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
- March 1999 (Revised October 1999)
- Case
Tufts Health Plan
By: Richard M.J. Bohmer and Nancy D. Beaulieu
Describes the introduction of capitation by a managed care company and the challenges of managing financial risk in the Medicare population. Focuses on the relationship between the health plan and physicians. View Details
Keywords: Health; Behavior; Motivation and Incentives; Risk and Uncertainty; Insurance; Health Industry; Insurance Industry
Bohmer, Richard M.J., and Nancy D. Beaulieu. "Tufts Health Plan." Harvard Business School Case 699-160, March 1999. (Revised October 1999.)
- April 2008 (Revised May 2008)
- Case
Commonwealth Care Alliance: Elderly and Disabled Care
By: Michael E. Porter and Jennifer F Baron
Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the US. Commonwealth Care Alliance, a small nonprofit insurer and care delivery system in Massachusetts, operated under a public demonstration... View Details
Keywords: Programs; Public Sector; Alliances; Policy; Age; Service Delivery; Value; Health Care and Treatment; Welfare; Insurance Industry; Health Industry; Massachusetts
Porter, Michael E., and Jennifer F Baron. "Commonwealth Care Alliance: Elderly and Disabled Care." Harvard Business School Case 708-502, April 2008. (Revised May 2008.)
- 08 May 2018
- First Look
First Look at New Research and Ideas, May 8, 2018
forthcoming Management Science Evidence of Upcoding in Pay-for-Performance Programs By: Bastani, Hamsa, Joel Goh, and Mohsen Bayati Abstract—Recent Medicare legislation seeks to improve patient care quality by financially penalizing... View Details
Keywords: Sean Silverthorne
- November 2019
- Article
A Review of Bundled Payments in Total Joint Replacement
By: Olivia Manickas-Hill, Kevin J. Bozic and Thomas W. Feeley
The Bundled Payments for Care Improvement (BPCI) initiative, developed by the U.S. Center for Medicare & Medicaid Innovation, aims to reduce health care expenditures while maintaining or improving patient outcomes.
Several published reports evaluating the impact... View Details
Several published reports evaluating the impact... View Details
Manickas-Hill, Olivia, Kevin J. Bozic, and Thomas W. Feeley. "A Review of Bundled Payments in Total Joint Replacement." Journal of Bone and Joint Surgery Reviews 7, no. 11 (November 2019).
- August 2024
- Article
How Do Copayment Coupons Affect Branded Drug Prices and Quantities Purchased?
By: Leemore S. Dafny, Kate Ho and Edward Kong
Drug copayment coupons to reduce patient cost-sharing have become nearly ubiquitous for high-priced brand-name prescription drugs. Medicare bans such coupons on the grounds that they are kickbacks that induce utilization, but they are commonly used by... View Details
Keywords: Prescription Drugs; Coupons; Impact; Health Care and Treatment; Markets; Price; Spending; Pharmaceutical Industry; United States
Dafny, Leemore S., Kate Ho, and Edward Kong. "How Do Copayment Coupons Affect Branded Drug Prices and Quantities Purchased?" American Economic Journal: Economic Policy 16, no. 3 (August 2024): 314–346.
- 13 Jul 2009
- Research & Ideas
Diagnosing the Public Health Care Alternative
from a 4/27/09 opinion on The Huffington Post coauthored with U.S. Senator Tom Coburn (R-OK), M.D. Some Democrats view Medicare as a successful cost controller, pointing to its low administrative overhead, which they peg at 3 percent. But... View Details
- April 2017
- Supplement
Imprimis (B)
By: Ramon Casadesus-Masanell, Karen Elterman and Marc Appel
This case is a supplement to Imprimis (A). It describes the company’s decision to enter into the pharmaceutical compounding business in 2013–2014. Imprimis purchased a compounded ophthalmological medication called Dropless Therapy, which was injected into patients’... View Details
Keywords: Healthcare; Drug Compounding; Drug Development; Pharmaceuticals; Small Business; Decision-making, Business Model; Mark Baum; Imprimis; Decision Making; Strategy; Health Care and Treatment; Policy; Pharmaceutical Industry; United States
Casadesus-Masanell, Ramon, Karen Elterman, and Marc Appel. "Imprimis (B)." Harvard Business School Supplement 717-496, April 2017.
- Article
A Public Option Can Be a Triple Win for U.S. Healthcare
By: Regina E. Herzlinger and Richard Boxer
The United States needs to control healthcare costs and quality while reaching universal coverage. The strongest choice is a public option that allows people to choose between Medicare and private payers. But a public option needs sustainable financing mechanisms that... View Details
Keywords: Healthcare; Public Option; Universal Health Coverage; Health Care and Treatment; Cost Management; Quality; United States
Herzlinger, Regina E., and Richard Boxer. "A Public Option Can Be a Triple Win for U.S. Healthcare." Health Management, Policy and Innovation 4, no. 3 (December 2019).
- Forthcoming
- Article
Vertical Integration and Cream Skimming of Profitable Referrals: The Case of Hospital-Owned Skilled Nursing Facilities
By: David M. Cutler, Leemore Dafny, David C. Grabowski, Steven Lee and Christopher Ody
We examine whether vertical integration of hospitals and skilled nursing facilities (SNFs) could lessen competition by foreclosing rival SNFs’ access to lucrative referrals. We find that it could: among integrated providers, a one percent increase in SNF reimbursement... View Details
Keywords: Antitrust; Competition; Monopoly; Vertical Integration; Customer Value and Value Chain; Health Industry; United States
Cutler, David M., Leemore Dafny, David C. Grabowski, Steven Lee, and Christopher Ody. "Vertical Integration and Cream Skimming of Profitable Referrals: The Case of Hospital-Owned Skilled Nursing Facilities." American Economic Journal: Economic Policy (forthcoming).
- November 2016 (Revised November 2016)
- Case
Radial Analytics Probes Post-Acute Care
By: Richard G. Hamermesh and Olivia Hull
Thaddeus Fulford-Jones and Eric Weiss, founders of healthcare technology startup Radial Analytics, have been busy developing a software program designed to save hospitals money and improve patient outcomes by producing customized care plans for patients leaving the... View Details
Keywords: Electronic Medical Records; Electronic Health Records; Data Science; Entrepreneurship; Health Care and Treatment; Business Model; Business Startups; Innovation and Invention; Growth Management; Marketing Strategy; Product Launch; Product Positioning; Science-Based Business; Business Strategy; Health Industry; Technology Industry; Cambridge; Massachusetts
Hamermesh, Richard G., and Olivia Hull. "Radial Analytics Probes Post-Acute Care." Harvard Business School Case 817-029, November 2016. (Revised November 2016.)