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February 2018
Case

Aetna and the Transformation of Health Care

By: Rebecca M. Henderson, Russell Eisenstat and Matthew Preble

Mark Bertolini, chairman and CEO of the health insurer Aetna, faces a number of questions as he seeks to transform Aetna from a classic insurance company into a business that will engage much more deeply with its members around their personal health goals. His strategy... View Details

Keywords: Health Care and Treatment; Insurance; Transformation; Behavior; Leading Change; Strategy; Health Industry; Health Industry; United States; Connecticut

03 Sep 2020
Op-Ed

Why American Health Care Needs Its Own SEC

A health care SEC could collect data on prices and outcomes that comply with its measurement standards, and certified, independent appraisers could attest that the numbers comply with accepted measurement standards—just as independent... View Details

Keywords: by Regina E. Herzlinger; Health

October 2016 (Revised March 2019)
Case

Carrum Health: Scaling Bundled Payments

By: Robert S. Huckman and Sarah Mehta

Founded in 2014, Carrum Health helped self-insured employers located in three markets (San Diego, California; Seattle, Washington; and San Francisco, California) save money on their employees’ planned surgeries. It did so by contracting directly with top-quality... View Details

Keywords: Health Financing; Health Insurance; Value-based Healthcare Reimbursements; Bundled Payments; Innovation; Scale; Health; Health Care and Treatment; Cost Management; Growth and Development Strategy; Decision Choices and Conditions; Health Industry; California; San Francisco; San Diego; Seattle

August 1989 (Revised May 1993)
Case

Computer Company's Health Plan

By: Regina E. Herzlinger

Keywords: Health; Insurance

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February 2015
Supplement

The Affordable Care Act (B): Industry Negotiations

By: Joseph L. Bower and Michael Norris

In 2009, the Obama administration and Senator Max Baucus, chairman of the Senate Finance Committee enter into talks with industry groups that will be affected by the health reform that the Congress is working on. View Details

Keywords: Health Care; Health Care Policy; Health; Health Industry; United States

June 1995
Case

Quorum Health Group, Inc.

By: William A. Sahlman and Jason Green

Facing increasing competition from much larger industry players, Jim Dalton, CEO of Quorum, and Russ Carson, Managing Partner of Welch, Carson, Anderson & Stowe attempt to set the future direction for Quorum. The company was successfully spun-off from HCA in a... View Details

Keywords: Growth and Development Strategy; Competitive Strategy; Consolidation; Leveraged Buyouts; Venture Capital; Acquisition; Health Industry

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March 31, 2022
Article

Two Approaches to Capping Health Care Prices

By: Michael E. Chernew, Maximilian J. Pany and Leemore S. Dafny

High health care prices for the privately-insured contribute to high premiums, which put downward pressure on wages, and induce employers to reduce benefit generosity and charge employees more for coverage. As the average annual premium for family coverage currently... View Details

Keywords: Price Caps; Health Care and Treatment; Price

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June 1994 (Revised February 1999)
Case

Marcia Radosevich and Health Payment Review--1989 (A)

Martha Radosevich, president of Health Payment Review, a small software start-up, confronts a serious cash-flow problem: Health Payment Review has built a PC-based prototype but has run out of funds to build a commercially acceptable mainframe product. As a stop-gap... View Details

Keywords: Negotiation; Cash Flow; Entrepreneurship; Applications and Software; Sales; Information Technology Industry

Article

Do We Spend Too Much on Health Care?

By: Katherine Baicker and Amitabh Chandra

Health system reforms—such as changes in insurance design, patient cost sharing, payment reform, or price regulation—should be judged by whether they move us toward higher-value use of resources, rather than by whether they reduce spending. View Details

Keywords: Health Care and Treatment; Cost; Governing Rules, Regulations, and Reforms; Value Creation

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2010
Chapter

Consumer-Driven Universal Health Care is the Best Solution

By: Regina E. Herzlinger

The best way to achieve universal health insurance coverage is to implement a consumer-controlled system rather than a government-controlled system. View Details

Keywords: Health Care and Treatment; Insurance; Customers; System

March 2008 (Revised January 2010)
Background Note

Note on Accountability in the U.S. Health Care System

By: Regina E. Herzlinger and Michael Millenson

This note explains how health care providers, health insurers, and consumers are held accountable for their performance and the entrepreneurial opportunities thus created. View Details

Keywords: Entrepreneurship; Ethics; Insurance; Corporate Accountability; Health Care and Treatment; Demand and Consumers; Health Industry; United States

27 Feb 2020
Sharpening Your Skills

How Following Best Business Practices Can Improve Health Care

Either Heal Health Care?A public insurance option could use its scale to hold prices down, but only if the approach avoids the financing gimmicks that are undermining Medicare. Research Papers Cohort... View Details

Keywords: by Sean Silverthorne; Health; Health

February 2012 (Revised June 2013)
Case

Moving to Universal Coverage: Health Care Reform in Massachusetts

By: Michael E. Porter and Jennifer F Baron

State health care reform in Massachusetts has involved a phased process, focusing first on coverage expansion and then turning to delivery system innovation and cost containment. In 2006, the state adopted an individual mandate to obtain health care coverage which,... View Details

Keywords: Health Care and Treatment; Business and Government Relations; Insurance; Massachusetts

2023
Article

Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping

By: Robin van Kessel, Divya Srivastava, Ilias Kyriopoulos, Giovanni Monti, David Novillo-Ortiz, Ran Milman, Wojciech Wilhelm Zhang-Czabanowski, Greta Nasi, Ariel Dora Stern, George Wharton and Elias Mossialos

Background: The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement... View Details

Keywords: Technology Adoption; Health Care and Treatment; Cross-Cultural and Cross-Border Issues; Price; Health Industry; Europe; Israel

August 2011 (Revised July 2014)
Case

Amil and the Health Care System in Brazil

By: Regina E. Herzlinger and Ricardo Reisen de Pinho

Dr. Edson Bueno created Amil, Brazil's largest health insurer. Unlike many others, it is vertically integrated. Dr. Bueno has two opportunities for growth. Which, if any, should he pursue? View Details

Keywords: Health Care and Treatment; Innovation and Invention; Opportunities; Insurance; Vertical Integration; Insurance Industry; Brazil

January 2019 (Revised June 2019)
Technical Note

U.S. Commercial Health Insurance Industry

By: Susanna Gallani, Mary Witkowski and Harry B. Wolberg

This note describes the role of commercial payers in the U.S. healthcare industry. We begin with a review of the historical evolution of commercial payers and their role in the market, from the beginning to the Affordable Care Act and beyond. Every wave of reforms in... View Details

Keywords: Health Care and Treatment; Insurance; Governing Rules, Regulations, and Reforms; Organizational Change and Adaptation; Health Industry; Health Industry; United States

April 5, 2023
Article

We Need an Operation Warp Speed for Long COVID

By: Esther K. Choo and Scott Duke Kominers

With millions of people affected and at least $1 trillion of economic value at stake, long COVID is our next national health emergency. View Details

Keywords: COVID; COVID-19; COVID-19 Pandemic; Scientific Research; Policy; Health Policy; Innovation; Science; Public Finance; Public Health; Health Disorders; Health Care and Treatment; Human Capital

September 2011
Article

How to Solve the Cost Crisis in Health Care

By: Robert S. Kaplan and Michael E. Porter

Existing health care costing systems have serious flaws that make it impossible to measure costs accurately at the individual patient and medical condition level. This gap has severely limited meaningful cost reduction throughout the system. The paper describes a new... View Details

Keywords: Cost; Health Care and Treatment; Measurement and Metrics; Service Delivery; Outcome or Result; Quality; Health Industry

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November 2010 (Revised May 2012)
Background Note

Assessing a Company's Future Financial Health

By: Thomas R. Piper

The case provides students with (1) an understanding of the essence of long-term financial health; (2) familiarity with the calculation and meaning of various financial ratios; and (3) an understanding of the influence of a company's operating and competitive... View Details

Keywords: Financial Condition; Forecasting and Prediction; Investment Return; Operations; Competitive Strategy

25 Jan 2013
Research & Ideas

Why a Harvard Finance Instructor Went to the Kumbh Mela

(Ganges) River, the Yamuna River, and the mythical underground Saraswathi. Legend says that on his return to the Himalaya, Vishnu flew over this spot and dropped sacred nectar from a pitcher—a kumbh. “We are all here to witness how devotion, design, health, and View Details

Keywords: by John D. Macomber; Construction; Real Estate

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