Publications
Publications
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(1,742)
- Faculty Publications (290)
- 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
- Article
Operational Efficiency and Effective Management in the Catheterization Laboratory
By: Grant W. Reed, Michael L. Tushman and Samir R. Kapadia
Operational efficiency is a core business principle in which organizations strive to deliver high-quality goods or services in a cost-effective manner. This concept has become increasingly relevant to cardiac catheterization laboratories, as insurers move away from... View Details
- August 2018 (Revised August 2019)
- Case
Oscar Health Insurance: What Lies Ahead for a Unicorn Insurance Entrant?
By: Leemore Dafny and Victoria Marone
Keywords: Oscar Insurance; Fintech; US Health Care; Affordable Care Act (ACA); Health Insurance Marketplaces; Insurer Competition; Provider Consolidation; Market Entry; Health Care and Treatment; Entrepreneurship; Market Entry and Exit; Negotiation; Growth Management; Health Industry; Health Industry; New York (state, US); New Jersey
- July 2018
- Article
Reimagining Health Data Exchange: An Application Programming Interface-Enabled Roadmap for India
By: Satchit Balsari, Alexander Fortenko MD, MPH, Joaquin A. Blaya PhD, Adrian Gropper MD, Malavika Jayaram LLM, Rahul Matthan LLM, Ram Sahasranam, Mark Shankar MD, Suptendra N. Sarbadhikari PhD, Barbara Bierer, Kenneth D. Mandl MD, Sanjay Mehendale MD, MPH and Tarun Khanna
In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world’s largest insurance program. To meet this target, the government will rely on technology to... View Details
- 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
- June 2018 (Revised November 2018)
- Case
Innovation at Insigne Health
By: Srikant M. Datar, Linda A. Cyr and Caitlin N. Bowler
Insigne Health is a fictional for-profit, integrated health insurer/health care provider whose leadership believes that by shifting members’ focus from “sickness” to “well-being” it could increase the overall health of its insured population and decrease the resources... View Details
- May 2018 (Revised October 2020)
- Supplement
La Ribera Health Department (B): Epilogue
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
- March 2018 (Revised January 2019)
- Case
Gilead Mexico
By: Michael Chu and V. Kasturi Rangan
With a breakthrough cure for Hepatitis C listing in the U.S. at $1,000/pill, Gilead must now solve the issue of making it available to patients across the world, much as it did for its blockbuster HIV/AIDS antiretrovirals. For Erik Musalem, the new general manager of... View Details
- Article
Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System
By: Phillip Tseng, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah and Kevin A. Schulman
The federal government mandated adoption of certified electronic health record systems (EHR), at least in part, to reduce administrative costs for physicians. This study used time-driven activity-based costing to determine the administrative costs associated with... View Details
- 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
- 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
- Article
The Economic Consequences of Hospital Admissions
By: Carlos Dobkin, Amy Finkelstein, Raymond Kluender and Matthew Notowidigdo
We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance,... View Details
- December 2017 (Revised April 2018)
- Case
The Children's Hospital of Philadelphia: Network Strategy 2016
By: Michael E. Porter, Thomas W. Feeley and Toyin J. Okanlawon
Children’s Hospital of Philadelphia (CHOP) began as a stand-alone hospital in the heart of downtown Philadelphia in 1855. By 2016 the CHOP Care Network stretched across Pennsylvania, New Jersey, and the New York metropolitan area, providing a wide range of services... View Details
- November 2017
- Article
A Retrospective Analysis of Hypertension Screening at a Mass Gathering in India: Implications for Non-communicable Disease Control Strategies
By: S. Balsari, P. Vemulapalli, M. Gofine, K. Oswal, R. Merchant, S. Saunik, G. Greenough and T. Khanna
Cardiovascular disease is the leading cause of mortality from noncommunicable diseases (NCD) in India. The government’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to increase capacity building, screening,... View Details
- September 2017 (Revised February 2023)
- Case
Intermountain Healthcare: Pursuing Precision Medicine
By: Richard G. Hamermesh, Kathy E. Giusti, Robert S. Huckman and Julia Kelley
Headquartered in Salt Lake City, Intermountain Healthcare operates 23 hospitals and hundreds of clinics in Utah and Idaho and provides insurance to approximately 850,000 patients through its insurance arm, SelectHealth. In 2013, Intermountain, known for its commitment... View Details
- Article
Narrow Networks on the Health Insurance Marketplaces: Prevalence, Pricing, and the Cost of Network Breadth
By: Leemore S. Dafny, Igal Hendel, Victoria Marone and Christopher Ody
Anecdotal reports and systematic research highlight the prevalence of narrow-network plans on the Affordable Care Act’s health insurance Marketplaces. At the same time, Marketplace premiums in the period 2014–2016 were much lower than projected by the Congressional... View Details
- 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