Publications

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

Keywords: Health Care and Treatment; Cost Management; Insurance; Problems and Challenges

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October 2017
Case

Pricing PatientPing

By: Frank V. Cespedes, Julia Kelley and Amram Migdal

In 2017, Jay Desai, the CEO of Boston-based health care technology company PatientPing, had to consider a number of interrelated pricing challenges. Founded in late 2013, PatientPing sold a software platform that allowed health care providers to receive real-time... View Details

Keywords: Pricing; Health Tech; Health Technology; Marketing; Sales Process; Sales Strategy; Price; Sales; Marketing Strategy; Health Care and Treatment; Health Industry; Health Industry; Boston; North America; Massachusetts; United States

January 2021
Article

COVID-19 Hasn't Been a Tipping Point for Value-Based Care, but It Should Be

By: Thomas W. Feeley

Four out of five health care provider organizations are suffering ongoing losses as a result of the COVID-19 pandemic, according to the recent NEJM Catalyst Insights Council survey on value-based payment and care. Yet Council members, who are still largely entrenched... View Details

Keywords: Value-based Health Care; Health Pandemics; Health Care and Treatment; Cost

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June 2008 (Revised January 2010)
Supplement

Name Your Price: Compensation Negotiation at Whole Health Management (C)

By: Brian J. Hall, Deepak Malhotra and Nicole Bennett

Supplements the (A) and (B) cases. View Details

Keywords: Compensation and Benefits; Negotiation; Health; Price; Health Industry

March 2011 (Revised March 2011)
Case

Horizon Blue Cross Blue Shield of New Jersey - Managing in the Shadow of Health Care Reform

By: Felix Oberholzer-Gee, Raffaella Sadun and Richard G. Hamermesh

Per the Patient Protection and Affordable Care Act (PPACA), which President Obama signed in 2010, states would be required to create state-wide health insurance marketplaces - the Health Benefit Exchanges (HBEs) - in which individuals and small employers could choose... View Details

Keywords: Insurance; Health Care and Treatment; Governing Rules, Regulations, and Reforms; Emerging Markets; Risk and Uncertainty; Health Industry; Health Industry; New Jersey

March 2015 (Revised November 2017)
Case

Bonitas

By: Regina E. Herzlinger and Natalie Kindred

Bonitas, a South African medical scheme (i.e., health insurer), must navigate highly restrictive regulations that make it difficult for Bonitas to innovate, grow, and compete with market leader Discovery as well as providers of alternative insurance products. Bonitas... View Details

Keywords: Health Insurance; Health Care; South Africa; Medical Scheme; Public Policy; Bonitas; Bonitas Medical Fund; National Health Insurance; Health; Health Care and Treatment; Insurance; Policy; Health Industry; Health Industry; South Africa; Johannesburg; Africa

February 2025
Supplement

Intenseye: Powering Workplace Health and Safety with AI (B)

By: Michael W. Toffel, Shane Greenstein and Sadika El Hariri

Intenseye used its $25 million series A funds to refine and expand its digital safety platform while refining its target markets and ideal customer profile. As the company implemented new approaches to create value for its clients, such as developing an AI-powered... View Details

September 2014 (Revised May 2017)
Case

Fresno's Social Impact Bond for Asthma

By: John A. Quelch and Margaret L. Rodriguez

In 2014, Social Impact Bonds (SIBs) were quickly gaining popularity as an investment vehicle which joined together private investors and nonprofits to tackle social issues. Although numerous SIB projects and proposals had cropped up across the U.S. following the launch... View Details

Keywords: Social Enterprise; Health Care; Marketing; Bonds; Financing; Asthma; Air Pollution; Air Quality; Chronic Disease; Public Health; Health; Health Care and Treatment; Finance; Health Industry; Health Industry; United States

2012
Report

Better Outcomes, Lower Costs: A Conversation with Dr. Atul Gawande

By: Mark R. Kramer

In the face of increasing health care costs and uncertainty about health care quality in the United States, community-based collective impact initiatives driven by regional funders offers a new way to improve patient outcomes at the local level. Collectively,... View Details

Keywords: Community Foundations; Health Outcomes; Health Care and Treatment; Quality; Cost Management; United States

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15 Feb 2022
Blog Post

Health is Wealth | The Path to Creating a Venture

opportunities to leverage technology to help people experience their healthcare in a better way. Driven by her own personal health experiences in where she constantly used a guess and check methodology to improve her health, she sought to... View Details

May 1994 (Revised February 2021)
Background Note

Note on Reimbursement of Health Care Providers: Case-Based and Capitation Payment

By: Regina E. Herzlinger and Tom Nagle

Explains how managed care organizations use capitation as a payment method for providers. View Details

Keywords: Managed Care; Capitation; Health Care and Treatment; Insurance; Accounting; Financial Management; Health Industry; Health Industry

02 Oct 2015
News

The Harvard Contest That's Trying to Improve Health Care Delivery

Keywords: healthcare; innovation; entrepreneurship; Ambulatory Health Care Services; Ambulatory Health Care Services

June 2008 (Revised January 2010)
Supplement

Name Your Price: Compensation Negotiation at Whole Health Management (B)

By: Brian J. Hall, Deepak Malhotra and Nicole Bennett

Supplements the (A) case. View Details

Keywords: Compensation and Benefits; Negotiation; Health; Price; Health Industry

Article

Disruptive Innovation: A New Diagnosis for Health Care's 'Financial Flu'

By: John Kenagy and C. M. Christensen

Keywords: Disruption; Innovation and Invention; Health; Finance

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July 2020
Case

King's College Hospital in Crisis

By: John R. Wells and Benjamin Weinstock

On December 11, 2017, King’s College Hospital NHS Foundation Trust (King’s), one of London’s leading teaching hospital groups, was put into “special measures” by NHS Improvement (NHSI), the financial regulator of England’s National Health Service (NHS). The future of... View Details

Keywords: Hospitals; Financing; Health Care and Treatment; Financial Condition; Crisis Management; Organizational Structure; Transformation; Strategic Planning; United Kingdom

September 2013 (Revised May 2014)
Case

OdontoPrev

By: Regina E. Herzlinger, Matthew Lingenbrink, Joshua Turnbull and Ricardo Reisen De Pinho

Brazil's largest dental insurer, a successful and innovative firm, has saturated the corporate market and faces stiffer competition. It must decide whether to enter a new market in Brazil or to expand into other parts of Central and South America. View Details

Keywords: Health; Business or Company Management; Market Entry and Exit; Insurance; Health Industry; Health Industry; North and Central America; Brazil

March 2015 (Revised January 2024)
Case

CV Ingenuity (A): How to Evaluate the Commercial Viability of New Health Care Technologies

By: Regina E. Herzlinger and Andrew Otazo

Duke Rohlen (HBS MBA ’01) hoped to win over a prominent venture capital investor for Series B financing of his firm CVI that was creating a drug-eluting balloon (DES) to treat peripheral arterial disease. As a second-mover, Duke felt he was more likely to acquire... View Details

March 2021
Case

Humana (A)

By: Regina E. Herzlinger and Ashley Ifeadike

To implement a bold new strategy, Humana needed to decide how to prioritize the pillars; where to own and where to partner; how much risk is acceptable; and how to continue to deliver strong operational performance while implementing a new strategy. Had the firm made... View Details

Keywords: Health ＆ Wellness; Health Care Industry; Health Care Costs; Health Insurance; Health Insurance Marketplaces; Health Care and Treatment; Cost; Insurance; Strategy; Health Industry; United States