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- May 2025
- Case
Humana Commits to Value-Based Care
By: V.G. Narayanan, Henry Eyring and David Lane
In late 2023, CEO Bruce Broussard reviewed health insurer Humana’s transformation into a value-based care ecosystem. Under its CenterWell brand, the several millions of members in Humana Medicare Advantage plans now had access to Humana-provided primary care, home... View Details
- December 2024
- Case
Blue Cross Blue Shield of Michigan (BCBSM): The AI Journey
By: Shikhar Ghosh
In early 2024, Bill Fandrich, Executive VP and CIO of Blue Cross Blue Shield of Michigan (BCBSM), faced a critical decision about AI adoption within the organization. Fandrich had championed AI implementation at BCBSM. After successfully developing three AI... View Details
Keywords: Blue Cross; Automation; Generative Ai; Health Insurance; Insurance Companies; Innovation; IT Strategy; Organizational Transformations; Technology; Non-profit; AI and Machine Learning; Health; Digital Strategy; Digital Transformation; Leadership; Technology Adoption; Job Cuts and Outsourcing; Innovation Strategy; Health Industry; Health Industry; Michigan
- October 2024
- Article
Medicare Part D Protected-Class Policy Is Associated with Lower Drug Rebates
By: Pragya Kakani, Michael Anne Kyle, Amitabh Chandra and Luca Maini
Medicare Part D does not allow plans to exclude drugs in six protected classes from their formularies, which may limit plans’ ability to negotiate rebates and lead to higher spending. We estimated the association between protected-class status, US-level estimated... View Details
- 2024
- Working Paper
Does Private Equity Have Any Business Being in the Health Care Business?
By: Nori Gerardo Lietz and Zirui Song
Private Equity (“PE”) has come under increased scrutiny by the press, academics, and policymakers, as well as the public, for its investments in health care delivery. This scrutiny has been exacerbated by recent high profile hospital bankruptcies following PE... View Details
- 18 Apr 2024
- Lecture
Innovation Opportunities Created by COVID-19 Can Help: And How to Make Them Happen
The crush of patients created by COVID enabled the creation of sites for care outside the traditional hospital, such as retail pharmacies, ambulatory surgery centers, urgent care centers, telemedicine, and wireless sensors. Public policy mirrored these changes by... View Details
- February 2024
- Article
An Economic Framework for Vaccine Prioritization
By: Mohammad Akbarpour, Eric Budish, Piotr Dworczak and Scott Duke Kominers
We propose an economic framework for determining the optimal allocation of a scarce supply of vaccines that become gradually available during a public health crisis, such as the Covid-19 pandemic. Agents differ in observable and unobservable characteristics, and the... View Details
- January 2024
- Article
Cost of Exempting Sole Orphan Drugs from Medicare Negotiation
By: Matthew Vogel, Olivia Zhao, William B. Feldman, Amitabh Chandra, Aaron S. Kesselheim and Benjamin N. Rome
Importance: The Inflation Reduction Act (IRA) requires Medicare to negotiate prices for some high-spending drugs but exempts drugs approved solely for the treatment of a single rare disease.
Objective: To estimate Medicare spending and global... View Details
Objective: To estimate Medicare spending and global... View Details
- December 12, 2023
- Article
Prices for Common Services at Quaternary vs Nonquaternary Hospitals
By: Brandon W. Yan, Maximilian J. Pany and Leemore S. Dafny
Using commercial health insurance claims data from 2017-2019, we assessed whether quaternary hospitals charged higher prices for common, unspecialized services also offered by nonquaternary hospitals. We found quaternary-hospital price premiums of 8.2 percent, on... View Details
- September 2023
- Case
Healthy.io: The Negotiation for the Medical Selfie
By: Amit Goldenberg and Kumba Sennaar
Healthy.io, an Israeli digital health company, prepares to enter the U.S. market with its chronic kidney disease test. A product safety approval is delayed, putting the company’s cash runway at risk. How should the CEO negotiate his offer to insurance companies ahead... View Details
- July 2023
- Case
DayTwo: Going to Market with Gut Microbiome (Abridged)
By: Ayelet Israeli
DayTwo is a young Israeli startup that applies research on the gut microbiome and machine learning algorithms to deliver personalized nutritional recommendations to its users in order to minimize blood sugar spikes after meals. After a first year of trial rollout in... View Details
- Summer 2023
- Article
Do Policies to Increase Access to Treatment for Opioid Use Disorder Work?
By: Eric Barrette, Leemore S. Dafny and Karen Shen
Even among commercially insured individuals, opioid use disorder is undertreated in the United States: nearly half receive no treatment within six months of a new diagnosis. Using a difference-in-differences specification exploiting the extension of insurance parity... View Details
- 3 Jun 2023
- Talk
Health Care Innovation Opportunities Created by COVID-19 and How to Make Them Happen
The crush of patients created by COVID enabled the creation of sites for care outside the traditional hospital, such as retail pharmacies, ambulatory surgery centers, urgent care centers, telemedicine, and wireless sensors. Public policy mirrored these changes by... View Details
- June 2023
- Teaching Note
From Cradle to Heaven: Taikang Insurance Group
By: William C. Kirby and Noah B. Truwit
Teaching Note for HBS Case No. 320-088. The case explores the rise of Taikang Insurance Group and its quest to be a leader of one of China's fastest-growing industries. Due to China's underdeveloped social welfare state, Taikang saw an opportunity for the private... View Details
- April 24, 2023
- Article
In the COVID Era, Why Corporate Benefits Demand CEO/CFO Leadership
The expectation that employers provide their employees’ health benefits has been around since World War II. Unfortunately, although today’s employees expect employers to treat them as individuals, ease their experiences, prioritize their wellbeing, and control cost,... View Details
Keywords: COVID; COVID-19 Pandemic; CEO; Leadership; Health Insurance; Benefits; CFO; Compensation and Benefits
- March 2023
- Teaching Note
VideaHealth: Building the AI Factory
By: Karim R. Lakhani
Teaching Note for HBS Case No. 621-021. The case “VideaHealth: Building the AI Factory” examines the creation of dental startup VideaHealth (Videa) and the development of its artificial intelligence (AI)-led business strategy through the eyes of founder and CEO Florian... View Details
- February 2023
- Article
A Different Framework to Achieve Universal Coverage in the U.S.
By: Katherine Baicker, Amitabh Chandra and Mark Shepard
This JAMA Forum discusses alternative ways to achieve universal coverage in the US such as administrative simplification in the Affordable Care Act plans to increase enrollment, having a basic policy that would be available to everyone, and options for supplemental... View Details
- January 2023
- Case
Thomas Buberl: Refounding AXA
By: Hubert Joly, Mihir Desai and Amram Migdal
In 2022, AXA and its CEO Thomas Buberl faced new types of challenges, including systemic risks such as climate change, geopolitical instability, public health crises, and social tensions caused by economic risks. AXA was one of the world’s largest insurers. Since... View Details
Keywords: Change; Change Management; Transformation; Transition; Trends; Environmental Management; Climate Change; Ethics; Values and Beliefs; Finance; Insurance; Management; Management Succession; Risk Management; Organizations; Corporate Social Responsibility and Impact; Mission and Purpose; Organizational Change and Adaptation; Planning; Strategic Planning; Risk and Uncertainty; Society; Human Needs; Social Issues; Strategy; Adaptation; Business Strategy; Corporate Strategy; Insurance Industry; Europe; France; Paris
- 2023
- Working Paper
Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor?
By: Katherine Baicker, Amitabh Chandra and Mark Shepard
The United States spends substantially more on health care than most developed countries, yet leaves a greater share of the population uninsured. We suggest that incremental insurance expansions focused on addressing market failures will propagate inefficiencies and... View Details
- November 2022
- Case
The Battle Among Channels for Marketing Pharmaceuticals: UpScript, Pharmacy Benefit Managers, and Direct-to-Consumer Sales
By: Regina E. Herzlinger and Tiffany Farrell
Can an online, direct-to-consumer pharmacy both improve the quality and speed of care for patients who need branded drugs and stabilize profits for pharmaceutical manufacturers? UpScript, after years spent achieving legal and regulatory compliance and simultaneous... View Details