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- 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
- July 2024
- Article
Mass General Brigham’s Patient-Reported Outcomes Measurement System: A Decade of Learnings
By: Jason B. Liu, Robert S. Kaplan, David W. Bates, Mario O. Edelen, Rachel C. Sisodia and Andrea L. Pusic
This article describes the strategies that leaders at the Mass General Brigham (MGB) health system have used in launching a standardized patient-reported outcome measure (PROM) collection program in 2012, a major step in the value-based transformation of health care.... View Details
- November 2023 (Revised April 2024)
- Case
BiomX: Bringing Phage Back to the Stage
By: Paul A. Gompers, Elie Ofek, Orna Dan and Emilie Billaud
In the spring of 2023, and following the favorable results of a trial involving its phage cocktail for treating lung infections among cystic fibrosis (CF) patients, the leadership of BiomX had several critical issues to wrestle with. First, given its precarious... View Details
- October 2023
- Article
What Does the Inflation Reduction Act Mean for Patients and Physicians?
By: Amitabh Chandra and Benedic Ippolito
The debate around prescription drug measures in the recently passed U.S. Inflation Reduction Act (IRA), which limit some patients’ out-of-pocket costs, has not fully addressed their effect on physicians and patients via their effect on payers. Reducing patients’ costs... 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
- Article
Supporting Value-Based Health Care—Aligning Financial and Legal Accountability
By: Mark M. Zaki, Anupam B. Jena and Amitabh Chandra
U.S. health care payment and delivery-system reforms have focused on improving care by making organizations accountable for outcomes, quality, and costs. Payers have supported the implementation of accountable care organizations (ACOs), bundled-payment models, and... View Details
- February 2021
- Case
New England Baptist Hospital: Getting Paid for Value
By: Robert S. Kaplan, Mary Witkowski, Toby E. Emanuel and Syed S. Shehab
New England Baptist Hospital (NEBH), a national leader in adult orthopedic care, has the lowest rate of complications and 30-day readmissions in New England, but gets paid 30% less for its surgeries than nearby institutions. NEBH introduces, with several large... View Details
- Article
Using the Balanced Scorecard for Successful Health Care M&A Integration
By: Robert S. Kaplan
The failure of merged organizations to achieve stated goals is commonplace. In health care, the challenge is exacerbated by the industry’s third-party payer system and multiple stakeholders, especially the physicians in the merging entities. This article describes how... View Details
- Working Paper
Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S.
By: Pragya Kakani, Michael Chernew and Amitabh Chandra
Rising list prices are often used to illustrate the burden of prescription drug spending, but payers routinely negotiate rebates from manufacturers that generate differences between list and net prices. List prices are easily available and affect patient cost-sharing,... View Details
- 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
- October 2018 (Revised August 2019)
- Case
Beth Israel Deaconess: Consolidating to Strengthen, or to Stave Off, Competition?
By: Leemore Dafny
In July 2017, CEO Kevin Tabb of Boston's Beth Israel Deaconess Medical Center announced his plan to consolidate 11 Massachusetts hospitals under a common management structure. These hospitals collectively generated $5 billion in patient revenue and 25% 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
- 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
- May 11, 2017
- Article
Good Riddance to Big Insurance Mergers
By: Leemore S. Dafny
Federal judges issued preliminary injunctions halting mergers of four of the five largest U.S. health insurers. These decisions provide more precedent to support challenges of mergers between competitors in health care markets—whether payers or providers. View Details
- Article
Time-Driven Activity-Based Costing for Surgical Episodes
By: Peter Najjar, Matt Strickland and Robert S. Kaplan
Health care costs related to surgical care account for 40% of all hospital and physician spending. Payers attempting to contain costs are replacing fee-for-service with value-based payment schemes that can encompass entire episodes of care, including physician services... View Details
- December 2016
- Article
Health Care Needs Real Competition
By: Leemore S. Dafny and Thomas H. Lee
The U.S. health care system is inefficient, unreliable, and crushingly expensive. There is no shortage of proposed solutions, but central to the best of them is the idea that health care needs more competition. In other sectors, competition improves quality and... View Details
- October 2015 (Revised July 2017)
- Case
OMV Petrom: Investment as Partnership—When It Takes Three to Tango
By: Dante Roscini, Emer Maloney and Daniela Beyersdorfer
Petrom was privatized by the Romanian state in 2004 and acquired by Austrian oil company OMV, with the state retaining a 20.6% stake in the company. The situation was particularly challenging for the foreign investor since the sector in which the company operated was... View Details
- March 2015
- Teaching Note
CVS Health: Promoting Drug Adherence
Email mking@hbs.edu for a courtesy copy.
This Teaching Note explains the theory of the case and teaching plan for the case: CVS Health: Promoting Drug Adherence (515010). The case finds Helena Foulkes, Executive... View Details
This Teaching Note explains the theory of the case and teaching plan for the case: CVS Health: Promoting Drug Adherence (515010). The case finds Helena Foulkes, Executive... View Details
Keywords: Medication Adherence; Affordable Care Act (ACA); Marketing Strategy; Communication Strategy; Customer Value and Value Chain; Decisions; Health Care and Treatment; Goals and Objectives; Resource Allocation; Marketing Communications; Consumer Behavior; Measurement and Metrics; Service Delivery; Behavior; Motivation and Incentives; Social Issues; Information Technology; Value Creation; Health Industry; Pharmaceutical Industry; Insurance Industry; Public Relations Industry; Retail Industry; United States
- Article
Better Accounting Transforms Health Care Delivery
By: Robert S. Kaplan and Mary L. Witkowski
The paper describes the theory and preliminary results for an action research program that explores the implications from better measurements of health care outcomes and costs. After summarizing Porter's outcome taxonomy (Porter 2010), we illustrate how to use process... View Details
- August 2012 (Revised December 2023)
- Background Note
Note on Health Insurance Coverage, Coding, and Payment
By: Regina E. Herzlinger and Jo Ellen Slurzberg
This note explains how health care technology and service innovators receive payment from government insurers, in the U.S. and abroad, and from private insurers. It describes each of the three steps needed to obtain reimbursement: coverage, coding, and payment. It also... View Details