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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
      Keywords: Private Equity; Government Administration; Acquisition; Health Industry
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      Lietz, Nori Gerardo, and Zirui Song. "Does Private Equity Have Any Business Being in the Health Care Business?" Harvard Business School Working Paper, No. 25-012, September 2024.
      • 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
      Keywords: Patient-reported Outcomes; Value Based Health Care; Health Care and Treatment; Transformation; Outcome or Result; Organizational Change and Adaptation; Performance Improvement; Health Industry
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      Liu, Jason B., Robert S. Kaplan, David W. Bates, Mario O. Edelen, Rachel C. Sisodia, and Andrea L. Pusic. "Mass General Brigham’s Patient-Reported Outcomes Measurement System: A Decade of Learnings." NEJM Catalyst Innovations in Care Delivery 5, no. 7 (July 2024).
      • 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
      Keywords: Working Capital; Financing and Loans; Health Testing and Trials; Product Development; Research and Development; Science-Based Business; Commercialization; Biotechnology Industry; Pharmaceutical Industry
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      Gompers, Paul A., Elie Ofek, Orna Dan, and Emilie Billaud. "BiomX: Bringing Phage Back to the Stage." Harvard Business School Case 524-051, November 2023. (Revised April 2024.)
      • 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
      Keywords: Government Legislation; Price; Health Care and Treatment
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      Chandra, Amitabh, and Benedic Ippolito. "What Does the Inflation Reduction Act Mean for Patients and Physicians?" NEJM Catalyst Innovations in Care Delivery 4, no. 10 (October 2023).
      • 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
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      Joly, Hubert, Mihir Desai, and Amram Migdal. "Thomas Buberl: Refounding AXA." Harvard Business School Case 523-059, January 2023.
      • 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
      Keywords: Value-based Health Care; Accountability; Health Care and Treatment; United States
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      Zaki, Mark M., Anupam B. Jena, and Amitabh Chandra. "Supporting Value-Based Health Care—Aligning Financial and Legal Accountability." New England Journal of Medicine 385, no. 11 (September 9, 2021): 965–967.
      • 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
      Keywords: Healthcare; Healthcare Spending; Healthcare Innovation; Healthcare Industry; Health Care Outcomes; Health Care Delivery; Health Care Reform; Bundled Payments; Health Care and Treatment; Spending; Innovation and Invention; Value Creation; Strategy; Health Industry; North America
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      Kaplan, Robert S., Mary Witkowski, Toby E. Emanuel, and Syed S. Shehab. "New England Baptist Hospital: Getting Paid for Value." Harvard Business School Case 121-036, February 2021.
      • 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
      Keywords: Health Care and Treatment; Mergers and Acquisitions; Integration; Balanced Scorecard
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      Kaplan, Robert S. "Using the Balanced Scorecard for Successful Health Care M&A Integration." NEJM Catalyst (May 21, 2020).
      • 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
      Keywords: Pharmaceuticals; Rebates; Health Care and Treatment; Markets; Price; Analysis; Pharmaceutical Industry
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      Kakani, Pragya, Michael Chernew, and Amitabh Chandra. "Rebates in the Pharmaceutical Industry: Evidence from Medicines Sold in Retail Pharmacies in the U.S." NBER Working Paper Series, No. 26846, March 2020.
      • 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; Insurance Industry; United States
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      Gallani, Susanna, Mary Witkowski, and Harry B. Wolberg. "U.S. Commercial Health Insurance Industry." Harvard Business School Technical Note 119-064, January 2019. (Revised June 2019.)
      • 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
      Keywords: Beth Israel Deaconess; Lahey; Partners; Health Care; Hospitals; Payers; Providers; Anti-trust; Health Care Regulation; Mergers and Acquisitions; Health Care and Treatment; Market Design; Duopoly and Oligopoly; Negotiation; Consolidation; Competition; Health Industry; Massachusetts; Boston
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      Dafny, Leemore. "Beth Israel Deaconess: Consolidating to Strengthen, or to Stave Off, Competition?" Harvard Business School Case 319-026, October 2018. (Revised August 2019.)
      • 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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      Tseng, Phillip, Robert S. Kaplan, Barak D. Richman, Mahek A. Shah, and Kevin A. Schulman. "Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System." JAMA, the Journal of the American Medical Association 319, no. 7 (February 20, 2018): 691–697.
      • 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
      Keywords: Precision Medicine; Healthcare; Innovation; Cancer; Cancer Research; Health Care; Technology; Health Care and Treatment; Innovation Leadership; Disruptive Innovation; Entrepreneurship; Decision Choices and Conditions; Health Industry; Insurance Industry; Utah; United States; North America
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      Hamermesh, Richard G., Kathy E. Giusti, Robert S. Huckman, and Julia Kelley. "Intermountain Healthcare: Pursuing Precision Medicine." Harvard Business School Case 818-018, September 2017. (Revised February 2023.)
      • 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
      Keywords: Mergers and Acquisitions; Insurance; Health Care and Treatment; Health Industry; Insurance Industry
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      Dafny, Leemore S. "Good Riddance to Big Insurance Mergers." New England Journal of Medicine 376, no. 19 (May 11, 2017): 1804–1806.
      • 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
      Keywords: Surgery; Time-Driven Activity-Based Costing; Bundled Payments; Health Care and Treatment; Cost Management
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      Najjar, Peter, Matt Strickland, and Robert S. Kaplan. "Time-Driven Activity-Based Costing for Surgical Episodes." JAMA Surgery 152, no. 1 (January 2017): 96–97.
      • 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
      Keywords: Competition; Health Care and Treatment; Health Industry; United States
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      Dafny, Leemore S., and Thomas H. Lee. "Health Care Needs Real Competition." Harvard Business Review 94, no. 12 (December 2016): 76–87.
      • 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
      Keywords: Partners and Partnerships; Privatization; Acquisition; Foreign Direct Investment; Cross-Cultural and Cross-Border Issues; Business and Government Relations; Energy Industry; Austria; Romania
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      Roscini, Dante, Emer Maloney, and Daniela Beyersdorfer. "OMV Petrom: Investment as Partnership—When It Takes Three to Tango." Harvard Business School Case 716-035, October 2015. (Revised July 2017.)
      • March 2015
      • Teaching Note

      CVS Health: Promoting Drug Adherence

      By: Leslie John, John Quelch and Robert Huckman
      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
      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
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      John, Leslie, John Quelch, and Robert Huckman. "CVS Health: Promoting Drug Adherence." Harvard Business School Teaching Note 515-086, March 2015. (Email mking@hbs.edu for a courtesy copy.)
      • 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
      Keywords: Activity Based Costing and Management; Research; Health Care and Treatment; Health Industry
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      Kaplan, Robert S., and Mary L. Witkowski. "Better Accounting Transforms Health Care Delivery." Accounting Horizons 28, no. 2 (June 2014): 365–383.
      • 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
      Keywords: Health Care Delivery; Health Care Costs; Health Insurance; Health Insurance Marketplaces; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Private Sector; Public Sector; Decision Making; Information Technology; Health Industry; Insurance Industry
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      Herzlinger, Regina E., and Jo Ellen Slurzberg. "Note on Health Insurance Coverage, Coding, and Payment." Harvard Business School Background Note 313-042, August 2012. (Revised December 2023.)
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