Health Care
Health Care
Over the past several decades, HBS has built a foundation in health care research, from Clayton Christensen's application of disruptive innovations and Regina Herzlinger's concept of consumer-driven health care to Michael Porter's use of competitive strategy principles. Today our research focuses on
- how management principles and best practices from other industries can be applied;
- how the process of innovation can be improved;
- how principles of strategy and consumer choice can be utilized;
- how information technology can expand access, decrease costs, and improve quality;
- how new approaches in developing nations can impact global health.
Initiatives & Projects
The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.
Health CareSocial EnterpriseRecent Publications
Tepid Uptake of Digital Health Technologies in Clinical Trials by Pharmaceutical and Medical Device Firms
By: Caroline Marra and Ariel D. Stern
- May 2024 |
- Article |
- Clinical Pharmacology & Therapeutics
Digital health technologies (DHTs) can enable more patient-centric therapeutic development by generating evidence that captures how patients feel and function, enabling decentralized trial designs that increase participant inclusivity and convenience, and collecting and structuring patient-generated data for regulators to use in approval decisions alongside traditional clinical outcomes. Although a growing body of evidence has documented increasing use of DHTs in clinical trials overall, the use of DHTs in clinical trials supporting medical product development is unclear; here, we quantify the use of DHTs in clinical trials sponsored by pharmaceutical and medical device firms. Despite interest from pharmaceutical and medical device manufacturers in DHTs, we find tepid uptake of DHTs in trials by these sponsor types over time. Further, to date, these sponsors have most frequently used conventional, hardware-based technologies that have been available for many years (e.g., Holter monitors and glucose meters) rather than newer activity monitors, mobile apps, and other online-based tools that are frequently used by non-industry sponsors. Considering the recent and evolving nature of regulatory guidance around DHT use in clinical trials, our findings suggest that organizations pursuing product development still appear hesitant to incorporate DHTs in trials that provide the most critical evidence for regulatory review and impact how new products are used. This suggests there are likely additional opportunities for sponsors of regulated trials to incorporate (more) DHTs and patient-centric endpoints into product development clinical trials. However, additional regulatory clarity and efforts to reduce operational barriers may be needed in order to more fully capture these opportunities.
True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period
By: Julia C. Bulman, Nicole H. Kim, Robert S. Kaplan, Sarah Schroeppel DeBacker, Olga R. Brook and Ammar Sarwar
- May 2024 |
- Article |
- Journal of the American College of Radiology
The study used time-driven activity-based costing (TDABC) to estimate the costs to perform uterine artery embolization (UAE). Utilization times for patients undergoing outpatient UAE for fibroids or adenomyosis were captured from electronic health record timestamps and staff interviews. Capacity cost rates were estimated using institutional data and manufacturer proxy prices. Costs were calculated using TDABC for personnel, equipment, and consumables. The mean total cost of UAE was $4,267, with the greatest contributor being consumables (51%), followed by personnel (33%), and equipment (7%). Embolic agents accounted for 51% of consumable costs, followed by vascular devices (15%). The cost of embolic agents was driven mainly by the number of vials used.
Stemming the Ripple Effect of Untreated Mental Illness: A Prescription for Change: Reimagining U.S. Healthcare
By: Lidia Moura and Susanna Gallani
- April 29, 2024 |
- Editorial |
- Psychology Today (website)
Unleashing Human Magic at Best Buy
By: Leonard A. Schlesinger, Sunil Gupta and Amram Migdal
- April 2024 |
- Case |
- Faculty Research
The case examines the transformation of Best Buy under CEO Hubert Joly's leadership from 2012. Facing significant business challenges, including competition from online and physical retailers, Joly implemented the "Renew Blue" turnaround strategy, which focused on improving price competitiveness, enhancing the customer experience both in-store and online, partnering with major tech companies, and investing in employee training and engagement. The case further explores the development and execution of the "Building the New Blue" strategy, aiming to enrich lives through technology by addressing key human needs and expanding services such as in-home advisors and entering the health care market. The case highlights the approach Joly calls "Unleashing Human Magic," which focuses on the importance of aligning company purpose with employee motivation and customer needs to drive business growth and transformation.
Keywords: Change; Change Management; Transformation; Transition; Communication Intention and Meaning; Communication Strategy; Customer Focus and Relationships; Customers; Health; Digital Transformation; Digital Strategy; Job Cuts and Outsourcing; Labor; Leadership; Leadership Development; Leadership Style; Leading Change; Management; Management Practices and Processes; Management Style; Business or Company Management; Crisis Management; Mission and Purpose; Organizational Change and Adaptation; Organizational Culture; Outcome or Result; Failure; Success; Personal Development and Career; Strategy; Strategic Planning; Adaptation; Competition; Retail Industry; Minneapolis; Minnesota; United States
Market Dynamics and Moral Dilemmas: Novo Nordisk’s Weight Loss Drugs
By: Joseph L. Badaracco, Tom Quinn and John Schultz
- April 2024 |
- Case |
- Faculty Research
Danish pharmaceutical company Novo Nordisk was owned by a charitable foundation, and since its founding in the 1920s had focused on producing insulin to treat diabetes. In 2017, however, it released Ozempic, a diabetes treatment with the revolutionary side effect of safe, effective weight loss. As demand in the U.S. reached a fever pitch, Novo faced opportunities and challenges. The case covers the markets in which Novo could expand, the manufacturing shortfalls it faced, the competition that was expected to arise, and the moral issues that came with selling a product that affected so many people worldwide.
Keywords: Cost vs Benefits; Decisions; Judgments; Values and Beliefs; Global Strategy; Health Care and Treatment; Patents; Growth and Development Strategy; Growth Management; Product Positioning; Supply and Industry; Supply Chain; Corporate Social Responsibility and Impact; Mission and Purpose; Philanthropy and Charitable Giving; Opportunities; Social Issues; Equality and Inequality; Pharmaceutical Industry; Health Industry; Denmark; United States; Europe; China; India; Middle East; North Africa
Retailers and Health Systems Can Improve Care Together
By: Robert S. Huckman, Vivian S. Lee and Bradley R Staats
- March–April 2024 |
- Article |
- Harvard Business Review
Health systems are struggling to address the many shortcomings of health care delivery: rapidly growing costs, inconsistent quality, and inadequate and unequal access to primary and other types of care. However, if retailers and health systems were to form strong partnerships, they could play a major role in addressing these megachallenges. While some partnerships do exist, they are rare and have only scratched the surface of their potential. Rather than focusing on the direct-to-consumer model that retailers have largely employed, the partnerships should offer much broader care.
Drawing on real-world examples, the authors outline four key actions that retailers and health systems should take: (1) They must move beyond convenience to offer comprehensive care. (2) They should move care from clinics into the home. (3) They should leverage data to improve clinical care and the customer experience. And (4) they should change how—and by whom—health care work is done. Implementing these four actions would generate improvements that would benefit not just patients but also the organizations that pay for their health care.
A Machine Learning Algorithm Predicting Risk of Dilating VUR among Infants with Hydronephrosis Using UTD Classification
By: Hsin-Hsiao Scott Wang, Michael Lingzhi Li, Dylan Cahill, John Panagides, Tanya Logvinenko, Jeanne Chow and Caleb Nelson
- April 2024 |
- Article |
- Journal of Pediatric Urology
Backgrounds: Urinary Tract Dilation (UTD) classification has been designed to be a more objective grading system to evaluate antenatal and post-natal UTD. Due to unclear association between UTD classifications to specific anomalies such as vesico-ureteral reflux (VUR), management recommendations tend to be subjective.
Objective: We sought to develop a model to reliably predict VUR from early post-natal ultrasound.
Study Design: Radiology records from single institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. Medical records were reviewed to confirm diagnosis of VUR. Primary outcome defined as dilating (≥Gr3) VUR. Exclusion criteria include major congenital urologic anomalies (bilateral renal agenesis, horseshoe kidney, cross fused ectopia, exstrophy) as well as patients without VCUG. Data were split into training/testing sets by 4:1 ratio. Machine learning (ML) algorithm hyperparameters were tuned by the validation set.
Results: In total, 280 patients (540 renal units) were included in the study (73 % male). Median (IQR) age at ultrasound was 27 (18–38) days. 66 renal units were found to have ≥ grade 3 VUR. The final model included gender, ureteral dilation, parenchymal appearance, parenchymal thickness, central calyceal dilation. The model predicted VUR with AUC at 0.81(0.73–0.88) on out-of-sample testing data. Model is shown in the figure.
Discussion: We developed a ML model that can predict dilating VUR among patients with hydronephrosis in early ultrasound. The study is limited by the retrospective and single institutional nature of data source. This is one of the first studies demonstrating high performance for future diagnosis prediction in early hydronephrosis cohort.
Conclusions: By predicting dilating VUR, our predictive model using machine learning algorithm provides promising performance to facilitate individualized management of children with prenatal hydronephrosis, and identify those most likely to benefit from VCUG. This would allow more selective use of this test, increasing the yield while also minimizing overutilization.
Objective: We sought to develop a model to reliably predict VUR from early post-natal ultrasound.
Study Design: Radiology records from single institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. Medical records were reviewed to confirm diagnosis of VUR. Primary outcome defined as dilating (≥Gr3) VUR. Exclusion criteria include major congenital urologic anomalies (bilateral renal agenesis, horseshoe kidney, cross fused ectopia, exstrophy) as well as patients without VCUG. Data were split into training/testing sets by 4:1 ratio. Machine learning (ML) algorithm hyperparameters were tuned by the validation set.
Results: In total, 280 patients (540 renal units) were included in the study (73 % male). Median (IQR) age at ultrasound was 27 (18–38) days. 66 renal units were found to have ≥ grade 3 VUR. The final model included gender, ureteral dilation, parenchymal appearance, parenchymal thickness, central calyceal dilation. The model predicted VUR with AUC at 0.81(0.73–0.88) on out-of-sample testing data. Model is shown in the figure.
Discussion: We developed a ML model that can predict dilating VUR among patients with hydronephrosis in early ultrasound. The study is limited by the retrospective and single institutional nature of data source. This is one of the first studies demonstrating high performance for future diagnosis prediction in early hydronephrosis cohort.
Conclusions: By predicting dilating VUR, our predictive model using machine learning algorithm provides promising performance to facilitate individualized management of children with prenatal hydronephrosis, and identify those most likely to benefit from VCUG. This would allow more selective use of this test, increasing the yield while also minimizing overutilization.
Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity
By: Mitchell Tang, Rebecca Mishuris, Lily Payvandi and Ariel Dora Stern
- March 2024 |
- Article |
- JAMA Network Open
Importance: The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient–care team communication.
Objective: To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.
Design, Setting, and Participants: In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.
Exposure: Patient race and ethnicity.
Main Outcomes and Measures: Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.
Results: A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, −5.34 to −2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.
Conclusions and Relevance: The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.
Objective: To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.
Design, Setting, and Participants: In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.
Exposure: Patient race and ethnicity.
Main Outcomes and Measures: Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.
Results: A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, −5.34 to −2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.
Conclusions and Relevance: The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.
Medicare Price Negotiation and Pharmaceutical Innovation Following the Inflation Reduction Act
By: Matthew Vogel, Pragya Kakani, Amitabh Chandra and Rena M. Conti
- March 2024 |
- Article |
- Nature Biotechnology
The Inflation Reduction Act (IRA) requires Medicare to negotiate lower prices for some medicines with high Medicare spending. Using historical data from public and proprietary sources to apply the IRA's negotiation criteria retrospectively, we identify all drugs that met the eligibility criteria from 2012 to 2021 to classify drugs that would have had a negotiated price in effect in 2022 and to calculate associated decreases in industry revenues. Our results suggest that the IRA's reduction in overall industry revenue will be modest, will not affect most top-selling drugs and will not likely result in large-scale defunding of research and development. Changes in the net present value of drug-development projects will be concentrated in medicines where Medicare is a notable purchaser and where the ratio between expected revenue and development costs was only marginally positive before the IRA. Policymakers considering narrowing or expanding the scope of Medicare negotiation should carefully consider the tradeoffs across medicines with diverse characteristics.
Cicely Saunders and the Modern Hospice Movement: A Brother's View
By: Amar Bhide and Srikant M. Datar
- 2024 |
- Working Paper |
- Faculty Research
This Case history describes the role of Dame Cicely Saunders (1918- 2005) in
shaping the modern hospice movement. It is narrated in the first person through the words of her
brother, Christopher Saunders (1926-2024) as told to one of the authors of this paper.