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The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation.

Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy.

The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care.

Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation.

This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework.

The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

The learning outcomes are as follows: identify and evaluate the impact of risk factors for health-care organizations during crisis; evaluate the role of different organizational factors in building resilient health-care organizations; define organizational resilience in a health-care context; and apply the effect-strategy-impact resilience framework.

September 2022 found Ranjan Thakur, the Hospital Director at Manipal Hospital, Jaipur (MHJ) reflecting on MHJ’s resilience toward future health-care crises. MHJ was established in the capital city Jaipur of the Indian state of Rajasthan in 2014, as a 225-bed multispecialty unit of the nationally renowned Manipal Health Enterprises Ltd. As the Hospital Director, Thakur had been responsible for navigating his team and the hospital through the multiple health-care related challenges exacerbated by the multiple waves of the Covid-19 pandemic in a large Indian state with a sizable rural and semiurban population. Though Thakur and his team of doctors had worked through the vulnerabilities of their health-care ecosystem, mapping the risks and mitigating the same, Thakur asked himself if they had done enough. He wondered how a health-care institution such as theirs could sustain effective health-care delivery during future crises situations to deliver high-quality health care to the vulnerable communities. Had they effectively mapped MHJ’s vulnerabilities and built resilience into the hospital’s functioning? The backdrop of the case is public health in the state of Rajasthan (Jaipur), and the case is rich in detailing social factors such as behavior issues of patients, doctors and nurses; operational factors such as standardization of treatment and standard operating procedures, availability of resources, clinical concerns; leadership and management of the hospital through the pandemic. This case can be used by instructors to teach organizational resilience building in the health-care context.

Graduate- and executive-level courses in managing change during crisis in health-care context; health-care management/leadership.

Teaching notes are available for educators only.

CSS 7: Management Science.

The case is based on data collected from in-depth interviews, and from company, third-party and regulatory–agency documents. In addition to prior conversations over several years between the company founders and the lead case writer, there were several rounds of interviews in 2023 with the surviving founder and in-depth interviews with eight of the company’s key managers. Company documents reviewed included bylaws, organization charts, profit and loss statements and staffing statistics, all from founding to sale. Also reviewed were documents and evaluations of company operations and performance produced by the merger & acquisition firm that handled the company’s eventual sale. The company owner insisted on complete disguise of the company and all its members and prohibited disclosure of detailed proprietary financial data.

At the strategic level, this case is about how the unique, complex and changing healthcare environment created opportunities and threats to which a women-owned and run start-up company, Aloe Health (AH), had to respond to become and remain successful. At the personal level, the case illustrates what it takes for an entrepreneur and leader having clinical but no real business acumen to start, expand and turn around a company and ultimately position it for a successful acquisition, continually learning and adapting along the way.

The case describes how two women who were friends for many years started up a home healthcare company later in their lives and grew it into the largest women-owned business of its kind in the USA. Based in the Southwest USA, an area with many factors conducive to success, they navigated the many complexities of US Medicare regulations to create a fully-integrated home healthcare company providing unskilled personal care, medically skilled homecare and end-of-life hospice services to thousands of clients. The case provides background on the founders and the home healthcare industry context, and details the steps taken to start up and build the company into a fairly successful enterprise; one of the largest of its kind in the region. The (A) case ends with one of the founders facing a crisis brought on by the death of her co-founder and the revelation of some significant organization dysfunctions, leaving her unable to profitably exit the company and unsure of whether she would be able to turn things around. The students are tasked with making recommendations for what she should do next.

The (B) case brings events up to fall 2023, describing the steps the surviving founder took to transform her leadership style and the company’s systems and culture, and to navigate the due diligence process associated with preparing for an (ultimately very successful) acquisition. It also shares the owner’s “lessons learned,” and briefly notes the current state of the acquired company and the many AH employees that it continues to employ.

The case provides ample information for students to appreciate the company’s strategy and the challenges of operating in the highly regulated health care industry. However, it is probably even better suited to illustrating the “soft” issues of new-venture management, such as the tendencies of founders to overload themselves by micro-managing their growing venture and not adapting to expansion, and for those with clinical backgrounds to focus on caring for patients and employees while overlooking business essentials and organization systems. It also illustrates how business partnerships among strong-willed individuals can produce dynamics in the founding team similar to a “marriage,” with affection and complementary talents, yet also tensions. It further illustrates the process of a successful turnaround strategy, and the “due-diligence” challenges of preparing for an acquisition.

This case has a range of course applications at multiple education levels. Although it is probably best suited for graduate and executive-level programs, it can also be selectively used in undergraduate classes, particularly if populated by upperclassman. It is ideally suited to courses on entrepreneurship and on healthcare management. For an entrepreneurship course, it could be positioned mid-way through the semester, after covering topics relating to the entrepreneurial mindset, founding teams and business models. It can be used to get the class focusing on competitive issues and the challenges of starting up a company in a highly regulated environment, on entrepreneurial founding-team characteristics and management tendencies (e.g. micro-management control tendencies), on transition issues from start up to growth stages and on exit strategies.

We believe this case is also well suited as a teaching exercise for students pursuing healthcare management studies in baccalaureate and graduate programs (MBA, MHA, MHS) in which instructors wish to broaden student exposure to a real-world scenario that focuses on entrepreneurial behavior in a healthcare setting (a topic of increasing interest to healthcare practitioners and managers given the current trend toward provider formation and ownership of health facilities). Here, the case may be used to focus on the complexities of the healthcare industry, the key differences between various healthcare service business models and on the challenges that technically (clinically) trained professionals often face when trying to manage a healthcare business. Ideal placement of the case would be in a capstone course, after students have been introduced to their functional coursework in topics such as introduction to management, organizational behavior and leadership, financial management and strategic thinking. The case also challenges students to apply knowledge obtained in specialized coursework in healthcare systems and policy, industry regulation, as well as healthcare reimbursement methods.

The case also may be used in organization behavior courses to focus on team, cultural and leadership issues and in strategic management courses to focus on strategy implementation. In addition, there are enough family business themes in the case (even though Aloe is not actually a family business) to use it in a course on managing family businesses.

This case is designed to enable students to understand the role of women in artificial intelligence (AI); understand the importance of ethics and diversity in the AI field; discuss the ethical issues of AI; study the implications of unethical AI; examine the dark side of corporate-backed AI research and the difficult relationship between corporate interests and AI ethics research; understand the role played by Gebru in promoting diversity and ethics in AI; and explore how Gebru can attract more women researchers in AI and lead the movement toward inclusive and equitable technology.

The case discusses how Timnit Gebru (She), a prominent AI researcher and former co-lead of the Ethical AI research team at Google, is leading the way in promoting diversity, inclusion and ethics in AI. Gebru, one of the most high-profile black women researchers, is an influential voice in the emerging field of ethical AI, which identifies issues based on bias, fairness, and responsibility. Gebru was fired from Google in December 2020 after the company asked her to retract a research paper she had co-authored about the pitfalls of large language models and embedded racial and gender bias in AI. While Google maintained that Gebru had resigned, she said she had been fired from her job after she had raised issues of discrimination in the workplace and drawn attention to bias in AI. In early December 2021, a year after being ousted from Google, Gebru launched an independent community-driven AI research organization called Distributed Artificial Intelligence Research (DAIR) to develop ethical AI, counter the influence of Big Tech in research and development of AI and increase the presence and inclusion of black researchers in the field of AI. The case discusses Gebru’s journey in creating DAIR, the goals of the organization and some of the challenges she could face along the way. As Gebru seeks to increase diversity in the field of AI and reduce the negative impacts of bias in the training data used in AI models, the challenges before her would be to develop a sustainable revenue model for DAIR, influence AI policies and practices inside Big Tech companies from the outside, inspire and encourage more women to enter the AI field and build a decentralized base of AI expertise.

This case is meant for MBA students.

Teaching Notes are available for educators only.

CCS 11: Strategy

This case is mainly about the development journey of Tujia, a unicorn in China's accommodations-sharing sector, as well as the development status of the sector. On December 1, 2011, Tujia.com—China's first medium- and high-end vacation apartment booking platform—was formally launched, and it announced the first round of capital injection in less than half a year after its launch. It completed D and D+ round of financing on August 3, 2015, securing $300 million with an estimated value exceeding $1 billion. The completion of this financing round meant that Tujia formally entered the $1 billion club composed of “unicorn” Internet companies. In June 2016, it announced the strategic M&A of Mayi; in October 2016, it announced its strategic agreement with Ctrip.com and Qunar.com for the M&A of their apartment and homestay businesses. The completion of these transactions manifested the matrix with the four major platforms Tujia, Mayi, Ctrip, and Qunar. Since then, Tujia has become the absolute pacesetter in China's online accommodations-sharing sector.

Aster Retail (AR) is the retail pharmacy division of the Aster Dr Moopen's Healthcare (ADMH) Group. The group delivers healthcare services across the Middle East, India and the Far East, with a portfolio of hospitals, clinics, diagnostic centres and retail pharmacies. AR, under the leadership of Chief Executive Officer (CEO) Jobilal Vavachan, is well known for its people-centric approach, unique culture and innovative human resource (HR) practices. AR has won multiple awards for HR practices, service quality and business performance. In a recent corporate restructuring (2018), “Aster Primary Care” was carved out by combining the group's Clinics and Retail businesses. This case discusses the evolution of AR's HR journey and the challenges associated with integrating culturally diverse businesses without compromising the values of ADMH and its promise, “We'll Treat You Well.”

The learning outcomes of this case study are to understand the business-to-business (B2B) consumer outlook on mental health care in emerging markets; analyse the challenges faced in creating a need for mental health care in Indian workplaces; explore the business attractiveness of the B2B model and understand the business potential of the B2B segment at heyy,; and contemplate different innovative strategies that could change consumer mindset on mental health care in emerging markets.

Ankit, the founder and CEO of heyy, was facing a conundrum. “heyy,” was built on normalizing mental well-being at workplaces. His mental health-care app heyy, had crossed 50,000 subscribers within a few months of launch. The mobile app was designed to spread mental health awareness and provide various levels of mental well-being interventions. Business-to-consumer and B2B customer segmentation had been targeted by this start-up. The B2B space consisted of employees working with partner organizations. The adoption rates of employees using the features of heyy, declined after the initial app download. The employees had yet to fully become acclimatized to the features of heyy,. Exploring the business potential and investigating the business attractiveness of the B2B segment were the focus of the present study. Ankit contemplated various strategies he could adopt to increase user adoption of “heyy,” services by employees in his partner organizations. The case study strives to address the question – “What are the risks faced by organizations when entering the mental health-care industry in emerging markets like India, where mental health care is still not openly discussed?”

This case study is designed to be taught as part of the “entrepreneurship development” and “strategic management” courses for undergraduates, postgraduates and students of executive programmes in management. Students need to be aware of basic strategic management concepts such as BCG matrix, SWOT analysis and business canvas before working on this case study, so they could dissect the case from multiple perspectives to get a comprehensive outlook on the case.

Teaching notes are available for educators only.

CSS 11: Strategy.

The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

This case was developed via primary data collected from personal (one to one) interview with the CEO and founder of Dialogue in the Dark Malaysia (Dialogue Malaysia), Stevens Chan. With Stevens’ contact, the authors also conducted personal interviews with Kaye Chan (co-founder and wife of Stevens Chan), Lynn Foo (project manager since inception until early 2022) and Dr Foo Yin Fah (academic researcher in social entrepreneurship and advisor for Dialogue Malaysia). Secondary data included reports on visually impaired context in Malaysia, Dialogue Malaysia’s annual reports and online articles. Prior to the primary data collection, the authors obtained ethics approval from the University Human Ethics Committee (Project ID: 35461).

This case narrative focuses on Stevens Chan, a blind social entrepreneur who champions the empowerment of the disabled and marginalised community. Through a social franchising model, Stevens founded Dialogue in the Dark Malaysia in 2012. As a social start-up, Stevens showcases the strengths of blind and visually impaired individuals through transformative experiential encounters and reimagining future possibilities. Although there are constant challenges in securing financial and human capital, Stevens never lacks psychological capital, characterised by hope, self-efficacy, optimism and resilience. His vision is to educate society on the power of empathy (and not sympathy) and to create a holistic experience of celebrating diversity and inclusion through an innovative discovery centre, where the elderly and the disabled community (including the deaf, mute and those with mobility issues) share their lives with the public through fun activities. However, the future of this social enterprise is uncertain, and this case invites participants to embark on this journey with Stevens to uncover future pathways for growth and social impact.

The case is tailored for higher level undergraduates and entry-level and mid-level managers of executive education programs.

Case information was mainly acquired through interviews with Richard Gammans, chief operating officer. Dr Gammans was a visiting professor at Fayetteville State University for a year, and two of the case authors developed personal friendships with Richard. Interviews were conducted over a two-year period as the accelerator got started. In addition, one author conducted a team-building session with the management team and one of the bio-startup researchers. An interview was also conducted with Clayton Duncan, chief executive officer, to gain his agreement with developing the case.

The Accele website included a write-up on each of the pharmaceutical startup companies. The write-up included a company summary, description of the science (disease and cure), the size of the market, results from testing, regulatory considerations and intellectual property. A literature review was conducted as the basis for the information on the pharmaceutical industry.

This case is about a biopharmaceutical accelerator founded in 2011 by two senior executives with experience in both large pharmaceutical companies and running biotech startup companies. The founders were successful in raising capital to start their first venture capital fund which they used to invest in four biotech startups. All four startups were working in very different disease areas. For example, one developed a drug to help with hearing loss that the department of defense was funding. Another of the startups discovered drug candidates that attack antibiotic-resistant bacteria. Biopharmaceutical accelerators were relatively new. They differed from business incubators because they invest in the startups and provide operational support, but the degree of support provided varies across accelerators. The Accele BioPharma accelerator operated in virtual, network type of organization, and Accele BioPharma provided primary strategic and operational management for the startups. The challenge in this case is to identify how the leaders managed the virtual network, and what additional resources were needed so that the management team could expand their ability to assist startups to get drugs approved by the food and drug administration.

This case is suitable recommended for undergraduate/graduate strategy, undergraduate/graduate organizational behavior, entrepreneurship and health-care management courses.