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This chapter assesses the doctrine of reasonable interchangeability through the lens of the US Department of Justice’s (DOJ’s) successful effort to enjoin the megamerger of two of the largest national insurance companies, Aetna and Humana. The DOJ focused its challenge on the companies’ Medicare Advantage business, arguing that it is a separate product market from original Medicare and the merger would substantially reduce competition in the market for Medicare Advantage in many geographic markets across the country. The case turned on whether there was reasonable interchangeability between original Medicare and Medicare Advantage in the eyes of consumers. The judge relied on both practical indicia of interchangeability, including evidence of how likely Medicare beneficiaries were to switch between Medicare Advantage and Original Medicare, along with econometric evidence. The decision provides a useful roadmap of how a knowledgeable judge reviewing a merger will consider both Brown Shoe factors and econometric evidence in assessing reasonable interchangeability.

IN THE SPRING OF 1989, PETER FISHER, A CLAIMS MANAGER AT AETNA LIFE & Casualty's Middleboro, Massachusetts, claim center, was about to witness a revolution. He didn't realize it at the time, however. He was too busy mollifying annoyed employees and peeved customers.

Healthcare industry, the largest sector of the US economy, is going through a dramatic transformation as the US economy recovers out of the current recession. In this chapter, we use data envelopment analysis, an operations research technique, to benchmark the performance of 12 publicly managed care organizations against one another for the period 2009–2011. We find that only 6 companies out of 12 are 100% efficient. We also identify the areas in which inefficient companies are lagging behind their efficient peers.

The first conference featuring presentations by line managers implementing reengineering was held in Orlando, Florida, in January by The Manufacturing Institute, a division of the Institute for International Research.

This chapter develops a productivity analysis of the New Jersey PPO Health Insurance Industry for 2018. The chapter concerns five New Jersey PPO insurance companies. The two output variables are claims paid and loss ratio. The two input variables include premiums collected and assets.

At the center of its core, Health Care is the application of a general body of knowledge to the needs of a specific patient. For centuries, this knowledge was generally regarded as the property of the healing professions and the individual clinician, not necessarily of the health care delivery organization. Managerial practice also had a tendency to treat this knowledge as an attribute of the provider, thus focusing on the resources clinicians used as they provided care and on the hotel-type functions associated with inpatient institutions. That is, there was a deliberate differentiation between management practice, focused on business processes, and clinical practice, focused on the activities and decisions of diagnosis and treatment. Though often described as bureaucratic and incrementally changing, health care is also a very dynamic and innovative field. Around the globe, research scientists, private industries, academics, and governmental and nongovernmental agencies continue to work in innovating new ways to provide better care, find cures, and improve health. At the same time, health care delivery has been undergoing a gradual but important change. Patient care, once the domain of the individual practitioner, is becoming the domain of the care delivery organization. Additionally, the mission of these organizations is shifting. As science, technology, care processes, and care teams have become more complex and diverse, the way in which the activities of care are organized and the institutional context in which they occur have become an increasingly important determinant of the effectiveness and efficiency of that care. As a result, the object of management has changed. In response to these changes, health care managers have started focusing on the management of the care as well as the management of the institutions in which the care takes place, thereby creating a set of ‘Best Practices’ which are briefly described in this paper along with how the process of innovation is developing in the health care system.

The purpose of this study is to understand how Amazon’s threat may impact the Pharmacy Industry as a whole and whether traditional drugstore chains such as consumer value stores (CVS) Pharmacy will need to re-think their business strategy, especially in the digital space, to account for potential disruption.

This is a hypothetical case study used as a teaching exercise to guide the learner through a decision-making process. The case starts by presenting a disruption in the retail pharmacy business that the main character must navigate by using real-world data and insights, provided in the case, to formulate a recommendation.

In an extremely competitive and consolidated pharmacy market, Amazon has the potential to change the business entirely. CVS Health will potentially face strong headwinds from Amazon’s PillPack and a downward trend in prescription sales. Regardless of the new competition, CVS Health continues to be innovative in the space. Instead of being a one-trick pony, CVS has encompassed the mentality of becoming a one-stop-shop by expanding into areas such as specialty pharmacy, health clinics, pharmacy benefits management and innovative digital capabilities.

This paper provides the reader with existing and known information about the evolving retail pharmacy business and allows the reader to interpret the new information to make their own decision on how a digital business strategy team can account for potential disruption.

This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies.

Viewpoint.

Fisher reports an increase in mobile and work-at-home jobs occurred in 2013. This trend is expected to continue as companies strive to be more competitive on a global scale. Service-oriented firms are not the only ones to benefit from supply chain flexibility strategies. Apple and Dell are both wildly successful and are considered highly flexible firms. One general complaint from all virtual workers is connectivity issues. This is inherent with the position. Locations in third world countries are more susceptible to online issues. If a constant source of electricity or internet availability is an issue, it goes without saying that workers’ productivity will be affected. So far, this potential downfall has not proven a major problem for companies. Will other companies follow the leader and begin using more remote access positions within their firms? If they value the knowledge from benchmarking, then yes. Rather they should, as long as they possess the needed resources.

The paper provides strategic insights and practical thinking that have influenced some of the world’s leading organizations.

The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

The purpose of this paper is to focus on “mindfulness” as an emerging wellness, performance, and leadership solution in business, and the role of human resources (HR) in effectively leveraging the potential value while minimizing the potential risks.

This paper reviews current research and current discussion of mindfulness in business, leadership, health, and management media, and provides recommendations for effective adoption.

Benefits of mindfulness practices include improved overall health and improved stress management for individuals and correlated benefits in productivity and performance of individuals, teams, and leaders. The potential risks of mindfulness include disengagement of non-participants and wasted investment if not integrated with company practices and culture.

This paper highlights the importance of aligning introduction of mindfulness with company practices and culture, ensuring voluntary participation, providing effective communication, and maintaining a secular nature of implementation.

This paper helps HR leaders leverage mindfulness for performance and wellness of individuals, teams and leaders.