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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.

Entrepreneurship.

The case has been used at Master's level but it has direct application to any MBA programme or entrepreneurship module.

Adrian Gore started Discovery in 1992 with seed-funding of R10 million from merchant banking group, Rand Merchant Bank (RMB), as a health insurance company within the RMB stable. By 2009, Discovery had become a large, listed, financial services institution employing more than 5,000 people and comprising not only Discovery Health (DH), but also Discovery Life (DL), Discovery Invest (DI) and Discovery Vitality (a wellness programme). In addition, it had operations in the USA, where it licensed Vitality for use by employers and other health insurers, and in the UK where it operated two joint ventures with The Prudential plc – Pruhealth and Prulife.

To understand the similarities and differences between corporate and start-up entrepreneurship; to understand the entrepreneurial process within an established organization; to explore the environment within an established company in terms of how much it supports or constrains entrepreneurship; and to look at creative ways to overcome obstacles to entrepreneurship in established companies.

Teaching notes.

After a successful transition from a projects-based IT business services company to a platform-driven analytics company, Saama's core leadership team gathered in 2017 to brainstorm the next phase of its growth. The year before, the team had decided to narrow its target market to the life sciences vertical. Saama now had to decide how to execute on this focused strategy by choosing a growth pathway within the life sciences vertical. Saama's leadership team was considering three alternatives: acquiring new customer accounts, developing existing customer accounts, or developing new products by harnessing artificial intelligence (AI) and blockchain technologies. The team had to evaluate these growth pathways in terms of both short- and long-term revenue potential, as well as their potential for sustaining Saama's competitive advantage.

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process.

This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources.

Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it?

This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

The purpose of this case study is to illustrate how Dianne Savastano, founder and CEO of Healthassist, Inc., a US-based health-care advocacy firm, successfully led her clients and team through the COVID-19 pandemic of 2020. To gather the data for this case study, the authors interviewed the protagonists, the members of her team and two clients. The authors read Healthassist Newsletters and the firm’s documents; and in fact, they included one Newsletter and several documents in the Exhibits of the case study. The authors conducted a literature review for articles in newspapers and journals about the newly developing field of “health-care advocacy,” a field which Savastano helped to create.

The authors illustrate how Savastano, using the five practices of exemplary leadership by Kouzes and Posner, in The Leadership Challenge, led her team through the pandemic of 2020. This is a story of a woman leader, using traits such as warmth, empathy, analysis and decisiveness, keeps her small business afloat when so many other firms collapsed in 2020.

The authors conducted seven interviews and literature searches on the topics of health-care advocacy; women leaders; leading through a crisis; and COVID-19.

The case study illustrates how a woman founder and CEO can lead her firm through a crisis.

This is an example of how a woman leader managed through the 2020 pandemic.

CSS 3: Entrepreneurship

The case on Moodcafe captures the journey of the start-up and its entrepreneurs from the beginning till the fund-raising stage. The case brings forth critical decisions that each entrepreneur or the team of co-founders have to address during their start-up journey. This short case gives opportunity to delve into two aspects mainly a) As a founder, which investor should one choose for seeking funds and what should be the terms and conditions of investment? and b) How can one review and assess the business model of a start-up?

Corporate social responsibility, specifically nonprofit business collaborations from a nonprofit’s perspective.

Graduate level programs in nonprofit management, corporate social responsibility and development management; it can also be used for executive education.

Social enterprises and nonprofits at present increasingly look to corporate firms for grant funds to finance their activities and assets. This case features the experiences of one of the largest nonprofit eye care providers in India, LV Prasad Eye Institute based in Hyderabad in accessing corporate financial support in the form of corporate social responsibility funding. The case deals with the organization challenges, stresses and strains that arise in a nonprofit–corporate partnership. Specifically, it focuses on the strategic and operational challenges that emerge from the partnerships. The partnerships reviewed in the case pertain to rehabilitation.

After solving the case, the participants will be able to understand the stages in developing collaborations between nonprofits and businesses for corporate social responsibility. They will also be able to understand the internal implications for nonprofits operations and strategy from such collaborations.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS11: Strategy.

The broad teaching objective is underpinned by the themes of purpose and partnerships. This is taught through application of business model innovation for sustainability where the value proposition is broadened to social and environmental, and multi-stakeholder partnerships in a time of crisis. Students will be expected to analyse the above concepts through a meso (sustainable value), micro (business models) and macro (ecosystems) lens. Upon completion of the case study discussion, successful students will be able to better understand the three features that support sustainable value, explore how a global pandemic can create new business models and partnerships to create social value and analyse how business ecosystems operate against the 6 C framework.

Discovery Holdings Limited is a leading financial service organisation in South Africa, and its Digital Health division is responsible for the platform which delivers telemedicine offerings to doctors and patients. The case highlights the development of the telemedicine offering and the period that is covered spans from the launch of the Discovery DrConnect platform in 2017 to April 2020. Adrian Moss is the protagonist in the case. He is a manager in the Special Projects, Digital Health team of Discovery Health, responsible for the DrConnect project. His challenge is how to raise more awareness of the DrConnect offering and how to enhance uptake from doctors and patients. COVID-19 and the lockdown in South Africa in March and April of 2020 presented an opportunity for both doctors and patients to use telemedicine as a new way of engagement and treatment.

This case is appropriate for masters, MBA and executive education students focusing on the fields of study of environment of business, strategy, business model innovation and social entrepreneurship.

Teaching Notes are available for educators only.

CSS: 11 Strategy.

The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions.

The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information.

Graduate capstone course in a finance course; masters in health administration; and/or the MBA program.

While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.

Human resources (compensation, total rewards, employee engagement, training and development), strategy.

Undergraduate HRM majors and postgraduate business and management.

This case highlights the strong growth and expansion of a former small to medium-sized enterprise (SME) in the United Arab Emirates, Tips & Toes. The company is a leader in the beauty and fitness service industry, and much of its growth and success is attributable to the leadership of its general manager and her implementation of a differentiation strategy, a market innovator in concepts, products and services, and a total rewards system for engaging and retaining employees. Tips & Toes is planning for continued, aggressive growth and expansion over the next five years. This case also highlights an underrepresented area of focus for case studies: women-led businesses, SMEs, and entrepreneurship and innovation.

The main focus of this case is for students to examine the beneftts of using a total rewards strategy to engage and retain employees, and more importantly to see the links between such a strategy and business and revenue growth. This is particularly a salient learning point for students in emerging markets, where more traditional types of compensation and views of the employment contract tend to prevail. In addition, this case could be used as a supplementary learning experience regarding strategy and strategic focus of an organization (i.e. the Treacy and Wiersema model of product leadership, customer intimacy, or operational excellence as a strategic discipline for a firm). And finally, this case provides an example of a woman-led organization which grew out of SME status into a market leader; this example provides students with insight into workable entrepreneur opportunities to which they might not see a direct linkage when reading case studies of large multinational organizations or conglomerates.

Teaching notes are available; please consult your librarian for access.