Search results

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor customer service, Key State's executives decided to invest heavily in service improvement, eventually achieving superior levels. Key State's high-quality customer service emerged as a true competitive advantage for its customers, who were primarily businesses and health benefits consultants who influenced corporate purchasers of health insurance. The Key State brand came to be synonymous with personal service, security, choice, and dependability. But the health care insurance market was changing under Key State's feet. Spiraling costs meant that high-quality service became less of a competitive advantage as employers were lured by low-cost, low-service providers. Many employers cut or dropped health care benefits entirely, swelling the ranks of the under- and uninsured, who in turn were extremely price-sensitive when shopping for health insurance on their own. Finally, the health care insurance market was being revolutionized by financial institutions willing to hold health benefit accounts and pay providers directly, thereby eliminating the need for Key State as a mediator. Key State executives were aware of these changes but were challenged by the mindset, culture, and organizational design custom-fit to their business accounts. The case asks the reader to consider whether Key State has the right number of target markets, whether it should have one brand or several for its different target markets, what it should do for the uninsured, and how it should improve its brand experience in light of the industry's changing landscape. All of these decisions will have significant implications for the organizational design of Key State.

To better understand the challenges involved in a successful health insurance company to cope with a rapidly changing and unpredictable environment; to formulate a new strategy and a new organizational design to accomplish this adaptation.

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

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 case is particularly well suited to entrepreneurship, marketing, technology, innovation, or strategy courses.

This teaching case is aimed at postgraduate students in management or business programmes.

This case follows the Kenyan healthcare tech company Savannah Informatics as they contemplate how the company will continue to grow in a post-pandemic world. Savannah is the market leader in electronic claims validation solutions for the Kenyan healthcare system. Their flagship product, the digital platform Slade 360, allows health insurers, healthcare providers, and patients to share claims information for health services in real time, drastically reducing payment transfer times, incidents of fraud, and account errors. The Covid-19 pandemic and the subsequent lockdown mandates from the Kenyan government have reduced short-term revenues by driving down hospital visits for citizens overall, but they have also created a demand for telemedicine and more online healthcare solutions. CEO John Muthee and his co-founders are left to consider their options for growing Savannah Informatics: expanding into new markets, creating more solutions for their insurance and provider customers in Kenya, or diversifying.

Identify the key challenges facing Savannah

Analyse the organisation using the 5Cs model (company, customers, competitors, collaborators and context) and VRIO (value, rarity, imitability, and organisation) analysis

Assess the growth opportunities available to Savannah and make recommendations

Students will have the opportunity to learn about differentiation strategy, business plans, strengths, weaknesses, opportunities and threats analysis. The primary objective is to allow students to evaluate Abhishek Singh’s decisions. After working through the case and assignment questions, students will be able to: understand the competitive landscapes in the Indian insurance broking market. Differentiate between selling and marketing. Understand the importance and application of differentiation strategy in the Indian insurance broking market. Emphasize the importance of value proposition in developing a competitive advantage for insurance broking organization. Critically analyze the internal strength and weaknesses of an insurance broking company.

RHIBPL, one of India’s largest insurance broking companies, operating for more than 12 years and has had a strong presence in eight major cities of India. RHIBPL had been known for life insurance, non-life insurance like cars, two-wheelers, Mediclaim and health. RHIBPL’s unique selling proposition was the best fit for each product and service after understanding the customer’s need. On October 16, 2020, Abhishek Singh, CDO at RHIBPL, was preparing for an upcoming management meeting on the company’s vision “to be the largest insurance provider in the country and to reach US$ 140 million by 2025,” which was communicated by the Ajay Bansal, founder and chief executive officer of RHIBPL. Singh had to prepare an action plan to achieve the RHIBPL’s vision. He had to develop and implement a differentiation strategy to achieve the RHIBPL’s vision from the available resources. How can he create a competitive advantage for RHIBPL in the highly competitive insurance broking market?

The case delineates the challenges facing an insurance broker company to achieve its new corporate vision. This case can be discussed in undergraduate and postgraduate courses (at the introductory level) in the business management discipline to understand the importance and application of differentiation strategy and competitive advantage. This case can also be significant for insurance-related courses for postgraduates and executives working in the insurance industry. The case can be useful for the courses on services marketing, strategic management, strategic marketing management and marketing management.

Teaching notes are available for educators only.

CSS 8: Marketing.

Organisational behaviour; Leadership; Organisational development; Public–Private partnership; Health care management; Public health.

Masters students in Business Administration, Post Graduate Diploma, Clinical Training of Medical Professionals, Health Leadership Programme.

Prof Jannie Hugo, the protagonist in the case, was considering his dilemma of aligning the multiple partners involved in public health care. A high level of collaboration was required of a multitude of stakeholders in developing the Daspoort clinic into a pilot site for the Tshwane district’s implementation of the National Health Insurance system. In addition, the re-engineering of primary health care with the focus on the patient and community orientated approach were launched on this site.

Gaining insight into international and national landscapes and principles of health care systems. Critically analyse the role of technology in delivering innovative health and social services. Present judgment of Prof Jannie Hugo’s contextual leadership effectiveness in enhancing collaboration between the multiple stakeholders and recommend next steps.

2 × DVDs on Vimeo, Slides and teaching plan with discussion or exam questions with model answers.

CSS 7: Management Science.

Impact investing, Social entrepreneurship.

MBA, EMBA, Executive Education.

CareCross Health describes the impact due diligence leading up to an investment into CareCross Health by impact investor Palm Capital. The case follows the protagonist, Caitlin Stevens, CEO of Palm Capital, as she identifies CareCross Health as a potential investment target, performs an initial screening of the company and visits the company and its sites as part of an in-depth impact due diligence.

By the end of this case, the student should be able to consider the critical steps associated with conducting an impact due diligence; understand the challenges associated with conducting an impact due diligence, with a particular focus on due diligence in an emerging market scenario; analyse a potential impact investment, in this case CareCross Health, and make a preliminary recommendation on whether the investment is viable from an impact perspective; identify the trade-offs between private sector and public sector provision of services to low-income groups, and consider unintended consequences in analysing the impact of a social enterprise; and prepare possible scenarios and weigh the potential outcomes of various arrangements to ensure alignment of investor objectives.

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

CSS 1: Accounting and Finance.

International business/International marketing.

Courses: the case is directly related to courses on “International Business” and “International Marketing” in the Master of Business Administration programme.

Training programmes: management development programmes for working executives, on the topics “Business across borders”, “Business stabilization in foreign markets”.

In 1999, the liberalization of the insurance sector as per the recommendations of the Malhotra committee gave way for privatization and foreign firms entered this sector through joint ventures. The business growth, which was enjoyed by these firms from 1999 to 2008, was tremendous. The growth percentage started declining following the global economic downturn in the capital markets. This situation compelled the insurance firms to re-look into their business strategy. On one hand whatever growth they had, 80 percent of it was through unit linked insurance plans depending on the capital market. On the other, it was identified that in a country like India the untapped market potential was among the rural millions. Reaching those people who are at the bottom of the pyramid necessitated a completely new business model to be developed as the need of the hour. The take stock of the position at this vnjuncture is the crux of the present case study, which envisages finding out alternative delivery models to suit the Indian rural market taking into account the intrinsic nature of life insurance and the basic living styles and mentality of the rural folk.

After discussion and analysis of this case, students will be able to:

• understand how market culture in a target country differs from that in the home country;

• appreciate how challenges in a developing country market have their own unique features to be understood;

• identify various courses of action and evaluate them on the basis of the host country factors;

• understand the “international planning process”; and

• appreciate how important it is for a country manager of a multinational firm to plan and execute the marketing mix suited to the inherent qualities of the target market.

understand how market culture in a target country differs from that in the home country;

appreciate how challenges in a developing country market have their own unique features to be understood;

identify various courses of action and evaluate them on the basis of the host country factors;

understand the “international planning process”; and

appreciate how important it is for a country manager of a multinational firm to plan and execute the marketing mix suited to the inherent qualities of the target market.

Teaching notes.

In March 2007 C. James Prieur, CEO of insurance provider Conseco, was faced with a crisis. The front page of the New York Times featured a story on the grieving family of an elderly woman who had faithfully paid for her Conseco long-term care (LTC) policy, only to find that it would not pay her claims. Her family had to pay for her care (until her recent death), which unfortunately resulted in the loss of the family business. The family was now very publicly pursuing litigation. For a company that depended on thousands of employees, investors, and independent agents who sold the insurance plans, this reputational risk was a serious threat. On top of this immediate crisis, all signs in the industry were pointing to the fact that the LTC business itself was not viable, yet over the years Conseco had acquired a number of LTC insurance providers. Students are asked to analyze not only what Prieur’s priorities should be in addressing the immediate crisis but also the risks inherent in the LTC industry and how this might affect Conseco’s success as a business moving forward

After reading and analyzing the case, students will be able to:

• Analyze the risks in the long-term care insurance industry

• Distinguish the various types of risk that caused a company’s crisis and recognize the potential for contagion

• Brainstorm how the risks faced by Conseco could have been avoided or better contained

• Recommend the first steps C. James Prieur and the Conseco leadership team should take to rectify the New York Times article crisis

Analyze the risks in the long-term care insurance industry

Distinguish the various types of risk that caused a company’s crisis and recognize the potential for contagion

Brainstorm how the risks faced by Conseco could have been avoided or better contained

Recommend the first steps C. James Prieur and the Conseco leadership team should take to rectify the New York Times article crisis

A midsize community hospital must choose a strategy to compete with an expanding regional rival. The strategy, focused on acquiring patient volume, includes expanding investment into integrated care, setting the reimbursement structure for revenue collection, and moving to a capitation-based payment system. The case presents an evaluation of revenue models to select that which best supports a given business strategy.

This case is designed to introduce a health care audience to financial analysis. It provides a straightforward introduction to hospital financial-statement ratio analysis and hospital operating statistics, so it can also serve to introduce any audience with a business or medical background to hospital finance.