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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.

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CSS 1: Accounting and Finance.

The area of focus is on organization strategies, specifically in developing appropriate strategies for business expansion in a situation of high economic uncertainties.

This case is designed for advanced undergraduate in the business and management programs and students in the MBA programs. It is suitable for courses of organizational management, organization theory and design, strategic management, and managerial economics.

At the end of 2009, Kumpulan Perubatan Johor Healthcare Group was the largest public-listed healthcare service provider in Malaysia, with revenues of RM1.5 billion (approximately USD0.5 billion) and a net profit after tax of RM115 million (approximately USD38 million). The country was experiencing economic downturn, which affected demands of the affluent as well as medical tourism segments, which were the targeted market of the company. Datin Paduka Siti Sa'diah Sheikh Bakir, the group's CEO and her management team realized that the company needed to seek a new growth strategy. The case stimulates a discussion on the future strategy of a high-growth healthcare company that aspired to be the leading healthcare player in the region.

Understanding the process of analyzing an industry, as well as formulating strategies, enables case analysts to extend the practice of making strategic decisions to many business situations.

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GE Healthcare was on a continuous lookout for investing into new and innovative super value products for the Bottom of the Pyramid markets in India. After launching its first successful super value ECG machine Mac 400, GE had recently launched its twenty-fifth super value product a PET CT machine. Serving the BOP markets has its own unique challenges that may be different for each product that is placed in the market. However, GE has so far successfully sailed through all the challenges and developed a steep learning curve about BOP markets. However, it is now facing the challenge of ensuring sustainability of product pipeline. The company is also keen to exploit the opportunities for reverse innovation that super value products have provided. The company also wants to assess the disruptive impact of these products in domestic medical device markets as well as markets outside India.

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.

International business, international marketing, and strategic management.

Advanced undergraduate and MBA students taking courses in international business, international marketing, and strategic management.

KPJ Healthcare Group started its operations in 1979. By the end of 2012, the Group operated 22 hospitals in Malaysia, two in Indonesia, one in Thailand, and one retirement resort in Australia. Its internationalization efforts began in mid-1990s with the provision of hospital management service in Indonesia, Bangladesh, and Saudi Arabia. Since 2010, the Group had pursued international acquisition projects in Australia, Indonesia and Thailand. In early 2013, the Group's newly appointed CEO and his management team had to decide on the strategies to ensure the success of these international acquisition projects. This case stimulates discussion on international strategies of a large healthcare group, operating in a highly competitive, high-growth industry in an emerging economy.

Understanding of approaches to service internationalization (incremental versus rapid), strategies in service internationalization, forms of service internationalization ventures will enable case analysts to apply and consider these concepts in many business situations involving internationalization process and business growth in general.

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Need for preventive health care: To comprehend the contribution of preventive health care in improving the health quotient. Sri Sathya Sai Sanjeevani Hospital (SSSSH) and its initiative is an apt example of the wonder which preventive care can bring in the context of rural health. Community participation: The case can be instrumental in showing the pathway to encourage community involvement in mainstream health by promoting the holistic model of SSSSH that understands mothers and children's health profile and needs, especially in the unreached rural segments of an emerging economy like India. Importance of healthy childhood: World Health Organization (WHO) promotes the school health programme to prevent health risks among children by inculcating healthy behaviours during childhood. The successful SSSSH model proves that it is implementable by integrating comprehensive health education modules in the existing institutions for medical care.

The challenge of a healthy childhood is inadequate availability and accessibility of quality care. Non-awareness of the parents is also a significant reason for the children who miss the benefit of a happy childhood. While much is planned by the Government and some part of it being executed, this case highlights the effectiveness of the maternal and child health programme executed by the Sri Sathya Sai Sanjeevani Hospital (SSSSH). This initiative fulfills the dire need of ensuring the preventive healthcare component leading to safe motherhood and safe birth of healthy children. Further, the case is also the culmination of pin-pointed innovative awareness activities such as school health screening and the Divine Mother and Child Health Program (DMCHP). It opens up the discussion on the current model of health care followed by SSSSH, Raipur, and its impact in the local areas to decide on its expansion across the country for nationwide implementation.

Bachelors in Business Administration, MBA, Executive MBA, Post Graduate Diploma in Healthcare Management

Teaching notes are available for educators only.

CSS 2: Built Environment.

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.

Marketing Management, Product & Brand Management, Entrepreneurship.

This case can be taught effectively to MBA/BBA students as part of Marketing Management, Product & Brand Management, Entrepreneurship.

The case talks about the marketing mix strategy of India’s fastest growing fast moving consumer goods (FMCGs) brand Patanjali, with a tremendous revenue growth rate of 100 per cent for the past five years, leaving major FMCG companies insomniac. Patanjali Ayurved Limited riding on Baba Ramdev’s brand equity positioned itself as an authentic Ayurved brand with ancient Indian roots. Patanjali’s product line ranges from healthcare, personal care, home care, to food and more. Patanjali’s products were priced 10-40 per cent lower than that of its competitors. Run by franchisees, Patanjali had a three-tier distribution system. These included Patanjali Chikitsalayas which were franchise dispensaries and clinics along with doctors, Patanjali Arogya Kendra which were health and wellness centres and Swadeshi Kendra, non-medicine outlets. The company has 15,000 exclusive outlets across India and plans to grow to 1,00,000 exclusive outlets by 2020. Patanjali amazed the world by achieving phenomenal success without spending much on advertising in its nascent stage. Recently Patanjali adopted the multinational corporation (MNC) style of advertising by hiring two top advertising agencies McCann and DDB Mudra to prepare the company for the next phase of growth. Patanjali diversified into various segments of the market, ranging from FMCG products, Ayurvedic medicines, Ayurvedic hospitals and a medical college. Patanjali plans to enter various categories of products including the beauty products segment to compete with major MNCs, the baby care segment to compete with Johnson & Johnson, and the sports segment to compete with Nike and Adidas. Patanjali as a brand has a strong positioning in the minds of consumers as a natural and Ayurvedic brand. Will Patanjali’s foray into so many diversified segments lead to a brand extension trap and confused positioning? Because Patanjali as a brand, solely rides on Baba Ramdev’s image, if Baba Ramdev ever finds himself at the centre of a controversy, will Patanjali’s brand equity take a hit? Will it affect the brand Patanjali? Even if Baba Ramdev does not get into any controversy, what will happen to the brand Patanjali when Baba Ramdev is no more? Who should be the next face of Patanjali? Can the brand survive without a face?

The case is designed to enable students to understand the following key learning points: The concept of marketing mix. Product mix, Promotion mix branding (especially “Person as a Brand”), customer-based brand equity (CBBE) model or brand resonance pyramid.

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 8: Marketing.

The case presents a significant amount of information on the outbreak of COVID-19 and the expected impact on the economy. Although the case is necessarily concise, several links are given to the online articles and video material on which the case is based. This allows participants to deepen their knowledge of the virus and their understanding of its likely economic impact. To frame the discussion, several philosophies, ranging from Libertarianism to Marxism, are lightly expounded. Readers will need to consider divergent ideas; the sanctity of human life versus the monetary value of a life; the hysteria evoked by COVID-19 deaths versus the placid acceptance of an annual 66,000 deaths by another disease – TB; and the differential economic impact of the virus across extremes of inequality. Perhaps, the key issue relates to the skewness in the death rate: Should young people’s livelihood be sacrificed for a few old people about to die anyway? The case also illustrates the essence of a dilemma – a situation in which a difficult choice has to be made between two or more alternatives, especially ones that are equally undesirable.

In March 2020, South African President Cyril Ramaposa ordered a 21-day national “lockdown” to enable and enforce social distancing in an effort to slow the spread of the COVID-19. Many other countries had already taken similar steps, but in a country with 43,000 murders annually, South Africa’s response to only 11 COVID-19 deaths and 1,071 cases was both rapid and harsh. Schools, businesses, social areas and parks were closed. Medical emergencies, essential services and weekly grocery shopping were the only permissible activities. Two weeks after lockdown, there were 1,845 cases and 18 deaths, a far cry from the predicted 30,000 cases and 300 deaths, estimated on the basis of the three-day doubling rate at the start of lockdown. Many businesses, pulverised by closure, daily wage earners and those fearful of losing jobs were hopeful that the lockdown would not be extended. In a country with immense inequality, how would the masses under the age of 65 years, already in poverty and now with their lives pulled apart by an imported disease of the wealthy, respond to extended social and economic deprivation followed by bailouts for business?

MBA and Executive Education

Teaching Notes are available for educators only.

CSS: 11 Strategy.

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