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This case builds on Regency Hospital Limited (A), which describes the struggles that the founder Dr. Atul Kapoor went through in setting up the hospital and the challenges he and his team faced. Regency Hospital Limited, a multi-specialty hospital in Kanpur, India, was founded in 1995. Case (B) examines the development and progress made at the hospital, and the way various issues that the hospital faced were dealt with. It also highlights what made the hospital successful. In the process, the case highlights issues on leadership, entrepreneurship, organizational culture, and management of change.

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.

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.

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.

Looks at the merger of two Chicago-based nonprofits that share similar missions and clientele, but have different strategies and capital structures. They also operate in the highly competitive job training/temporary work field, where organizational survival is at stake. Suburban Job Link is a fee-driven, largely commercial nonprofit, and STRIVE/CES is a philanthropic-based nonprofit dependent on grants and government for revenue. Explores alternatives to a merger and proceeds from merger discussions to post-merger outcomes.

To discuss strategic collaboration and alliances; how to get “more mission” through resource combinations; and how nonprofits compete in highly competitive industries.

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.

This case study would enable students to understand the concept, process and advantages of mergers and acquisitions as a growth strategy with respect to 1mg. Also, the students would be able to use the threats, opportunities, weaknesses and strengths matrix to map 1mg’s strengths, weaknesses, opportunities and threats.

This case study analyses the transformation journey of 1mg to Tata 1mg, one of the most trusted internet pharmacies in India. This case describes a small start-up that was launched in 2013 and had made many acquisitions since then. This case revolves around Tata Digital’s purchase of 1mg. The case starts out by explaining 1mg’s financial situation and why the company was acquired. This case study focuses on how the integration helped Tata Digital and 1mg realize their respective missions. Furthermore, the case study illustrates the benefits and difficulties of this integration.

This case study is basically aimed at postgraduate management students; it can be used in strategic management and health-care courses. Students can understand the concept of diversification and acquisition with the help of this case study. Students can also gain an insight into the organic and inorganic diversification as a growth strategy.

Teaching notes are available for educators only.

CSS 11: Strategy.

The case described the issues faced by a mid-sized Indian generic pharmaceutical firm, in its attempt to acquire a small unlisted Japanese generics manufacturer. It showcases the strong motivation of a successful emerging market pharmaceutical firm to expand into the developed market, buoyed by its cost competitiveness. The case presents an opportunity to discuss the trade-offs involved with most of the dynamic decisions in a cross-border acquisition, such as estimation of synergies and value, bidding, and financing the acquisition. The case may be used in programmes on valuation, and mergers and acquisitions.

India's diagnostics business valued at USD 10 billion was growing at 20% annually. Several players with different business models competed. Dr. Lal PathLabs, the world's largest histopathology centre led with a menu of 3,500 tests, 1,600 collection centres and 7,000 pick-up points. Its Initial Public Offer had been oversubscribed 33.41 times and the team at Dr. Lal PathLabs was excited about expanding its international footprint. Two overseas companies were incorporated in Netherlands and Nepal. Yet, there were enormous unmet needs in India alongside potential for public-private partnerships. Trade-offs over portfolio choice and regional versus international footprint needed thinking through.

The case offers a study of change management in the pharmaceutical industry in India.

The case is designed for undergraduate and postgraduate students to examine strategic decisionmaking in the context of mergers and acquisitions (M&As), firm capabilities and management practices. In particular, it has important pedagogical lessons for businesses eager to start operations in emerging countries. Students learn to recognize the unique nature of the pharmaceutical market and the factors affecting the demand and supply of drugs, including the economics of generics. The case can be discussed in one class session of approximately one-and-a-half to two hours duration.

In 2012, the pharmaceutical industry in India was undergoing dynamic changes. There was keen interest among MNC pharmaceutical giants to buy up Indian generic manufacturing companies since their revenues were drying up with the impending patent expirations of many blockbuster brand name drugs. Japan's Daiichi Sankyo's had taken over the largest Indian pharmaceutical company, Ranbaxy Laboratories, known for its heritage of process innovations and market leadership. However, after the acquisition, Ranbaxy slipped to third position in the domestic market and was facing multiple problems including net losses and falling share prices, cultural differences in management practices, recall of drugs from foreign markets and a US FDA ban on its manufacturing plants. Further, Ranbaxy had always been viewed as a national champion and a customer-friendly company but drug prices had increased after the merger causing problems of affordability. The new CEO of Ranbaxy was facing a dilemma: how to regain the company's position as the market leader. Students are asked to advise the CEO of Ranbaxy how to tackle the challenges arising from the integration of an Indian company with a Japanese company. More specifically, the case focuses on M&A as a strategy for growth and also touches on issues related to competition, regulation, innovation and corporate governance.

The case discusses the different motives behind the deal for Daiichi Sankyo and Ranbaxy and why it was a strategic move by both the alliance partners. The case also raises issues of corporate governance for the management of Ranbaxy and the need for a proactive corporate social responsibility (CSR) strategy. The case provides students with the opportunity to develop their analytical skills in a real-life setting and apply theoretical concepts to the consideration of the various issues raised by the acquisition deal.

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