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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.

The subject areas are business communication, human resource management and health care.

The case was designed for use in a first-year MBA-level course in business communication but would serve well in a course for executives or for advanced undergraduates. It might also be assigned in general management courses to evoke discussion on communication skills required in sensitive and critical situations; human resource courses; and course on health care.

Palliative care is a specialized medical care focussing on improving the quality of life of patients suffering from life-threatening illnesses. It addresses symptom management and psychosocial and spiritual concerns of the patient and its caregivers. With the intent to alleviate the sufferings of terminally ill patients, Rajbala Foundation, a non-government organization (NGO), works at the psychosocial and spiritual levels. While training their volunteers in effective palliative care communication, it often encounters challenges such as socio-cultural variations, organizational challenges, appropriate verbal and nonverbal communication, etc. This teaching case focuses on the communication challenges faced by the volunteers of Rajbala Foundation. It would lead to a broader discussion on communicating empathically during critical situations. The case has a focus on NGOs, and non-profit organizations, public sector management, health-care management and human resources management. There is significant literature on communication skills for medical practitioners in palliative care. As an increasing number of NGOs step in to provide the second level of care to critically ill patients in non-physical domains, there is a need to understand the role of effective communication for such care providers. This case deals with non-medical care providers in palliative care; the issues of communication they face as they interact with patients; and the skills they require to address the emotional and spiritual needs of patients and their families.

The aim of this case is to raise awareness of the complexities involved in the communication process during an emotional and sensitive interaction. It aims to encourage volunteers involved in palliative care to reflect on good communication practices when communicating with patients and family members. After reading this case, the students should be able to discuss the complexities involved in the communication process when communicating in situations with high emotional involvement; understand the core elements of emotional interactions for effective practice; and emphasize the need for the development of communication skills within palliative care.

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 6: Human Resource Management

The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

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

By working through the case and assignment questions, students will be able to conduct a marketing environmental analysis to aid strategic decisions; analyse the first-mover advantages of a retail firm and how these can be sustained; comprehend online retail business models and the challenges therein; understand the trade-offs of online/offline retail experiences specific to an emerging market’s beauty and personal care sector; conceptualize and formulate actionable growth strategies that balance the individual and collective requirements of brick and mortar and retail e-commerce environments.

The case is set in 2022, right after Nykaa – the pioneer of beauty and wellness e-commerce platforms in India makes a blockbuster stock market debut in 2021. Starting in 2012 with a disruptive online model for selling beauty and wellness products online in India, Nykaa had come a long way with expansions in physical retail and other segments such as fashion. The firm, which initially aimed to be a virtual store, is now thinking of aggressively expanding in the brick-and-mortar retail space as it opens its 85th retail outlet.

Falguni S. Nayar, founder and CEO of Nykaa, wanted to roll out 300 physical stores targeting 100 cities in India in the next couple of years. She aspired to establish Nykaa as a category leader as the “Indian Sephora” in the beauty and personal care market. Nykaa’s first-mover advantage in the online beauty and personal care marketplace worked well to establish it as a brand with positive endorsements by digital shoppers that enhanced the investment potential with potential financiers. However, the pandemic had brought every physical retailer to the online platform. Most e-commerce platforms dealing in grocery to lifestyle had added personal care products to their existing merchandise.

Additionally, several start-ups had ventured into the online marketplace. Online was a cluttered marketplace with little to no differentiation. In this bloodbath, would the first-mover advantage for Nykaa in the online space still count as a competitive advantage? Nayar was all set to expand Nykaa’s physical presence aggressively. The concern was that the beauty and personal care segment had also moved online as a function of long stay-at-home periods. In the post-pandemic times, would the customer indeed revert to brick and mortar once again? Nykaa was also into product formulations, but so was every big and small player in the space. What was the differentiated winning formula for the consumer’s heart and mind?

The case can be effectively used in foundation courses in marketing and a wide range of specialized courses on marketing management (core/foundation course), retail marketing and e-commerce/digital marketing and e-commerce for B-school learners. The complex decision points faced by an innovative e-commerce start-up firm on its road to market expansion make the case suitable for niche courses such as Marketing for Start-ups. Moreover, learners in executive MBA programs with considerable experience can benefit from the case analysis that balances a growing retail company’s long- and short-run objectives.

Teaching notes are available for educators only.

CSS 8: Marketing.

The case and discussion questions posed will allow the instructors the opportunity to introduce critical strategic concepts from strategic, nonprofit management and social enterprise literature. Specifically, (1) strategic transformation: countering drift and anticipating future trends and crises; (2) types of leadership: transactional versus transformational; (3) hybridity and mission drift; and (4) nonprofit funding models, the starvation cycle and the overhead myth.

Both primary and secondary sources have been used to prepare the case. The first two authors had the opportunity to interview Thomas Tighe, Direct Relief’s (DR) President and CEO in July of 2019. The interview lasted one hour and was transcribed by one of the authors and reviewed by the other two authors for accuracy. In addition, the authors conducted nonparticipant observations in DR’s headquarters in Santa Barbara (California). Given the longevity and media exposure of the organization, extensive internal and external archival data was also available for the analysis.

This real and undisguised case is based on DR, a +70-year-old humanitarian $1.2bn nonprofit organization headquartered in California (USA). From its headquarters in Santa Barbara, DR responds to emergencies and delivers medical support for vulnerable people affected by poverty, natural disasters and civil unrest in all 50 US states, six US territories including Puerto Rico and US Virgin Islands, and in more than 90 countries.

The case presents Thomas Tighe, DR’s President and CEO, reflecting in late 2018 on the transformation and growth that the organization had experienced since he started his tenure in 2000. Specifically, he is considering the most effective way to allocate an unrestricted recent cash donation. Should DR spend that money on traditional fundraising, reducing its efficiency rate, or should DR take a long-term approach and use the funds to build long-term capabilities? In addition, the case outlines the history and evolution of DR over its more than 70 years of existence, the CEO’s background and motivations, as well as a detailed description of the organization’s revenue portfolio. Students will have an opportunity to learn about a unique nonprofit named among “the world’s most non-for-profit organizations” by Fast Company; DR was also included in the Charity Navigator’s list of the “10 Best Charities Everyone’s Heard of.” In addition, in January 2009, DR was designated as a Verified-Accredited Distributor by The National Association of Boards of Pharmacy, which placed it as the first nonprofit to receive this designation to deliver prescription medicines to all 50 US states. Throughout Tighe’s tenure, DR had been lauded for its fundraising efficiency. The unique distinction to DR’s efficiency is its tradition of adopting new technologies and modern business practices for humanitarian purposes.

Students will learn how DR, under the leadership of Thomas Tighe, reinvented and reinforced the organization’s traditions to retain high levels of efficiency in the face of an ever-larger organizational scale, public scrutiny and demand for humanitarian support across the world. Students will witness many strategic and operational tenets that they may be more familiar with from the for-profit world. The case also will help students to understand the concept of hybrid organizations and different nonprofit funding models.

The case has been written to be used in graduate Nonprofit Leadership Management and Social Entrepreneurship courses. Given the scope and implications, the case could also be used on an upper-level strategy course. To maximize students’ learning, the case should be introduced halfway into the course after students have a solid understanding of what nonprofits are and how they operate. If students are not familiar with some of the concepts introduced in the analysis, the proposed readings will prepare them for a more fruitful discussion.

This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in project analysis for nonprofit organizations compared to for-profit companies and to highlight the unique issues relevant in a health care environment. Students must decide, based on cash flow analysis and nonfinancial factors, whether or not to propose a long-term acute care hospital (LTAC) project to the board of directors of the U. Va. Health System. Students must use the assumptions outlined in the case to create a cash flow analysis and then compute a net present value (NPV) calculation and internal rate of return (IRR) for the project. After assessing the base-case results and sensitivity analysis of the assumptions driving those results, students must decide if the project should be taken to the board of directors.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

After studying this case, the students should be able to: explain the importance of employee engagement; illustrate the role of the participatory management style in an organizational context; discuss why managers may use engagement practices to operate effectively in businesses to lead change and innovation; identify the critical success factors, barriers and outcomes of employee involvement in driving high performance; and discuss the dilemma faced by the managers in the emerging economies while driving the momentum of excellence in the long run.

This is a real case about a leading health-care service company located in the Middle East. The health-care organization’s name is changed to NOVA for reasons of confidentiality. The NOVA is an independent, public joint stock company created to meet the curative needs of the public health-care system in Middle East. The company introduced the Employee Suggestion Scheme named Minara in 2011 in a Federal Government decree, introducing innovation as a major pillar of management in 2013 with intent to encourage organizations build innovative solutions and pioneer initiatives and apply it effectively in services, processes and programmes. Making the Minara programme work in line with the national health agenda, Ms. Fatima who headed the Excellence and Innovation Department took the initiative of accelerating the innovative Programme (Minara). The case data were collected based on both primary and secondary sources. Although the case is based on the real data, it has been ammonised. The case describes the transformation of the innovation process at NOVA through the employee engagement programme (Minara) in meeting the disruptive challenges. This case addresses the challenges faced by the Excellence and Innovation manager who used effective employee engagement practices through the Employee Suggestion Programme in a creative way to bring about innovation in the health-care sector. The case outlines the dilemma faced by the Excellence and Innovation manager in bringing about innovation through the Employee involvement programme in the emerging economic scenario. The case will focus on the analysis of the different aspects of the issues pertaining to employee engagement, employee motivation and the framing of empowerment strategies to bring about innovation and continuous improvement through an effective employee suggestion programme. The case is intended to give budding managers an insight into innovation and employee engagement practices that impact performance in the organization.

This case will be suitable to be used in Human Resource Management and Management of Change and Innovation course at undergraduate and Master’s level.

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

The learning outcomes of this case study are as follows: Students will be able to comprehend and visualize the initial hiccups and operational hurdles faced by digital start-ups in an emerging market. Students will be able to evaluate the importance of digital marketing for promoting start-ups dealing with sustainable products in the service industry, thereby helping them to develop digital marketing strategies to organically promote a service. Students will be able to perform strategic positioning of a start-up based on perceptual mapping methodology. Students will be able to identify the various aspects for identifying and creating a viable business model. Students will be able to use Osterwalder’s business model canvas for identifying the important operational aspects of the start-up. Students will be able to visualize the entrepreneurial challenges in an emerging market.

This case study highlights the dilemma the protagonist, Prerna Prasad, faced in her travel start-up venture, Ecoplore. Ecoplore is an aggregator platform that onboards only eco-hotels. To the best of the authors’ knowledge, Ecoplore is India’s only platform that promotes and onboards only those hotels made up of mud, wood, bamboo, stone or any local architecture and that maintain at least 30% green space on their premises. Ecoplore has been recognized by the United Nations Environment Program for fulfilling Sustainable Development Goal 12 and has also been bestowed with the Gold Award by Indian Responsible Tourism Awards 2019. Prasad had already identified her target market. Prasad took conscious steps towards reaching her target audience, and her first step towards that was designing Ecoplore’s website. Being aware of the importance of content marketing, Ecoplore’s content was curated with fresh and quality write-ups, pictures, blog posts, etc. Ecoplore’s website was also optimized for mobile and desktop versions to deliver a great user experience. Features like easy navigation and the website's speed were also taken care of. Being active on social media platforms, Prasad made sure that the pages of Ecoplore across various social media platforms were well connected with her website. Despite doing so much, it was found that the number of visitors was few after a span of two years. Conversion on the website was low, which ultimately affected the return on investment. Prasad was befuddled as to why the conversions were low despite having a great website that was considered a window to the organization. She faced the challenge of reaching her target audience despite being present online. Upon detailed analysis, Prasad found that Ecoplore was showing up in the search engine research pages (SERP) in only a few keywords, meaning the keyword density was low. Also, the website lacked backlinks, which would eventually help them to rank high on search engine optimization (SEO). This means that Ecoplore will need to revisit its SEO strategy if Prasad wants to promote her organization organically. Now, to increase visibility and ranking on SERP, Prasad had two options before her; first, she could do it organically via SEO or through search engine marketing. She was keen to build the traffic organically, knowing its long-term benefits. As a marketer, what should be Prasad’s strategy? This case study can be used for class discussion purposes for the students pursuing the courses on digital marketing, SEO and digital marketing optimization.

This case study is suitable for students learning the fundamentals of digital marketing (basic and advanced) course, marketing management students and digital marketing workshops. The level of difficulty is medium. The knowledge pre-requirement is marketing management.

Teaching notes are available for educators only.

CSS 8: Marketing.