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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 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.

Aster Retail (AR) is the retail pharmacy division of the Aster Dr Moopen's Healthcare (ADMH) Group. The group delivers healthcare services across the Middle East, India and the Far East, with a portfolio of hospitals, clinics, diagnostic centres and retail pharmacies. AR, under the leadership of Chief Executive Officer (CEO) Jobilal Vavachan, is well known for its people-centric approach, unique culture and innovative human resource (HR) practices. AR has won multiple awards for HR practices, service quality and business performance. In a recent corporate restructuring (2018), “Aster Primary Care” was carved out by combining the group's Clinics and Retail businesses. This case discusses the evolution of AR's HR journey and the challenges associated with integrating culturally diverse businesses without compromising the values of ADMH and its promise, “We'll Treat You Well.”

Milaap is a popular medical crowdfunding platform in India, enabling interaction between those who want to raise funds and those who want to donate. To achieve the critical mass Milaap had to increase the trust among the donors and ensure a higher success rate of the campaigns. Milaap provided two types of services: Do it Yourself (DIY), and Supported Campaign (SC). Milaap charged 5% of the raised amount from the DIY campaigns and 15% of the raised amount from the SC. Overall the chances of success were high in the SC. The case explores the dilemma of type of service to be prioritized.

This case is mainly about the development journey of Tujia, a unicorn in China's accommodations-sharing sector, as well as the development status of the sector. On December 1, 2011, Tujia.com—China's first medium- and high-end vacation apartment booking platform—was formally launched, and it announced the first round of capital injection in less than half a year after its launch. It completed D and D+ round of financing on August 3, 2015, securing $300 million with an estimated value exceeding $1 billion. The completion of this financing round meant that Tujia formally entered the $1 billion club composed of “unicorn” Internet companies. In June 2016, it announced the strategic M&A of Mayi; in October 2016, it announced its strategic agreement with Ctrip.com and Qunar.com for the M&A of their apartment and homestay businesses. The completion of these transactions manifested the matrix with the four major platforms Tujia, Mayi, Ctrip, and Qunar. Since then, Tujia has become the absolute pacesetter in China's online accommodations-sharing sector.

In early 2014, recent Stanford University graduate Tyler Shultz was in a quandary. He had been working at Theranos, a blood-diagnostic company founded by Elizabeth Holmes, a Stanford-dropout wunderkind, for almost a year. Shultz had learned enough about the company to realize that its practices and the efficacy of its much-touted finger-prick blood-testing technology were questionable and that the company was going to great lengths to hide this fact from the public and from regulators.

Theranos and Holmes were Silicon Valley darlings, enjoying positive press and lavish attention from potential investors and technology titans alike. Just as companies like PayPal had revolutionized the stagnant payments industry and Uber had upended the for-hire transportation sector, Theranos had been positioned as the latest technology firm to substantially disrupt yet another mature sector: the medical laboratory business. By the start of 2014, the company had raised more than $400 million in funding, and had an estimated market valuation of $9 billion.

Shultz's situation was exacerbated by the fact that his grandfather, the highly respected former US Secretary of State George Shultz, was on the Theranos board and was one of Elizabeth Holmes's biggest supporters.

But Tyler Shultz worried about the customers he was convinced were receiving highly unreliable and often inaccurate blood-test results. With so much at stake, Shultz wondered how he should proceed. Should he raise his concerns with the firm's investors? Blow the whistle externally? Report to industry regulators? Go away quietly?

This case and its subsequent four brief follow-up cases are based largely on interviews with Tyler Shultz, and outline the dilemma he faced and the various steps he would take both to extricate himself from his unsavory position and let the public know the full extent of the deception at Theranos.

Five optional handouts are available to instructors to further discussion after the case has been debriefed. The handouts serve as additional decision points for the students if your class time permits.

The information used in the case study was obtained from secondary sources, such as internal documents, reports, news, and organization websites. Three of the four authors played a hands-on role in the case.

The COVID-19 pandemic exacerbated the global challenge of hiring and retaining health-care workers. To address its own challenges, Mayo Clinic decided to fundamentally transform its 30-year-old tuition assistance program: from a model centered on the premise that tuition assistance was an employee benefit for professional development purposes, to one that was more driven to meet the business needs of the employer by preparing internal talent for important roles throughout the institution. Herein, this case study first describes how the COVID-19 pandemic impacted health-care organizations like Mayo Clinic. Next, this study provides details on the original employee tuition assistance program, and then, focuses on the reasons for its need to be changed. Afterward, this study introduces the new tuition assistance programs. Finally, this study follows with examples of how both Mayo Clinic and its employees navigated through initial challenges, such as resistance to change and lack of engagement. In sum, this case study provides critical insight into designing workforce education programs that provide professional development for meeting the workforce needs of the organization.

This case can be used as teaching material in relevant undergraduate- and MBA-level courses, such as human resource management, human resource development and compensation and benefits. This case allows students to critically analyze workforce education programs (e.g. tuition assistance programs) and to plan how to strategically align those with the workforce needs of the organization.

The learning outcomes of this case study are to identify the role of non-governmental organizations (NGOs) in social upliftment of developing countries, understand the functioning of NGOs, understand the challenges faced by the NGOs in day-to-day operations and discuss the probable solutions for the same, appreciate the role of leader and leadership in an NGO, study the working style of NGO leaders, appreciate the importance of having a formal organizational structure for these informal organizations (NGOs) to ensure the sustainability of their ventures and design a sustainable organization structure having a proper succession plan for the NGOs.

The case study is about one NGO – Mahesh Foundation – located in a small town named Belagavi, nestled in the state of Karnataka, India. Mahesh Foundation worked towards the upliftment of poor children infected with HIV. Today, fighting against all odds, Mahesh Foundation is a safe shelter home for 45 HIV-infected children in the age group of 6–18 years and has reached more than 2,000 beneficiaries from the time of its inception (2008). In addition, Mahesh Foundation also provides skill-based education to the HIV-infected, slum and underprivileged children. The foundation also supported the livelihood of underprivileged women and till date has supported more than 1,500 needy women. Mr Mahesh Jadhav, the founder member of Mahesh Foundation, has been successful in overcoming different challenges faced by the NGO, may it be the requirement for funds or shelters or social agitation. However, Jadhav was worried about the succession planning of his organisation. Mahesh Foundation, being run as a one-man show, Jadhav was bothered about its sustainability after him. The case study therefore highlights and discusses the importance of having a formal organization structure for such informal organizations, thereby having a proper succession plan to ensure their perpetual existence.

This case study is best taught as part of a graduate and postgraduate Business Administration (BBA/MBA) programme, Management Development Programme or Executive MBA Programme.

Teaching notes are available for educators only.

CSS 11: Strategy.

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?

Upon completion of this case study, students should be able to apply lessons learned in core readings, analysis and discussion to a specific case study dealing with a current, real-world situation, specifically: critically assess Livestock Wealth’s case facts and present and justify their point of view – based on attentive reading, critical analysis and engagement – about the company; use a range of strategic tools such as strengths, weaknesses, opportunities and threats analysis, PESTLE analysis and the Ansoff matrix to thoroughly evaluate Livestock Wealth’s internal and external business environment for developing strategic options for business growth and improvements to marketing strategy; use strategic thinking to develop a range of creative solutions to guide the company’s business growth and improvements to marketing strategy; and assess their own growth and development in terms of personal preparation and organisation, collaboration, critical thinking, decision-making skills, participation and problem-solving.

By February 2022, Ntuthuko Shezi, the founder and chief executive officer of Livestock Wealth, had turned his idea of “crowd farming”, which enables anyone to invest in living farm assets and earn a profit at harvest, into a full-fledged business that was creating wealth for both investors and farmers. Underpinning this case study is Shezi’s vision of an African continent where there is “no ground that is not planted with something of value”, local economies are created in those areas, communities are wealthy, there is abundance, there is money for children to attend school and ultimately where “cows (and agricultural produce in general) are seen as money”. Shezi had grown up in a rural area with grandparents who owned a couple of cows, realizing that the cows were the bedrock of the family’s finances. Describing his business, he says, “Cattle are like a walking bank, and we see ourselves as the bank of the future, where every person who owns a cow can access financial services through Livestock Wealth, just like it has always been in Africa.” This case study describes the two key decisions that Shezi needed to make – what direction to take in terms of business growth and how to improve his marketing strategy (with a limited budget) to attract sufficient investment into Livestock Wealth to make his dreams a reality.

This case study is suitable for use for a post-graduate diploma in business, master of business administration or master’s in management.

Teaching notes are available for educators only.

CSS 11: Strategy.