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Dr. Lawrence Frazier was an emergency room physician who was an employee of Honore Staffing Services of Baton Rouge, Louisiana. He worked at Methodist Health System hospital in Grant, Georgia. He had recently added the title of ER Medical Director and served as liaison between Honore staffing and the Methodist hospital. His additional duties included overseeing the other physicians which staff the emergency room. Methodist had a bonus system in place based on obtaining 31 patients’ satisfaction surveys each month. Dr. Frazier believed that the small sample lead to erroneous results and created problems for the physicians under his supervision. He wanted to change the data collection process (e.g. sample size collected, instrument), but encountered obstacles when he broached the subject with his hospital administrators.

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.

In January 2013, small biotechnology firm Orexigen was in the final stages of testing Contrave, a promising new pharmaceutical product for the treatment of obesity. At the time, Orexigen had no products in the market, so all its hopes of financial success rested on this new treatment. Contrave had proven to be highly effective in clinical trials, and Orexigen executives were confident it would receive FDA approval.

At the same time, a much larger pharmaceutical company was considering acquiring Orexigen. Because the decision to acquire would ultimately be a financial one, the project team from the large company had to complete a valuation for Orexigen's only significant product in its pipeline, Contrave. What was the new product actually worth?

AstraZeneca is preparing for the launch of Crestor, the company's first entrant in the enormous and fast-growing statin category. The team responsible for the product launch is considering how best to bring Crestor to market. Should AstraZeneca simply follow the example set by Pfizer with the exceptionally successful launch of Lipitor? Or should the company instead launch Crestor as a niche product?

To teach new product strategy for both emerging and established categories, and competitive strategy.

This case looks at an important business task: forecasting a new product. The case can be used to teach finance, marketing (new product introduction), and healthcare strategy. The product is one of Amgen's most important new products: denosumab. On the surface, the case is fairly easy; students simply have to do some simple mathematical calculations. However, the challenges of forecasting quickly become apparent; every forecast depends on some critical assumptions, and the answer can vary dramatically.

Highlight the importance of forecasting as a business task. Give students the opportunity to create a forecast, using logical assumptions to generate an answer. Illustrate how dramatically forecasts can vary. Demonstrate why sensitivity analysis and customer understanding are both critical when trying to forecast a new product launch.

The learning outcomes of this paper is as follows: to analyse the drivers, mediators and threats of commoditisation. To critically evaluate the merits of different marketing options that may be employed to avoid commoditisation. To critically assess the branding-focussed or customer-focussed strategies that could be used. To develop appropriate strategies for Biotronik SA to counter commoditisation in the future.

The case begins with the protagonist and managing director of Biotronik SA, Robbie Nel, brewing over a new industry development. One of the leading private hospital groups has sent an open invitation to medical device suppliers to tender, where the lowest-priced products will win shelf space in their cathlabs. Robbie has to decide whether to sacrifice Biotronik SA’s profit margins to win the tender or risk not being stocked in their cathlabs. Or, he must find an alternative non-price-based strategy to pursue. The medical device industry is facing increasing price pressures from various stakeholders in the device-purchasing process. The decision to purchase is no longer the responsibility of specialist physicians alone. International and local market trends indicate that the medical device industry is threatened by commoditisation. Robbie has to make a decision on changing the Biotronik SA business model and strategy in response to these macro trends.

This teaching case is aimed at postgraduate students, particularly those pursuing MBA, EMBA and Postgraduate Diploma programmes, as well as specialist masters and executive education. The students should have some work experience to comprehend and assess the case from a practical perspective.

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.

Executives at biotechnology firm Genzyme are debating funding a clinical trial for a new version of a medical device called Synvisc. The trial is expensive and the odds of success are not high, but the upside is substantial. The case presents a common business question: invest or not? The case forces students to think about customer insights, wrestle with a number of complex issues, and evaluate the financials of the decision.

The case is ideal for teaching financial analysis and decision making. It can also be used to teach marketing, new product strategy, and healthcare industry management.

The case tells the story of Synthroid from its development in 1958 as the first synthetic thyroxine molecule to its competition against generic equivalents in 2004. The case introduces students to the pharmaceutical industry, its practices, and some of the complexities of pricing and drug choice, with drug manufacturers, insurance companies, physicians, pharmacists, and patients all playing a role. It also provides a primer on hypothyroidism, its symptoms, and its treatment.

Because Synthroid was developed and introduced before FDA regulations and drug standards of identity were fully established, it was difficult for competitors to get their drugs certified as identical to Synthroid. Through a series of efforts with physicians, especially endocrinologists, Synthroid's owners were able to maintain the perception for forty-six years that Synthroid was uniquely effective. In 2004, however, the FDA declared several competitive products to be bioequivalent to Synthroid, which posed a significant challenge to its owner, Abbott Laboratories. Students are challenged to consider options to maintain the drug's unit volume, revenue, and/or profit in these difficult circumstances.

The case is written in two parts. The (A) case provides background on the history of the drug, the pharmaceutical industry and its marketing practices, and hypothyroidism and its treatment, and it concludes in 2004 as Abbott's marketers face the impending challenge of defending the Synthroid business against generic competition. The (B) case describes what Abbott actually did to maintain its share in the United States and outlines its strategy in India, a market without patent protection for pharmaceuticals.

After analyzing the case students should be able to:

• Describe strategies that branded competitors can use to defend their business from lower-priced competition

• Understand the basics of pharmaceutical marketing and pricing, including the global challenge of defending branded drugs against generic equivalents

• Discuss ethical issues in the marketing of high-margin branded products that have lower-priced alternatives, especially in the healthcare industry

Describe strategies that branded competitors can use to defend their business from lower-priced competition

Understand the basics of pharmaceutical marketing and pricing, including the global challenge of defending branded drugs against generic equivalents

Discuss ethical issues in the marketing of high-margin branded products that have lower-priced alternatives, especially in the healthcare industry

The learning outcomes are as follows: what tasks are to be done by medical representatives in pharmaceutical industry? This study also highlights various competencies required to do effective selling in this industry; analyzes and discusses different unethical practices going on in the market; explains why ethical norms are necessary in sales context when sales targets are already achievable with unethical means; and develops and comments on strategies Flori Pharmaceutical can make to overcome on these unethical issues. What should be the response of Dahar to the email of Naveed khan? What course of action should be taken by Dahar in the deceitful reporting case of Mohsin Ali?

Flori is considered a leading and growing multinational organization in the highly competitive environment of Pakistan pharmaceutical industry with over 40 years of experience. The company aims to command a leading position in developing new health-care products as it offers a wide range of diabetic, cardiovascular, respiratory and vitamin products based on quality as a result of high research and examination. Recently, an email to Bilal Dahar on March 2017 from Flori’s star sales person Naveed Khan has forced management to take some strong decisions regarding ethical norms and values to be adopted by medical representatives of Flori pharmaceuticals. The email highlighted the issues related to sales pressure which are leading toward unethical sales practices. Dahar just not have to maintain Flori’s ethical code of conduct but he and his team also has to work hard to achieve more than 26% growth rate in sales revenue as compared to last year. Dahar knew that the highly competitive environment of pharmaceutical industry has led most of the stake holders to indulge in unethical behavior to achieve their individual targets. He knew that this is dangerous in long term for the multinational organizations such as Flori pharmaceuticals as if the similar behavior continues, the sales culture and values of the organization would be on stake. He also has to decide what decision to be taken against deceitful reporting issue of one of the top-performer territory managers, who was key person in helping Flori to close the sales year 2016 with the revenue of Rs. 6.4bn, a 26% growth over the last year. The case is rich enough to provide a platform regarding management of several ethical challenges in pharmaceutical selling and developing strategies based on them.

BBA, MBA final year.

Teaching Notes are available for educators only.

CSS 8: Marketing.

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.