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For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

Teaching notes are available for educators only.

CSS: 3 Entrepreneurship.

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.

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 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.

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 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 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.

Diagnostics services in India were growing at 20% annually with billing of USD 3.4 billion. With WTO's GATS, foreign competition was arising. Dr. Lal PathLabs had formidable brand recognition and Dr. Arvind Lal was wondering whether to accept private equity and induct management professionals to keep pace with competitors through acquisitions or greenfield or sell out. He worried over loss of proprietary control. The industry practice of incentivizing doctors for referrals meant that acquisitions brought perverse incentive systems. The choice of compromising ethics or inventing another business model had to be made alongside whether to expand in India or abroad.

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.