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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 outcomes of this study include: recognizing the strategic inflexion points and related business and strategic perspectives in the life of an organization; understanding sources of sustained competitive advantage and connect it with resource-based view for internal analysis; applying dynamic capability theory to identify capabilities that help an IT company stay relevant in an IT sector characterized by VUCA (an acronym for volatility, uncertainty, complexity and ambiguity) environment; analyzing the multi-dimensional and multi-contextual challenge an organization faces, or is likely to face, in the foreseeable future and the possible ways it addresses or should address them; evaluating strategies adopted at various points of an organization’s journey for their effectiveness; and helping a company co-create value for its customers.

This case of Nitor Infotech Private Limited (Nitor), a mid-sized software product outsourcing company, outlines its decade-long journey, highlighting its achievements. While the company has consistently grown by leveraging its expertise in software product engineering and its domain knowledge in the healthcare segment, it entered into a stage of its life cycle where it had to develop a long-term strategy to effectively compete in the product engineering market. Nitor’s strategy was built around product engineering and outsourced product development. The two major choices for a software company were either to develop its own product and thereby own the intellectual property (IP) or to develop modules which would be part of a product that would be owned by a client. In the latter case, the IP would be held by the client. So far Nitor chose to follow the second option by developing components for its client’s products. Although this strategy allowed it to develop expertise in a particular domain, and serve different customers in a particular market, the chances of a competitor attacking its position was high. On the other hand, if it developed its own product, it can create its own brand name and can sell packaged software to several different customers. However, the challenge with the latter is that the cost of marketing could be very high. The choice for the company in the future is to decide on selecting a specific strategy to expand its international business.

This case is appropriate for an undergraduate and postgraduate management course in the area of strategic management. The level of difficulty can be from medium to high depending on the learning level. Knowledge of management fundamentals is not a prerequisite but is desirable for case analysis.

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 11: Strategy

Entrepreneurship.

The case has been used at Master's level but it has direct application to any MBA programme or entrepreneurship module.

Adrian Gore started Discovery in 1992 with seed-funding of R10 million from merchant banking group, Rand Merchant Bank (RMB), as a health insurance company within the RMB stable. By 2009, Discovery had become a large, listed, financial services institution employing more than 5,000 people and comprising not only Discovery Health (DH), but also Discovery Life (DL), Discovery Invest (DI) and Discovery Vitality (a wellness programme). In addition, it had operations in the USA, where it licensed Vitality for use by employers and other health insurers, and in the UK where it operated two joint ventures with The Prudential plc – Pruhealth and Prulife.

To understand the similarities and differences between corporate and start-up entrepreneurship; to understand the entrepreneurial process within an established organization; to explore the environment within an established company in terms of how much it supports or constrains entrepreneurship; and to look at creative ways to overcome obstacles to entrepreneurship in established companies.

Teaching notes.

LifeBank is primarily focused on tackling the challenge of maternal mortality in Nigeria and other African countries by providing women access to blood, thereby tackling the challenge of gender inequality. The company employed both men and women at its workplace providing equal opportunities for men and women.

Discuss how women entrepreneurs are solving social problems in developing countries using technology and innovation.

Analyze the challenges faced by women entrepreneurs in getting the right human capital, raising funds and managing growth for their social business.

The case discusses how social entrepreneur Temie Giwa-Tubosun (Temie) founded LifeBank, a medical distribution company, to provide access to blood, medical oxygen and vaccines to hospitals in Nigeria. The company used technology to provide information to health providers about which blood bank stored the blood type they needed and delivered it quickly and safely to help save lives.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.

The subject areas are strategy, general management, health-care management, change management and inclusive growth model and application of technology to manage health care.

The case can be used to teach challenges in managing change in a health-care facility.

Tata Memorial Centre (TMC) is dedicated to provide best health-care services in the field of cancer cure. TMC established its credentials for service, education and research, which contributed to it being rated among the ten best hospitals year on year. Starting from humble moorings, TMC has grown to an institution of high repute from an 80-bed hospital to a 700-bed hospital. TMC held a number of pioneering efforts, which included bone marrow transplantation, external beam radiotherapy (linear accelerator), tumor tissue bank and bio-imaging to name a few. The management team of TMC had ensured that the growth had been orderly and appropriate to the changing needs of the community. Managing a hospital with disparate skill sets in the face of ever-increasing demand for services had always been a challenge in itself. As a government-run facility and well funded by the trust, TMC offered excellent services and post-operative care to the patients. So, it became imperative for the hospital to adopt technology to improve its hospital services and maintain transparency. Patients came to the hospital from different states in India and across the globe. TMC registered international and national patients online. Online medical reports were checked before the patients visited the hospital. TMC has developed an e-system that will allow patients around the world to send their tissue samples that are suspected to be cancerous for medical advice to the hospital. This case study is developed to provide insights into the transformation of TMC into an e-health-care service and explains the process of change management.

They are to provide insights into the challenges in health-care management, to illustrate the challenges faced by organization in implementing information and communication technology- managing change and to bring about best practices in the case organization and find solutions to the following questions: What are challenges faced by health-care officials in providing health care using new technological innovations? How can hospitals equip themselves with new technology? With the advent of improved and modern communication methods, medical practices and cases are more easily shared. Cases are discussed, recorded and, in many cases, put up for general public viewing through the electronic media. How can hospitals manage change? How can hospital administrators manage speed of delivery, quality healthcare, innovation and brand image?

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:11 Strategy.

After discussing this case, students will be able to understand the challenges faced by social entrepreneurs in starting a health-tech start-up in Africa; create and evaluate lean business models of health-tech companies as a social enterprise; evaluate how health-tech start-ups were developing innovative business models and supply chain networks to make prescription drugs accessible and available in Africa; understand how inorganic growth strategies can help health-tech start-ups scale up; and evaluate what promises investors were seeing while investing in social enterprises in the health-care sector in Africa and what social wealth they were creating.

In August 2022, Gregory Rockson (Rockson), social entrepreneur and founder of for-profit health technology (health-tech) social enterprise in Ghana, mPharma, stated that he had plans to replicate the company’s business model, which provided people access to drugs and at affordable prices, to other African nations, beyond the company’s existing footprint. However, analysts pointed out that the fragmented drug supply chain and poor regulation in the health-care market across Africa could act as a challenge for mPharma to replicate its business model successfully across the African continent. People in Africa were forced to pay higher prices to buy life-saving drugs due to the continent’s fragmented drug supply chain. To add to their woes, pharmacies struggled to keep life-saving and life-sustaining medicines in stock. Often, patients traveled miles to a pharmacy only to find out that the drugs they needed were not in stock. In addition to this, the markets were flooded with counterfeit drugs. And the Covid-19 pandemic only exacerbated the situation. mPharma managed the prescription drug inventory for pharmacies and drug suppliers using its proprietary vendor management information system. By using the technology infrastructure it had built, the company connected patients, pharmacies and hospitals through a cloud-based software. The system enabled doctors to track in real-time which drugs were available and at which location, thus giving patients reliable access to medicines. Patients registering with mPharma with their prescriptions and medical history received an alert on their mobile phones notifying them where the drugs they needed were available. mPharma bought drugs from major drug manufacturers such as Novartis International AG, Pfizer Inc. (Pfizer) and Bayer AG, on behalf of the pharmacies. This enabled the pharmacies to save on the up-front costs of stocking the drugs, reduced supply constraints and ensured availability of drugs to consumers in these underserved markets. The company had a consignment model wherein member pharmacies had to pay only for what they sold. Most pharmacies forecast the number of drugs they needed and purchased them from mPharma at pre-agreed rates. The company took the inventory liability to prevent pharmacies from going out of stock. As mPharma used its purchasing power to buy drugs in large quantities from drug manufacturers and suppliers, it was able to help patients realize cost savings of 30% to 60% in the purchase of medicines. mPharma was focusing on achieving its ambitious goal of dominating the health-care market in Africa in future. However, analysts felt that the company would face challenges related to poor regulation in the health-care market, high prices of drugs and the fragmented pharmacy retail market in the continent.

This case is intended for use in MBA/MS level programs as part of a course on Social Entrepreneurship, Sustainability, Business Model Innovation, Disruptive Business Models, and Supply Chain Management in the Drug Industry.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.

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.

First National Healthcare (FNH) runs a large network of hospitals and has worked to systematically reduce waiting times in its emergency departments. One of FNH's regional networks has run a successful marketing campaign promoting its low ED waiting times that other regions want to emulate. The corporate quality manager must now determine whether to allow these campaigns to be rolled out and, if so, which waiting time estimates to use. Are the numbers currently being reported accurate? Is there a more accurate way of estimating patient waiting time that can be easily understood by consumers?

The subject area is entrepreneurship.

Graduate and executive education level in leadership, entrepreneurship and strategic management are used to discuss leadership, entrepreneurship and strategy in health services.

This case talks about the passionate journey of a pediatrician practicing in the Mumbai city of India, who as an individual private practitioner is contributing to the fulfilment of the global health agenda and the fourth Millennium Development Goal (MDG) – “reduce child mortality”. His vision is to make quality and affordable expert pediatric care accessible to all the individuals, right from pre-birth to adulthood. Surya Mother and Child Care Hospital (SMCH) is being strengthened as a nation-wide network of mother and child hospital offering patient/consumer-centric integrated collaborative quality care, and it needs to be seen how this model can be made sustainable as it enlarges in scale for the future.

The case is structured to achieve the following learning outcomes: to understand about effectuation as a logic for entrepreneurial success through the lens of Dr Avasthi and his venture SMCH; To understand and apply Porter’s Principles of value transformation that essentially focus on outcome-driven cost-efficient work practices in a collaborative integrative fashion, where transformation must come from within (some practices suggested can be applied to the Indian Healthcare Services Delivery systems); to critically analyze the overall strategic position of SMCH as an organization and its competitive environment; to discuss the factors influencing health-care delivery capacity build up, given the MDGs 2015, Every Newborn Action Plan and Indian Newborn Action Plan framework, as applicable to India; and to discuss and analyze mechanisms for future sustainable service delivery options for SMCH. Although each of these principles is important, possibly, the instructor could emphasize and encourage more discussions on potential models of shared partnerships that can help quality health-care services reach the unreached and the incorporation of technology in achieving this. The learning process can also facilitate discussions about leadership qualities in the creation of health-care entrepreneurs, for the “Change That They Would Want To See”.

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:3 Entrepreneurship.

This case was developed from secondary sources. The secondary sources included company websites, social media and news reports. This case has been classroom tested in multiple executive master of business administration (MBA) courses on business model innovation and entrepreneurship.

The case traces the entrepreneurial journey of Dozee, a remote patient monitoring system in India. Dozee was manufactured by Turtle Shell Technologies Private Limited, cofounded by Mudit and Gaurav. The primary customers of Dozee’s offering were households with elderly citizens and health-conscious individuals who sought preventive health care. The cofounders identified the unmet need for a convenient and user-friendly contactless health tracker. Dozee team built a thin sensor-embedded sheet and module that can be placed beneath the mattress to track sleep patterns and health vitals. They also provided data analysis and data interpretation services. After four years of conceptualization, Dozee launched its product and service in 2019. Although the initial response was lukewarm, the onset of the COVID-19 crisis led to significant changes in the health-care industry. Demand for virtual assistance and contactless monitoring devices became increasingly important elements of COVID-19 treatment. Unlike other sensor-based fitness trackers, the sheet could be easily placed under the patient’s bed to capture health vitals. Choosing to pivot from a home-based individual customer segment to a medical-grade device provider for hospitals could significantly increase the scale and scope of the offering for Dozee, but it would also place Dozee in direct competition with other health monitoring devices from different business categories.

This case is appropriate for MBA and executive-level courses related to entrepreneurship and business model innovation. The case explores issues such as digital disruption and how start-ups can design a go-to-market strategy. The case works well in the classroom, even if people are unfamiliar with the health-care industry. Participants can certainly relate to the concept of adopting artificial intelligence–enabled devices for monitoring their health. The instructor should be able to quickly engage participants in a lively discussion about Dozee’s vision and the opportunities and challenges in adopting digital solutions in health care.