Health Care
Health Care
Over the past several decades, HBS has built a foundation in health care research, from Clayton Christensen's application of disruptive innovations and Regina Herzlinger's concept of consumer-driven health care to Michael Porter's use of competitive strategy principles. Today our research focuses on
- how management principles and best practices from other industries can be applied;
- how the process of innovation can be improved;
- how principles of strategy and consumer choice can be utilized;
- how information technology can expand access, decrease costs, and improve quality;
- how new approaches in developing nations can impact global health.
Initiatives & Projects
The Health Care Initiative and the Social Enterprise Initiative connect students, alumni, faculty, and practitioners to ideas, resources, and opportunities for collaboration that yield innovative models for health care practice.
Health CareSocial EnterpriseRecent Publications
Market Dynamics and Moral Dilemmas: Novo Nordisk’s Weight Loss Drugs
By: Joseph L. Badaracco, Tom Quinn and John Schultz
- April 2024 |
- Case |
- Faculty Research
Danish pharmaceutical company Novo Nordisk was owned by a charitable foundation, and since its founding in the 1920s had focused on producing insulin to treat diabetes. In 2017, however, it released Ozempic, a diabetes treatment with the revolutionary side effect of safe, effective weight loss. As demand in the U.S. reached a fever pitch, Novo faced opportunities and challenges. The case covers the markets in which Novo could expand, the manufacturing shortfalls it faced, the competition that was expected to arise, and the moral issues that came with selling a product that affected so many people worldwide.
Keywords: Cost vs Benefits; Decisions; Judgments; Values and Beliefs; Global Strategy; Health Care and Treatment; Patents; Growth and Development Strategy; Growth Management; Product Positioning; Supply and Industry; Supply Chain; Corporate Social Responsibility and Impact; Mission and Purpose; Philanthropy and Charitable Giving; Opportunities; Social Issues; Equality and Inequality; Pharmaceutical Industry; Health Industry; Denmark; United States; Europe; China; India; Middle East; North Africa
Retailers and Health Systems Can Improve Care Together
By: Robert S. Huckman, Vivian S. Lee and Bradley R Staats
- March–April 2024 |
- Article |
- Harvard Business Review
Health systems are struggling to address the many shortcomings of health care delivery: rapidly growing costs, inconsistent quality, and inadequate and unequal access to primary and other types of care. However, if retailers and health systems were to form strong partnerships, they could play a major role in addressing these megachallenges. While some partnerships do exist, they are rare and have only scratched the surface of their potential. Rather than focusing on the direct-to-consumer model that retailers have largely employed, the partnerships should offer much broader care.
Drawing on real-world examples, the authors outline four key actions that retailers and health systems should take: (1) They must move beyond convenience to offer comprehensive care. (2) They should move care from clinics into the home. (3) They should leverage data to improve clinical care and the customer experience. And (4) they should change how—and by whom—health care work is done. Implementing these four actions would generate improvements that would benefit not just patients but also the organizations that pay for their health care.
Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity
By: Mitchell Tang, Rebecca Mishuris, Lily Payvandi and Ariel Dora Stern
- March 2024 |
- Article |
- JAMA Network Open
Importance: The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient–care team communication.
Objective: To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.
Design, Setting, and Participants: In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.
Exposure: Patient race and ethnicity.
Main Outcomes and Measures: Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.
Results: A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, −5.34 to −2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.
Conclusions and Relevance: The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.
Objective: To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups.
Design, Setting, and Participants: In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023.
Exposure: Patient race and ethnicity.
Main Outcomes and Measures: Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded.
Results: A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, −5.34 to −2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients.
Conclusions and Relevance: The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.
Medicare Price Negotiation and Pharmaceutical Innovation Following the Inflation Reduction Act
By: Matthew Vogel, Pragya Kakani, Amitabh Chandra and Rena M. Conti
- March 2024 |
- Article |
- Nature Biotechnology
The Inflation Reduction Act (IRA) requires Medicare to negotiate lower prices for some medicines with high Medicare spending. Using historical data from public and proprietary sources to apply the IRA's negotiation criteria retrospectively, we identify all drugs that met the eligibility criteria from 2012 to 2021 to classify drugs that would have had a negotiated price in effect in 2022 and to calculate associated decreases in industry revenues. Our results suggest that the IRA's reduction in overall industry revenue will be modest, will not affect most top-selling drugs and will not likely result in large-scale defunding of research and development. Changes in the net present value of drug-development projects will be concentrated in medicines where Medicare is a notable purchaser and where the ratio between expected revenue and development costs was only marginally positive before the IRA. Policymakers considering narrowing or expanding the scope of Medicare negotiation should carefully consider the tradeoffs across medicines with diverse characteristics.
Cicely Saunders and the Modern Hospice Movement: A Brother's View
By: Amar Bhide and Srikant M. Datar
- 2024 |
- Working Paper |
- Faculty Research
This Case history describes the role of Dame Cicely Saunders (1918- 2005) in
shaping the modern hospice movement. It is narrated in the first person through the words of her
brother, Christopher Saunders (1926-2024) as told to one of the authors of this paper.
Best Buy Health: Enabling Care at Home
- February 2024 |
- Case |
- Faculty Research
This case explores retailer Best Buy’s decision to enter health care. Best Buy Health aims to enable care at home across three prongs: consumer health, active aging, and virtual care. A key pillar of Best Buy Health's strategy is leveraging the Geek Squad—the company's technical support agents who install technology and media products in the home—to set up remote patient monitoring devices for people with a chronic disease or those enrolled in a hospital-at-home program. Set in April 2023, the case finds senior company leaders reviewing the results of a pilot with Pennsylvania-based Geisinger Health System evaluating whether Geek Squad agents can safely expand timely access to care
Retired Military Officials: Protecting Abortion Care Keeps America Safe
By: Louis Caldera, Ray Mabus and Deborah James
- February 1, 2024 |
- Editorial |
- Washingtonpost.com
Beyond the 510(k): The Regulation of Novel Moderate-Risk Medical Devices, Intellectual Property Considerations, and Innovation Incentives in the FDA’s De Novo Pathway
By: Mateo Aboy, Cristina Crespo and Ariel Stern
- 2024 |
- Article |
- npj Digital Medicine
Moderate-risk medical devices constitute 99% of those that have been regulated by the U.S. Food and Drug Administration (FDA) since it gained authority to regulate medical technology nearly five decades ago. This article presents an analysis of the interaction between the 510(k) process—the historically dominant path to market for most medical devices—and the De Novo pathway, a more recent alternative that targets more novel devices, including those involving new technologies, diagnostics, hardware, and software. The De Novo pathway holds significant potential for innovators seeking to define new categories of medical devices, as it represents a less burdensome approach than would have otherwise been needed historically. Moreover, it supports the FDA in its effort to modernize the long-established 510(k) pathway by promoting the availability of up-to-date device “predicates” upon which subsequent device applications can be based, reflecting positive spillovers that are likely to encourage manufacturers to adopt current state-of-the-art technologies and modern standards of safety and effectiveness. We analyze the characteristics of all the De Novo classification requests to date, including the submission type, trends, FDA review times, and device types. After characterizing how the De Novo process has been used over time, we discuss its unique challenges and opportunities with respect to medical device software and AI-enabled devices, including considerations for intellectual property, innovation, and competition economics.
Compass Pathways: Pioneering Psychedelic Treatment
By: Tiona Zuzul, Kisha Lashley and Gamze Yucaoglu
- February 2024 |
- Case |
- Faculty Research
This case follows Compass Pathways, a pioneering company developing treatment for depression based on psilocybin, the compound found in ‘magic mushrooms.’ Psilocybin was a federally illegal substance in the U.S., and a “Schedule I” drug, defined as a drug “with no currently accepted medical use and a high potential for abuse.” As the case opens in 2023, CEO Kabir Nath is preparing for the release of the company’s Phase 3 clinical trial results, expected to lead to FDA clearance and the “re-scheduling” of the company’s product. As Nath and his team prepare for commercialization, they grapple with decisions that balance short-term success and long-term sustainability in an uncertain, stigmatized industry.
Representation and Extrapolation: Evidence from Clinical Trials
By: Marcella Alsan, Maya Durvasula, Harsh Gupta, Joshua Schwartzstein and Heidi L. Williams
- February 2024 |
- Article |
- Quarterly Journal of Economics
This article examines the consequences and causes of low enrollment of Black patients in clinical
trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is
more relevant for decision-making by physicians and patients when it is more representative of
the group that is being treated. This generates the key result that the perceived benefit of a
medicine for a group depends not only on the average benefit from a trial, but also on the share of
patients from that group who were enrolled in the trial. In survey experiments, we find that
physicians who care for Black patients are more willing to prescribe drugs tested in representative
samples, an effect substantial enough to close observed gaps in the prescribing rates of new
medicines. Black patients update more on drug efficacy when the sample that the drug is tested
on is more representative, reducing Black-White patient gaps in beliefs about whether the drug
will work as described. Despite these benefits of representative data, our framework predicts that
those who have benefited more from past medical breakthroughs are less costly to enroll in the
present, leading to persistence in who is represented in the evidence base.