Case Studies


Every leader stands on the shoulders of the giants who’ve come before them. Case-based learning allows them to walk in their shoes and hone the invaluable skill of judgment. The value-based health care delivery case studies accelerate this ability to learn from others, examining organizations that have faced — and overcome — challenges applying value-based health care principles.  The Redefining Health Care Workshops are rooted in the case study method of teaching and learning — the same model pioneered by business schools decades ago to impart important lessons in judgment and leadership on MBA candidates. Spanning large- and small-care delivery organizations, health plans and employers, these case studies are actual stories of organizations that have made dramatic leaps in health care value.

Each case study brings theory to life through practice, and gives workshop participants the opportunity to exercise judgment and leadership to solve the real problems leaders confront. In a case discussion, workshop participants become the decision makers as they read through the case, understand the situation, and identify with and analyze the problem — examining the causes and considering alternative courses of action to inform new approaches, ideas and strategies. By studying these cases, they will understand that it is possible to improve health outcomes and gain the confidence to make change happen.

The Redefining Health Care Workshops rely on active participation, specifically through discussions of the cases facilitated by the faculty leaders. The faculty guides the dialogue and asks the questions, but ultimately, it is the insight and analysis of the participants that is the basis of the discussion. Through the experience, participants gain the skills and knowledge needed to build the strategy for their organizations.

The cases are factual and no names have been changed. They are available from Dartmouth and Harvard Business School Press, and include:

The Cleveland Clinic
Internationally renowned for quality, Cleveland Clinic (the Clinic) is making strides in integrating care delivery cycles throughout northeast Ohio. This extends initiatives started in 2007 to restructure the entire organization into teams defined around patient needs, rather than traditional medical specialties. Under the Clinic’s “Patients First” philosophy, teams measure and report outcomes, coordinate care and develop processes to support improving value for patients, and develop IT systems to support measurement and coordination. In addition to restructuring care delivery in hospitals and throughout northeastern Ohio, the Clinic has investments, facilities and staff in several other states in the U.S., as well as in Canada and Abu Dhabi. Students explore strategy transformation, systems integration, geographic expansion, the process of introducing new measurement approaches, alignment of activities with strategic goals, and issues in leading change both within a company and across an economic sector.

West German Headache Center
The West German Headache Center is outpatient-centric, caring specifically for headache and migraine patients in dedicated facilities. To improve quality and health outcomes, the German health plan KKH and Essen University Hospital joined forces to create an integrated practice unit (IPU). Following new legislation in 2004 allowing health plans and selected providers to contract outside of the regular group purchasing scheme, the two organizations developed a novel delivery structure for migraine care, which included an interdisciplinary team of neurologists, psychologists and physical therapists who work together with a network of community neurologists and an affiliated inpatient unit. This case details challenges and hurdles (for both the health plan and IPU) to implementation, and provides detailed data to allow students to evaluate successes, identify current challenges, and recommend improvements to the integrated care system.

Commonwealth Care Alliance
Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the U.S. Commonwealth Care Alliance, a small nonprofit insurer and care delivery system in Massachusetts, operated under a public demonstration program designed to provide comprehensive coverage and care for the elderly dual eligible population. Led by Dr. Robert Master, Commonwealth Care Alliance worked with its contracted providers to implement and support a care delivery model that would allow as many members as possible to live independently outside of nursing homes. This case examines Commonwealth Care Alliance’s insurance and care delivery approaches amidst a changing policy environment and various resource constraints.

The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care
In 2006, the University of Texas MD Anderson Cancer Center became an internationally leading institution for cancer care, education, and research. In 1996, it began reorganizing itself from a cancer hospital that was physically organized around clinical specialties into one that was organized into disease-based integrated practice units called multidisciplinary care centers. These units were supported by a new construction project that had created new disease-specific facilities and a widely-supported administrative plan in which physicians reported both to leadership of specialty-based academic departments and disease-based clinical centers.

The Joslin Diabetes Center
The Joslin Diabetes Center (Joslin) in Boston is a leading center for diabetes care, clinician training and research. The incidence of diabetes is rising precipitously worldwide, challenging quality of life with its complications and rapidly accelerating health care expenditures for employers and governments. Joslin’s multi-specialty, team-based care and patient education programs provide opportunities to examine integrated practice units, early-stage and preventive care, and clinical coordination along the full care cycle. The focus on diabetes also enables discussion of what services need to be included in integrated practice units serving patients with complex, chronic diseases. However, despite its renown, Joslin’s clinical operations lose money, raising the challenge of how to align financial success and clinical success in health care delivery.

Michelin Employee Health Strategy
In 2007, Michelin North America was confronting a steep rise in health benefits costs, a projected growth rate that threatened the company’s profitability and a growing realization that productivity, disability and absenteeism were related to employee health.  The company began a comprehensive study of its approach to employee benefits, and was deciding whether to simply wait for the problem to resolve itself, move to a defined contribution health plan, comprehensively redesign its benefits, wait for government action or shift more costs to employees.  The teaching focus for this case is to identify unmet health needs, measure health improvement, structure benefits for optimal health, partnerships between providers and employers, and chronic disease care.

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