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Harvard Case - New England Baptist Hospital: Getting Paid for Value

"New England Baptist Hospital: Getting Paid for Value" Harvard business case study is written by Robert S. Kaplan, Mary L. Witkowski, Toby E. Emanuel, Syed S. Shehab. It deals with the challenges in the field of Strategy. The case study is 8 page(s) long and it was first published on : Feb 18, 2021

At Fern Fort University, we recommend New England Baptist Hospital (NEBH) adopt a multi-pronged strategy to transition from a fee-for-service model to a value-based care system. This strategy encompasses a blend of innovation in care delivery, digital transformation, and strategic partnerships to achieve sustainable competitive advantage in the evolving healthcare landscape.

2. Background

The case study focuses on NEBH, a renowned orthopedic hospital facing challenges in the shift from a traditional fee-for-service payment model to a value-based care system. This transition requires NEBH to demonstrate improved patient outcomes and cost-effectiveness, while navigating a complex regulatory environment and increasing competition. The main protagonists are Dr. David Levine, the CEO, and his team, who are tasked with developing a strategy to ensure NEBH's continued success in this new paradigm.

3. Analysis of the Case Study

Porter's Five Forces Analysis:

  • Threat of New Entrants: High, due to the increasing presence of specialized orthopedic centers and the rise of telehealth platforms.
  • Bargaining Power of Buyers (Patients): Moderate, as patients have increasing choices in healthcare providers and are becoming more price-sensitive.
  • Bargaining Power of Suppliers: Moderate, as NEBH relies on specialized medical equipment and pharmaceuticals, but has some leverage through volume purchasing.
  • Threat of Substitutes: Moderate, as alternative treatments and non-invasive therapies are gaining traction.
  • Rivalry Among Existing Competitors: High, with established hospitals and specialized orthopedic centers vying for market share.

Value Chain Analysis:

NEBH's value chain needs to be re-engineered to focus on value creation rather than volume. Key areas for improvement include:

  • Inbound Logistics: Streamlining supply chain management and negotiating better pricing with suppliers.
  • Operations: Implementing lean methodologies to reduce waste and improve efficiency in surgical procedures and patient care.
  • Outbound Logistics: Optimizing patient discharge processes and coordinating post-operative care.
  • Marketing & Sales: Shifting from volume-based marketing to value-based messaging highlighting superior outcomes and patient experience.
  • Service: Implementing patient engagement programs and leveraging technology to improve communication and satisfaction.

SWOT Analysis:

  • Strengths: Strong brand reputation, specialized expertise in orthopedics, experienced medical staff, and a dedicated patient base.
  • Weaknesses: Reliance on fee-for-service model, limited experience with value-based care, potential for technology adoption lag, and a need for improved data analytics.
  • Opportunities: Growing demand for orthopedic care, increasing adoption of value-based care models, advancements in technology and data analytics, and potential for strategic partnerships.
  • Threats: Increasing competition from specialized centers, rising healthcare costs, evolving regulatory landscape, and potential for disruptive innovation.

4. Recommendations

1. Develop a Value-Based Care Strategy:

  • Define Value Proposition: Clearly articulate NEBH's value proposition based on improved patient outcomes, cost-effectiveness, and enhanced patient experience.
  • Target Specific Patient Populations: Focus on high-volume, high-cost procedures where NEBH can demonstrably improve outcomes and reduce costs.
  • Implement Outcome-Based Payment Models: Negotiate contracts with payers based on achieving specific clinical and financial targets, such as reduced readmission rates or improved functional outcomes.

2. Embrace Digital Transformation:

  • Invest in Technology and Analytics: Implement advanced data analytics platforms to track patient outcomes, identify cost-saving opportunities, and personalize care plans.
  • Leverage Telehealth and Remote Monitoring: Expand telehealth services for pre-operative consultations, post-operative follow-ups, and remote patient monitoring to improve access and reduce costs.
  • Build a Robust Data Infrastructure: Ensure secure data storage and integration across systems to facilitate data-driven decision making and improve patient care.

3. Forge Strategic Partnerships:

  • Collaborate with Payers: Partner with insurance companies and government agencies to develop innovative payment models and share data to improve patient care.
  • Form Strategic Alliances: Collaborate with other healthcare providers, such as rehabilitation centers and home health agencies, to create a seamless care continuum.
  • Explore Joint Ventures: Consider joint ventures with technology companies or other specialized providers to leverage complementary expertise and resources.

4. Cultivate a Culture of Innovation:

  • Encourage Continuous Improvement: Foster a culture of continuous improvement by empowering staff to identify and implement cost-saving measures and improve patient care.
  • Invest in Staff Training: Provide staff with training on value-based care principles, data analytics, and new technologies to enhance their skills and knowledge.
  • Promote Innovation and Collaboration: Create a platform for sharing best practices and fostering innovation through cross-functional teams and internal hackathons.

5. Basis of Recommendations

These recommendations are based on:

  • Core Competencies: NEBH's strong brand reputation, specialized expertise in orthopedics, and experienced medical staff provide a strong foundation for success in value-based care.
  • External Customers and Internal Clients: The recommendations prioritize patient needs and outcomes, while also addressing the concerns of payers and internal stakeholders.
  • Competitors: The recommendations aim to differentiate NEBH from competitors by focusing on value creation, innovation, and strategic partnerships.
  • Attractiveness: The recommendations are expected to improve financial performance through increased efficiency, reduced costs, and enhanced revenue streams.

6. Conclusion

By embracing innovation, digital transformation, and strategic partnerships, NEBH can successfully transition to a value-based care system, achieving sustainable competitive advantage and ensuring its continued success in the evolving healthcare landscape.

7. Discussion

Alternatives:

  • Maintaining the status quo: This would likely lead to declining market share and financial performance as NEBH falls behind competitors in the shift to value-based care.
  • Focusing solely on cost reduction: While cost reduction is important, it should be balanced with improving patient outcomes and enhancing the patient experience.
  • Merging with another hospital: This could provide access to resources and expertise, but may also create challenges in integrating cultures and systems.

Risks:

  • Technology adoption challenges: Implementing new technologies and data analytics platforms can be complex and require significant investment.
  • Resistance to change: Staff may resist changes to their work processes and routines, requiring effective communication and training.
  • Regulatory uncertainty: The evolving regulatory landscape for value-based care can create uncertainty and require ongoing adaptation.

Key Assumptions:

  • Patient demand for value-based care will continue to grow.
  • NEBH can successfully implement the recommended strategies and achieve the desired outcomes.
  • The healthcare industry will continue to evolve towards value-based care models.

8. Next Steps

  • Develop a detailed implementation plan with clear timelines and milestones.
  • Secure necessary funding and resources for technology investments and staff training.
  • Communicate the strategy to all stakeholders, including staff, patients, and payers.
  • Monitor progress and make adjustments as needed.

By taking these steps, NEBH can position itself as a leader in value-based care, delivering high-quality, cost-effective orthopedic services to its patients and achieving sustainable success in the evolving healthcare landscape.

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Case Description

New England Baptist Hospital (NEBH), a national leader in adult orthopedic care, has the lowest rate of complications and 30-day readmissions in New England, but gets paid 30% less for its surgeries than nearby institutions. NEBH introduces, with several large employers, bundled payment plans that cover the patient's surgical treatment from day of surgery until discharge from the hospital and subsequent post-discharge care, including eight physical therapy appointments and treatment for any complications during 60 days post-surgery. But the new payment plan, even with a much lower price than the fee-for-service payments being paid to competitive institutions, has not led to increased patient volumes from employers. The case, in addition to facilitating discussion about design features for bundled payment plans, illustrates the challenges of a hospital leader trying to benefit from its better patient outcomes and lower prices when its payers - employers, health plans, and the government - change only slowly.

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