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State health care reform in Massachusetts has involved a phased process, focusing first on coverage expansion and then turning to delivery system innovation and cost containment. In 2006, the state adopted an individual mandate to obtain health care coverage which, along with a Medicaid expansion and creation of an exchange for two new health insurance programs, reduced the proportion of uninsured to below 3% within three years. In 2009, high and rising health care spending called into question the sustainability of these reforms. Massachusetts prepared to implement its second wave of changes, which included delivery system reforms and a proposed shift from fee-for-service to "global payments" covering all or most of an individual's care. The case examines the content and sequencing of both phases of health care reform in Massachusetts, enabling discussion of health care system-level strategy and the relationship between coverage, care delivery, and spending.

In 2010, organ transplantation remained among the few sets of medical conditions in the US for which bundled payments were a dominant reimbursement model, and for which patient health outcomes were universally measured and reported. In 1986, UCLA Medical Center was approached by Kaiser to develop a new bundled pricing approach to kidney transplant care that was quickly adopted by many payers and providers for various transplant types. This case study examines the history and current state of care delivery, reimbursement, and measurement for the UCLA Kidney Transplant Program, among the nation's highest-volume transplant providers. The UCLA Kidney Program is an interdisciplinary unit that involves clinicians from multiple Departments and engages in continuous care management throughout the often protracted transplant care cycle.

Sweden's Highland District County Hospital, similar to a community hospital in the US, undertook a major restructuring to integrate care delivery for medical conditions served by the Department of Medicine. Each subspecialty within the Department would form a single, co-located unit with its own budget that encompassed both inpatient and outpatient care. This case examines the experience of the Highland Gastroenterology Unit, comparing the delivery model for inflammatory bowel disease in 2001 and 2009, before and after the reorganization. The case can be used to examine health care provider strategy, integrated care delivery, and quality measurement. The case also profiles Sweden's single-payer health care system, allowing for a discussion of national health systems and health policy.

Taiwan's Koo Foundation Sun Yat-Sen Cancer Center has developed an integrated, team-based care delivery model for breast cancer care that is being expanded to other cancer types in 2009. A decade earlier, President and CEO Dr. Andrew Huang and the Center had worked with the Taiwan National Health Insurance system to create a pay-for-performance reimbursement program for breast cancer care that has since been adopted by five other providers. The program issues capitated, per patient base payments for breast cancer care, with bonus payments based upon provider reporting and performance on a set of quality measures. This case allows readers to examine health care provider strategy, development and implementation of bundled reimbursement, integrated care delivery, quality measurement, and Taiwan's universal health care system.

Global Health Partner was founded in 2006 as a privately owned health care provider in Sweden serving both public and private paying patients. In contrast to most providers in the country, GHP organized around specific service lines where it saw the potential to provide the most value. This case details the GHP approach to both Spine Care and Obesity Care demonstrating the power of specialization for quality improvement as a basis for competitive advantage. Students will examine the organization of integrated multidisciplinary care, the impact of volume on learning and efficiency , and the importance of demonstrating quality through outcomes reporting. The case also provides a window into the Swedish Health Care System.

Pitney Bowes, a Fortune 500 mail and document management firm, offered its first health plans in the years following World War II. Over the ensuing decades, Pitney Bowes adapted its approach to employee health amid rising health care costs, shifting employer attitudes towards health benefits, and a rapidly changing policy environment. By 2008, the firm was widely regarded as an innovator in employee health, having dedicated substantial time and resources to its health benefits under the leadership of then CEO Michael Critelli and Corporate Medical Director Jack Mahoney. The case provides an overview of the history of employee health benefits in the U.S. and at Pitney Bowes. The range of health plans Pitney Bowes offered to employees in 2008, as well as the firm's contracting policies with commercial insurers and self-insured plan administrators, are examined in detail. Pitney Bowes health and wellness programs are also described, enabling an analysis of the firm's overall employee health strategy in 2008 and a discussion of where Pitney Bowes should focus its attention moving forward.

Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the US. 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 could allow as many members as possible to live independently outside of nursing homes. The case examines Commonwealth Care Alliance's insurance and care delivery approaches amidst a changing policy environment and various resource constraints. This case can be used to teach: Approaches to value-based insurance and care delivery; Insurance and care delivery considerations for underserved, high-cost populations; Evolution and structure of US Medicare and state Medicaid programs and demonstrations; and payer and provider reimbursement models.