Pear Therapeutics seemed off to a promising start as a young digital therapeutics (DTx) company, taking a focused approach to demonstrate the efficacy of new software therapies, generate value for prescribers and patients, and secure reimbursement from insurance companies. Investors were also excited about the potential for evidence-based, software-driven therapeutic interventions - instead of going to a pharmacy for a bottle of pills, patients would get a prescription to download a software app designed to help treat their disease. And new DTx companies like Pear Therapeutics saw great promise in packing the power of a pharmaceutical products into a software products. The case study provides background on the rapid growth and challenges in the new DTx field, and details of Pear's early successes with digital therapies designed to treat insomnia and substance use disorders. But for Pear, continuing investment in the development of a robust produce portfolio proved difficult, in light of the difficulties navigating the insurance reimbursement minefield, while managing investor expectations. Were Pear's troubles - and eventual failure - an ominous cloud over the future of the DTx sector?

Health equity became a hot topic during the pandemic, when health care disparities and higher mortality rates for Black and Latino patients became front-page news. New discussions about the structural determinants of health in the United States looked deeply at the impact of racial disparities and racism on health behaviors, clinical care, social and economic factors, and physical environment on health outcomes. The Unite Us technology platform was devoted to helping identify, deliver, and pay for services that affected whole-person health, with the goal of screening at-risk individuals for referrals to broader assistance from government services and community-based organizations. Could Unite Us and its partners build the coordinated care networks to provide whole-person health to populations that had long borne the brunt of racial disparities-and reduce health care costs?

New digital technologies and advances in hearing aids could help people hear more clearly, but hearing aids could cost thousands of dollars-and Medicare didn't cover the cost of the devices. This case study discusses the disruption to the U.S. hearing aid market in the United after the Biden administration created a new regulatory pathway for the sale and service of over-the-counter hearing aids, without a prescription. How would the five companies that had long dominated the market adjust to the change? How would new competitors like Apple develop retail strategies for Bluetooth-based products, and provide support and troubleshooting services?

While India had made significant progress against diseases like polio and tetanus, the pandemic revealed marked differences in COVID-related illness and death among the country's most vulnerable. Urban-rural and other societal divides added to long-time disparities in access to health care, and public resources could be overwhelmed. Could a new national health plan and digital health mission allow India to innovate on health care, with the goal of creating high-quality affordable health care for all? This case explores a multi-stakeholder, collaborative approach to understanding and leveraging new technologies that could integrate a complex, fragmented health care system. This ambitious effort would involve harnessing mobile technologies and expanding broadband access to provide critical digital health solutions for India's large rural population. And this effort would capitalize on best practices and lessons elsewhere in the digital health ecosystem-allowing India to leapfrog the shortcomings of national health information systems that had emerged elsewhere in the world.

Health care was one of the largest sectors of the U.S. economy, but administration costs accounted for a growing share of health care spending. The administrative burden for health care in the United States was far higher than in other countries-was this an area ripe for transformation, and greater efficiency? While a typical credit card transaction might process immediately, health insurance payments could take many weeks to process. A primary care physician in the United States, for instance, might have to spend $20 or more to submit a single bill and collect payment, far more than the comparable cost in other countries. This case study explores the structural factors that contribute to high administrative costs in health care, from regulatory compliance costs, to the large number of unique contracts between insurance companies and providers, to the complex contractual requirements-and multiple provider manuals and updates. For this sector, what was holding back the innovation and efficiency that had evolved within the traditional finance ecosystem? Would health care billing emerge as the next big disruption target-and what pathway would offer innovators the best chance of success?

Teladoc and Livongo had ridden the tailwinds of the COVID-19 pandemic-and a merger between the two would offer a "one-stop-shop" for technology-driven care for patients with acute, chronic, and specialty care needs. The case study describes the regulatory history of telemedicine in the United States, and the licensing barriers that had inhibited virtual doctors' visits-until the 2020 COVID-19 pandemic forced urgent changes to the ways doctors and patients interacted. Would the Teladoc business model-and the proposed merger with Livongo-help establish the company firmly in the increasingly competitive telemedicine field? Analysts projected the telehealth space would grow at a compounded annual growth rate of more than 20 percent over the coming years. Livongo, with 147 million members, offered software and personalized health coaching to address diabetes, hypertension, behavioral health, and weight management. Did this acquisition make sense for Teladoc?

Cataracts robbed an estimated 65 million people around the world of their vision. In the Himalayas, where hundreds of thousands of people went needlessly blind from cataracts, doctors Sanduk Ruit and Fred Hollows began to tackle this health crisis in 1995 with the Himalayan Cataract Project, believing they could adopt new techniques and lens technology to scale high-quality, high-volume, and low-cost cataract operations in remote communities. This case study details the development of the Tilganga Institute of Ophthalmology (TIO) in Kathmandu, Nepal, including efforts to establish cost-effective cataract treatment centers and ophthalmic education programs to train current eye care technicians and specialists, as well as the next generation of eye care leaders. Students will also understand the time-driven activity-based costing analysis process, as TIO needed to calculate resource needs as the institute expanded services into rural areas, where eyecare needs were high but patient resources were limited. What would this analysis reveal about ways to ensure safe, effective cataract surgery in other low-income countries-and were there also takeaways that might inform cataract surgery practices in the United States and other high-income countries?

In February 2020, companies around the world contemplated their next moves as the pandemic news grew more grim each day. For Savannah Informatics, one of the first information services firms in Africa's health care sector, the uncertainties and immediate supply chain challenges prompted nimble moves to make sure the technology continued to perform, but also served as a call to innovate further, and add new digital offerings. This case study addresses the challenges of new product development in the health care sector, and the complexities of meeting the needs of medical providers, insurance companies, and individual customers. How would the company prioritize its next moves, and expand its technology platform? How could Savannah use its existing data on health care spending in Kenya to map out new products, including health information, telehealth and prescription services, and disease care management? And how could it distinguish its services from new competitors who also saw new demands for innovative health care solutions arising as the COVID-19 pandemic continued.

As the COVID-19 pandemic shut down businesses and schools in 2020, global health authorities and governments kick-started the quest for a vaccine for the novel coronavirus. This case study details Operation Warp Speed, the $18 billion public-private partnership initiated by the U.S. government to accelerate the research, development, manufacture and distribution of COVID-19 vaccine therapies. The case explores the history of public-private partnerships in the United States, and the ambitious U.S. government effort to deliver 300 million doses of a COVID-19 vaccine by January 2021.

Devoted Health aimed to build the next-generation Medicare Advantage health insurance plan, taking advantage of tech solutions to ensure cost containment for the company's bottom line- and a high-quality health care plan that treated members like family. The technology platform would be critical to coordinate the logistics of patient-centered care, identify and recruit the highest-quality providers, and keep a tight control on operating and administrative costs. The case discusses the cost calculations and competitive landscape in the fast-moving Medicare Advantage market, where start-ups and big insurers were jostling to provide America's seniors with health plan options beyond the basic Medicare coverage. This type of plan covered one-third of Medicare beneficiaries in 2019, and this figure was projected to grow to 42 percent by 2028. To generate profits, Medicare Advantage companies focused on high-touch patient care to keep patients healthy and out of the hospital. In Devoted's operating model, high-tech efforts and predictive modeling would also be key to its successful expansion to new markets.