This case describes how Boston Medical Center, a hospital and safety net organization, changed its strategic approach to health equity after realizing that previous efforts were not sufficient to address the health disparities among their patients. In 2021, the Health Equity Accelerator was formed to coordinate this strategic approach, which adopted race-based disparities as their primary focus. Over three years the Accelerator demonstrated impressive reductions in racial and ethnic disparities in health outcomes among pregnant women and patients with diabetes. These results reinforced their drive to scale their innovative approach, and set an example for other institutions nationwide. However, scaling presented significant challenges: balancing replicable and standardized "off the shelf" solutions with distributing a "methodology" to enable other institutions to identify their own solutions to inequities in their patient population.

The case study examines the journey toward value-based healthcare at Karolinska University Hospital. The hospital's ambitious shift to a patient-centered care delivery model, accompanied by the construction of a new facility, encountered challenges such as high costs, staff dissatisfaction, and growing waiting lists. The departure of CEO Melvin Samsom in 2018 left the new director Bjorn Zoega with a budget deficit, discontented staff, and an outdated IT system. By 2023, however, Zoega had achieved a remarkable turnaround. Ranked among the top 6 international hospitals, the institution boasted a positive budget and had exceeded production assignments for three consecutive years. In 2023, Zoega pondered if his changes were long-lasting and how the Hospital should face new challenges such as an aging population and a shortage of qualified nurses.

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.

The case describes two pilot projects on applying activity-based costing to measuring the cost of treating patients. It presents process maps and financial data relating to the processes used during (1) an office visit to a plastic surgeon for three different diagnoses, and (2) application and removal of three different casts in the orthopedic cast room. Students calculate and compare the costs and margins of the three procedures at the two different sites using the hospital's existing cost system and a proposed new system based on time-driven activity-based costing.

The case describes two pilot projects on applying activity-based costing to measuring the cost of treating patients. It presents process maps and financial data relating to the processes used during (1) an office visit to a plastic surgeon for three different diagnoses, and (2) application and removal of three different casts in the orthopedic cast room. Students calculate and compare the costs and margins of the three procedures at the two different sites using the hospital's existing cost system and a proposed new system based on time-driven activity-based costing.

The case illustrates how a leading German hospital group has invested deeply in the measurement of patient-level outcomes and costs, the foundations of a health care value framework. The company launches a pilot project to use time-driven activity-based costing (TDABC) for measuring the cost of total knee replacements. The costing project complements an existing initiative for comprehensive outcomes measurement. The combination of accurate measurement of outcomes and costs empowers local personnel - physicians, nurses, and administrators - to improve the value of care they deliver. It also permits benchmarking across the group's multiple hospital sites to identify best practices that can be shared. The case concludes with a decision on using outcome and cost measurement to inform the adoption of a new recuperative approach that promises to dramatically lower post-surgical length-of-stays.