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A medical device startup seeks to complete its clinical trials with very little startup funding and a small staff when compared to its competitors.

MedCath is a horizontally integrated chain of heart hospitals that partners with local cardiologists. It claims that its focus leads to better and cheaper results than those of an everything-for-everybody general hospital. Community hospitals generally vehemently oppose their entry into a new area. What options does MedCath have?

The La Ribera case studies depict an innovative low cost/high quality privately financed hospital model struggling to achieve alignment with the Six Factors. It is reimbursed by the public sector in a Spanish environment whose Consumers, Structure, and Public Policy favor public health care. But the Accountability factor shows it to be the highest quality hospital in the region with 25% lower costs and Spain's Financing is weak. The A case (9-315-006) asks: What Business Model elements enabled La Ribera to achieve this level of value? How can it improve on its 1% profit margin and better align itself with the Six Factors? The hospital hired a consulting firm that presented four new options that could potentially increase returns. Which, if any, best fit with the ten elements of its Business Model? The B case (9-318-134) contains the dénouement for La Ribera.

Describes the challenges facing Dr. John Noseworthy, President and CEO, in implementing a long-term strategy for the growth of the Mayo Clinic-a leading academic medical center with a reputation for excellence in tertiary and quaternary health care. The case highlights the concurrent forces of regional and national competition and federal health care reform as factors complicating the plans of Mayo Clinic to grow through several channels. Students must ultimately decide whether Mayo Clinic should focus its future growth on its current areas of expertise (regional provision of integrated medical care and international provision of tertiary and quaternary care), new opportunities in a broader range of services and treatment channels (e.g., telemedicine, mobile health, enterprise learning and training for other health care systems), or some combination of these opportunities.

Hospital for Special Surgery, a focused factory for orthopedics and joint disease, is contemplating various growth options: further growth in the United Kingdom's National Health Services, management of hospitals in the United States, and/or hospital consulting. Reviews the issues surrounding growth of a nonprofit institution and the United Kingdom's socialized health care system.

This case, a follow-up to Cancer Treatment Centers of America (A), HBS No. 313-012, begins with the debate over New Hampshire's certificate-of-need (CON) law, which restricts hospital expansion. This debate ignited significant public criticism of Cancer Treatment Centers of America (CTCA), a for-profit chain of five cancer-focused hospitals that had previously won a CON exception in Georgia, over its for-profit status and low acceptance of government-insured patients. The case also introduces the controversy over CTCA's cancer treatment outcomes-reporting practices, as well as the disparities in outcomes-reporting practices by cancer treatment providers generally. By providing perspectives on both sides of the issues, the case allows students to debate and draw their own conclusions about whether organizations like CTCA should be granted CON exceptions and whether the criticisms of its patient-acceptance and outcomes-reporting practices are well founded.

The management of Germany's Brainlab AG, a leading provider of software-driven oncology and surgery solutions, needs to evaluate strategic options for proceeding without an exclusive hardware partner in its most profitable business segment.

Through the lens of biopharmaceutical contract research organization (CRO) PAREXEL, this case traces the evolution of the firm as it reinvents itself in response to the transformation of the CRO sector from a small, secondary cluster of firms into a major player with essential capabilities for global drug development. The case begins as PAREXEL is pursuing an expensive globalization and IT strategy while many of its competitors focus on cost cutting. Over the prior 20 years, CEO Josef von Rickenbach had grown PAREXEL into a billion-dollar company by taking calculated risks and making bold investments based on anticipated industry trends and client demand. Now, despite slowing demand for CRO services, PAREXEL is betting that a global footprint and technology capabilities will become its key future competitive advantage. Near the end of the case, the timing transitions to a decade after Rickenbach made this strategic decision, describing the development of the industry and PAREXEL's place within it.

Brazil's largest dental insurer, a successful and innovative firm, has saturated the corporate market and faces stiffer competition. It must decide whether to enter a new market in Brazil or to expand into other parts of Central and South America.

Contains the framework for the second-year Innovating in Health Care course. Delineates the role of six exogenous forces on new ventures: structure, financing, regulations, consumers, accountability, technology, and public policy. Also, presents the essential elements of business models for new health care ventures.

The management of Germany's Brainlab AG, a leading provider of software-driven oncology and surgery solutions, needs to evaluate strategic options for proceeding without an exclusive hardware partner in its most profitable business segment.

Would the advent of global payment models and ACOs create sufficient demand for a telemedicine offering covering the care continuum, from hospitals to the home? This was the decision facing Royal Philips Electronics (Philips), the Netherlands-based producer of lighting, consumer electronics, and health care products, in 2012. Philips already offered several remote monitoring systems for hospitals, including the eICU, which it obtained through the 1998 acquisition of Visicu. In the eICU model, patients in hospital ICUs were monitored using bedside devices, which transmitted patient data to a remote station from which clinicians monitored and directed care as needed. The model aimed to improve care quality by enabling early interventions and reducing adverse events, and to cut costs by allowing clinicians to care for a larger number of patients. Building on this and other offerings in its portfolio, including numerous home care devices, Philips could extend this model to create an integrated remote monitoring offering managed through a centralized clinician-staffed station. In doing so, it could gain a deep and early foothold with ACOs and position itself as a leader in telemedicine-enabled care. However, U.S. telemedicine adoption to date was slow, in part due to insufficient cost-effectiveness evidence, and ACOs-the likely target customer-remained underdeveloped. Philips would also contend with a complex selling process and numerous operational challenges. Was it too early to invest? And, if not, who were the ideal ACO beta sites?

Shanghai Pharmaceuticals (SPH), a vertically integrated Chinese pharmaceutical conglomerate, was considering its strategic options in the context of a rapidly evolving industry, policy, and economic environment. The company-essentially a collection of subsidiaries operating under a unified management structure-was formed through the 2009 merger of several state-owned enterprises, part of a broad policy effort in China to streamline state assets, consolidate the fragmented pharmaceutical sector, and enhance the global competitiveness of domestic firms. As it competed with other large domestic firms to become one of the few national champions that the government hoped to create, SPH was also considering an acquisition in the U.S. or Europe. This case allows students to consider the broad trends sweeping China's pharmaceutical industry and health care sector and assess future opportunities there for domestic and foreign businesses.

This case asks students to price a new drug that is in Stage II of its clinical trials. It contains detailed estimates of the time required and costs for all the steps needed to commercialize a drug in the U.S. Students will learn virtually all the steps required to bring a drug from an idea to commercialization, and the time and resources these steps require.

This case compares and contrasts four different models for delivering cancer care in India and the US. Students are asked to select the best model in its alignment with the Six Forces in those two countries and Africa, to which one of the models is considering expansion, and intrinsic business characteristics. The Indian models are all focused factories, but one is a hub and spoke model, with a radiology hub and ambulatory spokes, while the other offers only ambulatory services. The U.S. models are all focused factory hospitals, one academic and the other a private, for-profit firm located on the grounds of teaching hospitals.

Cancer Treatment Centers of America (CTCA), a U.S. network of four privately owned oncology focused factory hospitals, was weighing options for growth. CTCA was entirely cancer focused and specialized in treating patients with complex and advanced-stage cancers, who were reached through advertising its integrative, team-based approach to care. CEO Stephen Bonner needed to decide whether to focus future expansion on building additional full-scale hospitals or pursuing a hub-and-spoke model, in which numerous oncology outpatient centers would be built in the region of each CTCA hospital. His decision would be made in the context of CTCA's unique business model and treatment philosophy and the public policy landscape, including certificate-of-need laws and the advent of Accountable Care Organizations (ACOs) and bundled payments. CTCA's for-profit status and direct-to-consumer advertising made it a target, he knew.

McKesson, a large, diversified drug distribution and health care IT company, is considering development of new business offerings to help private practice physicians remain independent. The company, with $122 billion in 2010 revenues, just made its first foray into health care services with the acquisition of U.S. Oncology, an integrated cancer care company, whose expertise it could leverage in offerings catered to other physician specialties. With a vast portfolio of products and services serving a wide spectrum of health care stakeholders, McKesson appears uniquely positioned to understand and capitalize on the needs of health care businesses. With the recent passage of health care reform adding to the pressures already squeezing the health care industry-including new payment models requiring significant coordination and IT capabilities-independent physicians are migrating in droves to large health care organizations, abandoning the private practice model. McKesson could potentially provide them with an alternative. McKesson is an exceedingly large company with somewhat autonomous business units, making the prospect of collaborating to create a "cross-disciplinary" offering for independent practices difficult. Moreover, doing so would potentially extend McKesson into the clinical health services (and potentially risk-sharing) business, the strategic merits of which can be debated. Given the uncertainty surrounding the physician practice environment, the ideal shape of a solution to help these customers remains unclear, and competitors with a different product mix could be better positioned than McKesson to provide it. Finally, it could be too late altogether to reverse the trends eroding the private practice model.