This case tells the story of Included Health, a U.S. health care venture born from the unification of a major virtual care provider and two health care navigation platforms. The company's overarching mission is to raise the standard of health care for everyone by becoming a single source where all of a patient's services are provided - such that the patient is fully supported physically and financially. As of late 2023, it served tens of millions of individual members across America, counting as clients 32 of the Fortune 100 companies. We enter the case almost three years since the merger of the health navigation platform that Included Health's CEO Owen Tripp first founded, Grand Rounds, and the virtual care provider Doctor On Demand. He and Dr. Ami Parekh, the chief health officer, are at a crossroads. As the case describes their options for strategic direction going forward, Included Health becomes a window into several important industry themes: rethinking future models of in-person care, government regulation of virtual care after its boom during the COVID-19 pandemic, opportunities and challenges of incorporating AI, the increasing "consumerism" in health care, the primary care doctor shortage, and more.

This case describes the founding and evolution of Oak Street Health, a primary care provider operating in the "value-based" health care space, focused on Medicare patients in the United States. This case introduces students to value-based health care in the United States, in which providers assume full risk for the overall cost of patient care under a system of capitated payments, and contrasts it with traditional fee-for-service health care. Oak Street Health was focused on a resource-intensive model of primary care clinics in more than 20 states, primarily serving low-income seniors. The company had grown rapidly since 2013 and had an IPO in 2020. However, the company was facing increasing competition from large players as health care groups like CVS became more vertically integrated and tech companies like Amazon expressed interest in the industry. This poses strategic questions for Oak Street on how fast to continue growing and what next steps to take, and how to deal with competition while driving toward profitability in a challenging macroeconomic environment.

This case follows the story of Suelin Chen in her career as the founder of Cake, a digital platform that provided "one-stop access" to a wide range of advance care and end-of-life planning products and services. The case highlights the societal, technological, and cultural trends that led to innovation in end-of-life planning. Chen debates which users to target and whether to utilize a B2B or B2C business model to do so.

This case considers the state of telehealth, or the remote delivery of healthcare services via telecommunications technology, in 2019. Doctor On Demand, a promising start-up in the space, sought to solve the four main challenges that the telehealth industry had faced historically. First, although most Americans who had health insurance coverage through their employers also received telehealth benefits, very few knew about these services, and an even smaller number had tried them. Second, the right incentives for payors, such as health plans and large self-insured enterprises, were not in place, a situation that kept utilization rates for telehealth services at stubbornly low levels. Third, Doctor On Demand and its peers needed to add more providers and offer a broader range of healthcare services to patients if they hoped to drive the next leg of growth for their platforms. And fourth, the regulatory environment in which the platforms operated was incredibly complex, and if history were any indicator, other stakeholders in the U.S. healthcare system who felt threatened by telehealth would do whatever they could to impede its rise. The stakes were high, and not just for Doctor On Demand. If CEO Hill Ferguson and his team could address the industry's four major issues, they could unlock the potential of telehealth to deliver better medical care for more people at lower cost.

This case is primarily about the opportunity for mid-career professionals to return to work after a career break. It focuses on the company iRelaunch, which helps companies develop and implement career re-entry programs and connects employees and employers. The case protagonist is Carol Fishman Cohen, co-founder of iRelaunch. The case also touches on the different types of return to work programs and includes a vignette on Chevron which highlights the experience of three women participating in the company's pilot return to work program.

Uncertain how they would monetize their idea, they began with a pilot study in Redwood City. They formed groups of 10-12 seniors and one facilitator; the inexplicit goal was to create a sense of trust and cohesion such that each member would walk away with one friend. With time, they learnt that their programs could do so much more for communities than just provide friendship. By creating environments that enabled structured learning and peer-to-peer sharing, they could bridge many of the gaps in care and encourage members to look after each other and, interestingly, peer-pressure them into looking after themselves. Moshe and Darin realized that being the convener of these communities placed Wider Circle in a unique position in the healthcare value chain, which was attractive from the perspective of healthcare plans. The Wider Circle program could be a way for plans to improve the care experience and reduce costs as well to attract and retain members. Four years on, Moshe and Darin now had clinical validation that their programs were effective and had shown that their business model could generate healthy unit economics. As they prepared to scale and raise their series B financing, their minds were flooded with numerous questions, especially around scaling a people intensive business. Would they be able to identify, recruit, and train facilitators fast enough? Would they be able to recreate at scale the community experience members so loved? Would they be able to sell their program to enough health plans to have meaningful impact on elderly care? Reaching their next milestones would entail scaling from 5,000 to 50,000 members and increasing their revenue 10-fold - this would be their biggest challenge yet and they knew that if they couldn't address these questions, success was not guaranteed.

From quitting a stable post-MBA job and starting FINDMINE, a start-up in the retail technology space, to finally negotiating venture capital investment offers, Michelle Bacharach-and FINDMINE-had come a long way. Two years of uncertainty with virtually no outside capital raised, a pivot from B2C to B2B, two accelerator programs, and numerous meetings with potential investors and customers had made her an entrepreneur who was comfortable with difficult times and choices. However, none of that had prepared her for the decision she faced in March 2016. After over two years of scraping by, Bacharach had finally found investors interested in putting in much-needed funding to help move FINDMINE forward. Just hours before signing the deal, however, one of the investors had requested additional terms at the last minute: he asked for advisory shares and, most importantly, he wanted to add pernicious terms that seemed very unusual. Bacharach's decision was bound to define the future of FINDMINE and, ultimately, her own career as an entrepreneur.

Paul Markovich felt that a time bomb was ticking inside his industry. Each year, the cost of healthcare was rising steadily, while incomes were only inching upward. In 2018, the median income for a family of four in the United States was $65,000. His company's most popular health insurance product for such a family? A package that would cost them $16,000 a year -- a whopping 26 percent of their gross pre-tax income. That was almost three times the cost of such a plan in 1999. In the San Francisco Bay Area, where Blue Shield of California (BSC) was headquartered, the situation was even worse. "If you have a Silicon Valley engineer, it would cost the company more to pay for the health benefits of that engineer [in the United States] than to hire one in India for a year," said Markovich, the CEO of BSC. The problem with insurance companies, Markovich thought, was not out-of-control administrative expenses or fat profit margins. For every dollar that Blue Shield of California customers paid, 87 cents went to pay directly for health care costs, taxes and fees. And as one of the largest not-for-profit health care insurers in the United States, Blue Shield of California capped its profits at just 2 percent per year. "Just being more efficient as an insurance plan is not going to solve the affordability crisis," Markovich believed. "Even if we eliminated our profit and our administrative costs, that would only buy us three years [before costs caught up again]." Something much more fundamental needed to change, Markovich reasoned. Insurers like Blue Shield of California needed to reimagine their role. No longer could they simply define themselves as middlemen who tried to bring together tens of thousands of scattered physicians, hospitals and pharmacies into a network, and make arrangements for treatment and payments.

Fabien Beckers, Founder and CEO of Arterys, walks through the creation of his medical / AI imaging company, including the equity struggles of the founding team, building the right team and final the right channel sales partners.

Dylan Smith, Co-Founder and CFO of Box, describes the various stages of founding the enterprise digital document and data storage company. At each financial raise, beginning with the very earliest family-and-friend money all the way through IPO, Smith describes the options and the thought process that went into each decision.

"Stanford Medicine: Health IT Purchasing Decisions in a Complex Medical Organization" examines how a complex medical organization evaluates new health information technology products to pilot, purchase, and utilize. Every year, hundreds of companies pitched their health IT solutions to Stanford Medicine and its associated entities: the Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, and Stanford Health Care. However, Stanford Medicine would only select a few of these IT products to purchase and implement. Highlighting a few specific health information technology companies and products, this case explores the organizational decision-making process at Stanford Medicine and the criteria used to evaluate new technologies.

In 2007, Jody Greenstone Miller founded Business Talent Group (BTG), a company that connected top independent professionals, including consultants and executives, with global companies for project-based work at a lower cost and with more precision than traditional consulting. From BTG's inception, Miller and cofounder Amelia Warren Tyagi believed that the way people work - and the way companies use talent - was changing for several reasons. High-end business professionals were growing weary of the commonly accepted notion that in order to succeed in one's career, it was necessary to work 60 to 80 hours per week. In addition, the increasing scope and complexity of business around the globe meant that firms were competing across multiple industries and geographies, with products and services launching at a faster pace than ever before. As such, companies demanded human capital with targeted skills and knowledge, as well as workers who could take on specific, time-sensitive projects. Moreover, improvements in technology, including the widespread use of e-mail, smartphones, cloud computing, and video conferencing, allowed individuals to work effectively from almost anywhere in the world. Given these trends, BTG's mission was "to bring together the world's top companies and independent professionals to enhance business performance and improve people's lives." Although BTG encountered some early resistance from companies that were skeptical about the idea - and quality - of independent talent, it did not take long for the BTG model to gain traction. Companies were increasingly convinced of the value proposition associated with utilizing high-end, independent business talent, and the market for independent professionals grew rapidly. Not surprisingly, this growth attracted an influx of new competition. "Business Talent Group: Growing the Market for Independent Business Talent" explores the challenges BTG faced as it pioneered the market for high-end business talent in

Despite the existence of large social networks, such as Facebook and LinkedIn, co-founders Jeff Tangney and Dr. Nate Gross believed there was a unique opportunity to create a social network specifically targeted at physicians. The two envisioned a social network that would enable doctors to find any doctor in the United States, regardless of whether they had signed up for Doximity. By combining hundreds of medical databases and journals onto a single platform, Doximity would immediately contain information on nearly every U.S. physician, including their medical school, specialty, location, phone number, fax number, and associated journal articles. In addition to locating doctors, Doximity would allow for HIPAA secure messaging between any doctors in the United States. Finally, Doximity would provide custom-curated news and research, personalized to the clinical interests on their Doximity profiles. Doctors within any geography or specialty would receive the most up-to-date and relevant information without having to read through dozens of journal articles. Tangney and Gross's vision proved wildly successful; in just two years, Doximity became one of the largest networks for U.S. healthcare professionals, with approximately 10 percent of U.S. doctors as members. By the beginning of 2014, 40 percent of U.S. physicians had signed onto Doximity's platform. "Doximity: Financing a Social Network for Physicians" examines how Tangney and Gross raised capital for their rapidly growing healthcare start-up.

Centered on Practice Fusion, a free web-based electronic health record (EHR) company based in San Francisco, the Practice Fusion case examines the rapid growth of EHR systems in the United States from 2009 to 2014. The case discusses the challenges associated with adopting an EHR system (also referred to as an electronic medical record [EMR] system) from the standpoint of health care providers, both large and small. It also examines the benefits of EHR systems for health care providers, patients, insurance companies, pharmaceutical companies, and society as a whole. In addition, the case explores how Practice Fusion can best grow its revenue in light of slowing EHR adoption among physicians.

This case focuses on major strategic challenges faced by Tenet Healthcare (Tenet), a U.S.-based health care provider, in 2014. It discusses major changes to the health care provider industry over the previous decade―customer, demographic, reimbursement, structural, technological, financing, and regulatory―and raises questions related to the strategic direction Tenet should pursue in response to these changes. The case emphasizes two primary decisions to be taken by Tenet: 1) the acquisition of Vanguard Health Systems (Vanguard), another U.S.-based health care provider, in 2012; 2) portfolio management for Tenet's primary business units (acute-care hospitals, outpatient facilities, health plans, and Conifer Health Solutions) in 2014.

The case follows Brad Griffith, the founder of Gametime, a mobile application for purchasing and redeeming event tickets. The case examines how Griffith assesses whether he has found an attractive business opportunity initially, and later whether he has found product/market fit. It also describes Griffith's decision to be a solo founder and how he leverages contractors and advisors in building the product.

International healthcare and reimbursement systems underwent a radical transformation in the 2000s, resulting from growing financial pressures incited by economic depression and a steady rise in healthcare spending. This phenomenon was most pronounced in the United States, where the health-spending share of GDP rose from five percent in 1960 to 17.9 percent in 2011. In Organization for Economic Co-operation and Development (OECD) countries on average, healthcare spending as a percentage of GDP grew from four percent to 9.6 percent over the same period. Although specifics varied by country, the systemic evolution of international healthcare and reimbursement standards was characterized by two main trends-a shift toward value-based pricing; and more stringent reimbursement standards for new drug evaluations. With this in mind, each country developed its own methods and decision-making processes for reimbursing companies looking to penetrate its market with new innovations. The United Kingdom, Germany, and Japan exemplified this dynamic.

The case profiles the protagonist, Chas Eggert, CEO of OPXBIO-a bio-based, renewable chemicals startup-as he decides on the job positions and specific individuals and candidates to hire after a recent successful round of venture financing. The case provides an overview of OPXBIO, its company history, and the company's technology, as well as its founding team. It discusses the company's upcoming goals and objectives, and its human resource needs. It provides an overview of potential job positions to fill, as well as specific job candidates for those positions. Given the company's limited financial resources, it discusses the main considerations Eggert must debate in order to decide upon the positions and individuals to hire.

Brown Robin Capital details the experiences of Stanford GSB graduates Ryan Robinson and Lucas Braun in pursuing a search fund acquisition. The case explains the search fund model and provides historical asset class performance statistics. Then, the protagonists detail the decision to engage in a search fund, raising the initial search capital, performing due diligence on a series of prospective acquisition targets, abandoning several potential deals, and ultimately buying and running a data services business called OnRamp. The case weighs the personal and professional factors inherent in operating a search fund.

The iPierian case profiles a startup biotechnology company leveraging the recent development of induced pluripotent stem cells (iPSCs)-adult stem cells that have been reprogrammed to a "pluripotent" state whereby they can differentiate into approximately 200 different cell types in the body. The science in this field is in the nascent stages, but the pace of change is rapid as new discoveries are made and as companies devise applications for the technology. iPierian has established itself as an early leader in the space by creating a consistent way to create high volumes of high quality iPSCs and subsequently differentiate those cells into motor neurons. The company must decide between three major directions-tools, drug development of therapeutics-in which it can steer the business and continue to develop its technology. iPierian must also make this decision in the context of the role of large pharmaceutical players in the industry with whom they can either partner or potentially compete against in the race to find successful applications for iPSC technology.