Early on the morning of April 27, 2020, Justin Oppenheimer stood outside the entrance to the lobby of the Hospital for Special Surgery (HSS) Pavilion Building with mixed emotions. On one hand, Oppenheimer, HSS' Enterprise Chief Operating Officer and Chief Strategy Officer, was excited that HSS was only two weeks away from resuming in-person outpatient office visits (i.e. physician visits not requiring admission to the hospital). Since the middle of March 2020, the global COVID-19 pandemic had forced HSS and other hospitals in New York to suspend nearly all outpatient office visits in an effort to slow the spread of respiratory illness. The Outpatient Care Task Force (OCTF) chaired by Oppenheimer had anticipated the difficulty of reopening while the future of the pandemic was still uncertain and made various accommodations, including dramatically limiting physicians' schedules. Simulations run by the OCTF, however, suggested that even with these accommodations, several patients would be forced to wait outside of the Pavilion building. Given HSS' reputation for patient experience and that many patients seen at HSS suffered from ailments that made it painful to stand, Oppenheimer knew that asking people to wait outside of the building would not (and should not) be tolerated for long, particularly during inclement weather. Oppenheimer opened his phone and sent an urgent meeting request to OCTF to see what further adjustments could be made to alleviate this problem.

Health systems are struggling to address the many shortcomings of health care delivery: rapidly growing costs, inconsistent quality, and inadequate and unequal access to primary and other types of care. However, if retailers and health systems were to form strong partnerships, they could play a major role in addressing these megachallenges. While some partnerships do exist, they are rare and have only scratched the surface of their potential. Rather than focusing on the direct-to-consumer model that retailers have largely employed, the partnerships should offer much broader care. Drawing on real-world examples, the authors outline four key actions that retailers and health systems should take: (1) They must move beyond convenience to offer comprehensive care. (2) They should move care from clinics into the home. (3) They should leverage data to improve clinical care and the customer experience. And (4) they should change how-and by whom-health care work is done. Implementing these four actions would generate improvements that would benefit not just patients but also the organizations that pay for their health care.

This case explores retailer Best Buy's decision to enter health care. Best Buy Health aims to enable care at home across three prongs: consumer health, active aging, and virtual care. A key pillar of Best Buy Health's strategy is leveraging the Geek Squad-the company's technical support agents who install technology and media products in the home-to set up remote patient monitoring devices for people with a chronic disease or those enrolled in a hospital-at-home program. Set in April 2023, the case finds senior company leaders reviewing the results of a pilot with Pennsylvania-based Geisinger Health System evaluating whether Geek Squad agents can safely expand timely access to care.

Set in early 2020, this (B) case provides an update to the (A) case (no. 622-009) and provides additional context regarding the challenges facing Somatus.

When Dr. Ikenna Okezie founded Somatus, a value-based kidney care provider, his goal had been nothing short of transforming kidney care delivery in the United States. Rather than relying on dialysis, a costly and intensive treatment for late-stage kidney disease, the Somatus model called for early identification of patients at high risk along with active management of the underlying conditions that accelerated kidney damage. But he had struggled to find health plans willing to take a chance on his unproven startup, especially in the highly concentrated dialysis treatment market. Thus, in 2017, Somatus agreed to manage traditional dialysis services for a group of hospitals in Virginia, focusing on improving the quality of care. In 2018, Somatus won its first contract with a health plan, finally allowing the startup to implement its full care model. But the contract generated just 10% of Somatus's revenues. Now, in December 2019, Okezie must decide whether to prioritize improving traditional dialysis services or continue to chase health plans willing to implement Somatus's innovative kidney care model.

Soon after closing the 2019 merger of Catholic Health Initiatives (CHI) and Dignity Health to create CommonSpirit Health, Lloyd Dean and Kevin Lofton--jointly appointed to the role of CEO--must make several operational and strategic decisions related to the integration of the legacy organizations. As the second-largest, non-profit hospital system in the United States, CommonSpirit Health was focused on improving population health and increasing the value of the care it delivered to patients. To achieve these objectives, Dean and Lofton needed to make decisions about the extent to which key activities, such as branding and electronic health records, would be consolidated for all of CommonSpirit Health or allowed to remain as parallel functions attached to the legacy organizations. The case allows for a discussion of issues associated with the process and governance of post-merger integration in complex service organizations, with a particular emphasis on such topics in the context of the health care industry.

Amidst the onset of COVID-19 pandemic in the United States, Marcus Obsborne, Vice President for Health and Wellness Transformation at Walmart was planning to scale its new health care clinic business, Walmart Health, to additional locations in Georgia and beyond. Walmart Health aimed to differentiate its offerings from those of competing retail clinics, most notably by offering a wider range of services including visits with primary care physicians, dentists, and behavioral health specialists. Osborne wondered how the pandemic might affect the growth of Walmart Health. How quickly and where should the clinics scale across the country? What services should Walmart Health offer to address broader gaps in public health exposed by the COVID-19 pandemic? Finally, how could Osborne and his team prove the value proposition of Walmart Health to both customers and the leadership of Walmart?

In December 2014, Dr. Anthony Furlan, chair of the Department of Neurology at University Hospitals Cleveland Medical Center (UH), faced a mandate from the hospital's executive leadership team. Specifically, all UH departments were directed to take steps within six months to reduce the waiting time for outpatient appointments-measured as the time to first available outpatient appointment-to no more than 15 days. For Furlan and his colleagues in neurology, achieving this target was a significant challenge, as the department's current time to first available appointment was 93 days. The case considers several alternatives for reducing waiting time in outpatient neurology without increasing the total clinical staff. The case allows students to evaluate opportunities for expanding the effective capacity of a complex service operation and to understand the tradeoffs between customer service and labor utilization.

In February 2016, Kathy Hannun--a project leader at X, Alphabet Inc.'s so-called "moonshot factory--had to prepare a recommendation for the senior leadership of X regarding the future of Foghorn, a project she was leading to develop a carbon-neutral process for converting sea water into fuel. Recognizing the blueprint for projects at X--(1) addressing a huge problem with a (2) radical solution using (3) breakthrough technology--Hannun had to decide whether to recommend killing the project. Despite the technical feasibility of the Foghorn process, its expected cost per gallon of fuel produced was signficiantly higher than the established "kill metric"--the maximum unit cost that Hannun and colleagues had set for continuing the project. The case provides an opportunity to examine the management of radical innovation and the challenges associated with assessing early stage ideas. Topics covered include the importance of experimentation and failure as well as the management of opportunity costs in solving large problems.

In recent years, health care organizations have made sizable investments in information technology. They've used their IT systems to replace paper records with electronic ones and to improve billing processes, thereby boosting revenue. But so far, IT has been of little value in making medical care delivery more effective or less expensive. How can health care organizations change this? One key is to prioritize quality improvement over cost cutting. By harnessing IT to help design better clinical practices, it's possible to achieve better patient outcomes and better financial performance. It is also vital to gather good information--by using simpler, more-organic collection methods--and to make it actionable by applying analytics. Finally, many organizations will need to forge new business and operating models, expanding their IT staffs, revamping how their clinical staffs work, and creating new payment structures. The authors provide numerous examples of health care organizations that are taking these steps--and seeing impressive results.

Headquartered in Salt Lake City, Intermountain Healthcare operates 23 hospitals and hundreds of clinics in Utah and Idaho and provides insurance to approximately 850,000 patients through its insurance arm, SelectHealth. In 2013, Intermountain, known for its commitment to improving health care outcomes and lowering costs by reducing treatment variation, made the surprising decision to invest significant resources in an innovative precision medicine unit, which would provide life-extending, genetically-targeted therapies to late-stage cancer patients. Precision medicine was associated with treatment variation and high costs, the latter of which was of particular concern given that Intermountain often served as both payer and provider for its patients. But Intermountain's management was convinced by Lincoln Nadauld, MD, PhD, who joined Intermountain's oncology team in 2013 and spearheaded the creation of Intermountain Precision Genomics (IPG). By 2016, IPG had a cutting-edge genomic sequencing laboratory that provided sequencing services to Intermountain and non-Intermountain physicians, and IPG's team had conducted research indicating that targeted therapies administered through IPG extended patient lifespans but increased overall costs. Now, in mid-2017, IPG is undergoing a major transition as it prepares to outsource the bulk of its genomic testing volume to Navican Genomics, a for-profit, Intermountain-owned spinoff. As Nadauld contemplates the future of IPG, he must evaluate two exciting opportunities, and students are asked to consider where Nadauld should focus IPG's resources: should IPG partner with Intermountain's behavioral health team to conduct joint research on the relationship between genetic markers and antidepressant effectiveness, or should IPG push for the testing of a large biorepository, which will cost $12 million but could lead to the identification of new precision medicine applications?

The case explores the challenges facing Massachusetts General Hospital concerning the adoption of a new infection control policy, which promises to improve operational performance, patient safety, and profitability. The new policy requires coordination between different departments within the hospital, namely the Emergency Department, the Infection Control Unit, and Admission Services. Students are initially asked to assess the operational, financial and clinical implications of the new policy. They are then asked to examine different approaches to its implementation. Objective: The case allows readers to examine a setting where internal coordination across different departments provides significant aggregate benefits for an organization. Coordination in this case, however, also leads to inequitable allocation of costs and benefits across the different departments, which then provides students with an opportunity to explore various implementation challenges and strategies.

CareMore Health System-a physician-founded care delivery system and health plan-had developed and refined an innovative care model for at-risk seniors enrolled in Medicare managed care (i.e., Medicare Advantage) plans. CareMore's President, Sachin Jain, and his colleagues believed their model achieved the elusive goal of improving outcomes while reducing costs. A key mandate for Jain was to scale the CareMore model beyond its current 75,000 Medicare Advantage members in California, Arizona, Nevada, and Virginia. One approach to scaling was to maintain a focus on Medicare Advantage but expand into new geographic markets. Alternatively, CareMore could focus on serving new populations. For example, CareMore had recently started serving Medicaid (i.e., younger, low-income) patients in Tennessee and Iowa. This case allows for a discussion of whether diversifying to serve these new populations was the key to ensuring CareMore's successful growth or a distraction from its core competency of caring for seniors.

This supplement to CareMore Health System (A) discusses the company's early experience introducing its managed Medicaid model in the Des Moines, Iowa market. It also provides an update on the Memphis program discussed in the (A) case.

In 2015, the Department of Veterans Affairs (VA) ran the largest healthcare system in the United States, with over 1,700 sites of care that served nearly 9 million veterans. One year earlier, a scandal had erupted over a cover-up of the excessive wait times veterans faced to get medical appointments in some VA facilities. The fallout led to the resignation of the Secretary of Veterans Affairs, a criminal investigation by the Federal Bureau of Investigation, and the eventual replacement of 14 of VA's top 17 leaders. This case documents the efforts of the new leadership team to improve access, regain trust, and transform the organization to address the broadening medical needs of the nation's growing veteran population.

In 2013, Sam Frons founded Addicaid-a mobile application (app) that allowed people in addiction recovery to track their progress, check in with counselors, and connect with others in recovery programs. The app was grounded in cognitive behavioral therapy and used the rich set of data it collected from users to suggest tailored coping mechanisms for avoiding relapse. In September 2016, six months after quitting her full-time job to focus solely on Addicaid, Frons struggled to transition what was once a passion project into a full-fledged business. Two weeks earlier, Frons had approached a private, for-profit chain of addiction treatment centers about offering the app to its clients as a support tool for the recovery process once they completed treatment. The chain's management team was interested, but wanted more information about how Addicaid could help it reach its target bed occupancy rate. A recovering addict herself, Frons founded Addicaid in 2013 to help people with substance abuse problems and process disorders (such as food, gambling, internet, pornography, and sex addictions) reach their goals-which presumably included staying out of treatment centers. But now Addicaid needed to establish a business model that also created value for treatment centers. How should Frons address this inherent tension? What path should she pursue to scale her company into a sustainable, revenue generating business?

Founded in 2014, Carrum Health helped self-insured employers located in three markets (San Diego, California; Seattle, Washington; and San Francisco, California) save money on their employees' planned surgeries. It did so by contracting directly with top-quality hospitals located within the area, and negotiating a set fee (known as a bundled payment) for each of five common surgical procedures: knee replacement, hip replacement, cervical spinal fusion, lumbar spinal fusion, and coronary bypass. By 2016, the company was growing steadily and saving its clients over 40% on average on these five procedures. In September 2016, Sachin Jain, Carrum's CEO, received an email from North Beach Apparel, a large retailer based in San Francisco with a growing presence near Chicago, Illinois and Columbus, Ohio. North Beach was ready to partner with Carrum, but the terms of the deal required Carrum to enter the Chicago and Columbus markets in order to serve all North Beach employees. The deal would significantly increase Carrum's revenue and begin to move the entrepreneurial venture closer to profitability. However, by expanding to Chicago and Columbus, the young company ran the risk of spreading itself too thin, especially given the opportunity for growth in Carrum's current three markets. But Jain knew that if he waited too long to expand geographically, Carrum might lose its first-mover advantage in several markets. With limited resources, Jain needed to decide how to scale his young company: should Carrum enter the Chicago and Columbus markets with a guaranteed initial client base and then focus on selling the existing five bundles to new customers there; or, should the company add new bundles to its product line through the existing provider networks in the three markets it currently served?

In the fall of 2012, Hurricane Sandy forced a full evacuation of NYU Langone Medical Center in New York City. The institution, which comprises NYU Medical School and several teaching hospitals, had been on an upward trajectory for several years under the leadership of Dr. Robert I. Grossman. Grossman's central initiative, which he credited with helping to create a performance-driven, transparency-focused culture was an information technology dashboard system that provided managers and front line workers with a wealth of real-time information. Would the disruption posed by the hurricane throw NYU Langone off track?

In 2015, the I-PASS Patient Handoff Program Team, led by six pediatricians around the U.S., had to determine the best way to disseminate their program that had been proven to reduce communication errors in patient handoffs in hospital settings. Should they turn it into a standalone business, continue publishing in academic journals, license their content to an established medical vendor, or do some combination of these? This case allows students to develop and evaluate approaches to disseminating simple and proven innovations with complex service settings.