An increasing number of companies are using the E-liability carbon-accounting method as an important tool for tracking progress toward reducing global emissions in their supply chains. The system does not require formal accounting for downstream emissions-those occurring after a company sells its products to immediate customers, for several good reasons. Certain companies, however, are accountable for disclosing downstream emissions generated by consumers' use of their products. Three principles govern accountability: (1) Downstream accountability is limited to companies whose products are directly used by end customers. (2) Accountability for B2C companies is limited to cases where a reasonable causal link exists between product-design decisions and the downstream emissions generated by consumers. (3) Companies are accountable for disclosing emissions produced per unit of use, not for total emissions. This article presents the principles and explains how and to what standards of reliability the companies should disclose downstream emissions.
Markets for carbon trading function poorly, and many traded offsets do not actually perform as promised. Without robust protocols for monitoring offsets and in the absence of proper accounting mechanisms, market-based approaches to reducing atmospheric GHG will be vulnerable to misrepresentation and fraud. This article presents an accounting framework based on five core principles. The first two define what can and cannot be counted as an offset and what may or may not be traded. The remaining principles set out basic accounting guidelines for offsets. Together they provide the foundation for a well-functioning market that accelerates innovation and deployment of improved offsetting technologies, leading to atmospheric decarbonization.
The case describes Harvard University's consideration to decarbonize its supply chain by replacing cement with a low-carbon substitute called Pozzotive®. Developed and produced by Urban Mining Industries, Pozzotive® is a ground-glass material made with post-consumer recycled glass. A successful pilot project using Pozzotive® could jump start Harvard's initiative to reduce embodied carbon emissions, but Harvard needs credible information about the magnitude and validity of potential carbon reductions. This case illustrates the flow of emissions along a simple supply chain, from Pozzotive® to concrete production to Harvard University's construction project. Students explore the different methods of measuring carbon emissions, including the greenhouse gas protocol and the E-liability approach proposed by Professors Robert Kaplan and Karthik Ramanna. The case further features the opportunity to leverage blockchain technology to facilitate the flow of comparable and reliable emissions information.
Corporations are facing growing pressure--from investors, advocacy groups, politicians, and even business leaders themselves--to reduce greenhouse gas (GHG) emissions from their operations and their supply and distribution chains. About 90% of the companies in the S&P 500 now issue some form of environmental, social, and governance report, almost always including an estimate of the company's GHG emissions. The authors describe these as "catchall reports that are often made up of inaccurate, unverifiable, and contradictory data." They propose a remedy: the E-liability accounting system, whereby emissions are measured using a combination of chemistry and engineering, and principles of cost accounting are applied to assign the emissions to individual outputs. The authors provide a detailed method for assigning E-liabilities across an entire value chain, using the example of a car-door manufacturer whose furthest-removed supplier is a mining company, which transfers its products to a shipping company, which transports them to a steel company, and so on until the car reaches the end customer.
Dr. Andrea Pusic, breast cancer reconstruction surgeon, wants to extend outcomes measurement beyond traditional surgical metrics of infections, complications, and survival rates. The case describes her development of a new mobile phone app, which collects patients' responses to questions about their post-surgical outcomes and experiences using BREAST-Q, a statistically-validated patient-reported outcomes survey instrument she helped develop. The app provides patients with immediate feedback about their progress, and access to resources customized to their recovery needs. Dr. Pusic also leads a time-driven activity-based costing study to measure the cost of treating patients for all disease stages and across all stages of care and treatment modalities, including psychosocial oncology and physical therapy services. The case describes several care decisions based on the new information on patient outcomes and preferences, and the costs of care. The case ends with Dr. Pusic deciding whether to undertake a project that would adapt the new app for community cancer care centers, which have limited resources, more diverse patient populations, and worse outcome than urban academic medical centers.
The case illustrates the application of value-based health care to dental medicine. ClearChoice Dental Implant Centers was a rapidly-growing network of dentist-owned independent implant clinics. The targeted market included 23 million people, 15% of the US adult population aged 65 or older, who were completely edentulous (toothless), and the 12 million more who were edentulous in either their upper or lower jaw. Relative to dentures, dental implants enabled stronger biting forces and greater chewing capacity, leading to healthier diets and a higher quality of life. Each ClearChoice clinic was staffed with a multidisciplinary care team to provide one-site, full-mouth dental implant restorations during a single surgical day. ClearChoice Management Services provided management and administrative support to all the clinics in the ClearChoice network, including a proprietary electronic dental records system to capture patient information, patient reported outcomes (PROs), site costing, and process times. CEO Kevin Mosher wanted to double the company's size within three years, and faced the challenge of sustaining its highly-rated patient experiences and excellent patient outcomes during the next period of rapid growth.
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.
Kurt Meyer, chief risk officer of Swissgrid, the Swiss national electricity transmission system operator, reflects on the risk management system he installed after the deregulation and liberalization of the European energy market. With 41 connections to other European networks, a failure in Swissgrid's network could interrupt the supply of electricity in Switzerland and much of Europe. Meyer describes the periodic interactive risk workshops conducted at each business unit to identify, assess, and mitigate risks. Executive Risk Workshops of the CEO and the company's leadership team discuss the business units' risk profiles and risks that cut across the units, such as safety, weather, and regulatory changes. New and emerging risks are discussed at Extraordinary Risk Workshops. Meyer recently deployed an app on employees' smartphones for them to easily report anomalies or concerns. Reports from the app are embedded in a new real-time crisis management platform used by several Swiss companies, federal authorities, and the Swiss Army. Despite a full array of risk management tools and processes, Meyer remains concerned about risks yet to be identified.
A gerontologist in Kaiser Permanente's Colorado region is concerned with the high and growing cost of treating the elderly population. She introduces a new care model, Primary Care Plus, using an interdisciplinary team of a primary care doctor, palliative care specialist, nurse coordinator, clinical pharmacy specialist, and behavioral and social service specialists. The team focuses on the highest-risk patients to see if the new, pro-active care model can improve patient, family, and provider satisfaction and lower Kaiser Permanente's total cost of care for this patient segment.
Medtronic is adapting its strategy to changes in health care competition and payments. It has decided to develop new relationships with payers, hospitals, and physicians to become more accountable for patient outcomes and total costs. The case describes new forms of partnerships for therapy optimization, management of acute care episodes, and management of chronic care patients.
Partners in Health, a global NGO focused on delivering health care to residents of rural underserved communities, conducts a project on the cost of primary care at five sites in the Central Highlands of Haiti. It devises a simple approach for tracking the resources used by patients being treated for diverse medical conditions, as an input to a time-driven activity-based costing model. The results show considerable cost diversity across the five sites, but organizational leaders differ on the interpretation and action implications of the findings.
More than a billion people in the developing world remain in extreme poverty and outside the formal economy. Traditional CSR programs have done little to alleviate the situation and rarely produce transformative change. Instead of trying to fix local problems, the authors argue, corporations need to reimagine the regional ecosystems in which they participate. They should search for systemic, multisector opportunities; mobilize complementary partners; and obtain seed and scale-up financing from organizations with a mission to alleviate poverty. They should also align the various stakeholders around the new strategy, using proven tools such as a co-created strategy map. These principles are informed by the authors' experience with several successful inclusive-growth projects. An initiative in Uganda is bringing small maize farmers into the mainstream regional economy, while a training program in El Salvador is giving unemployed youths the skills to work in the country's growing service sector.
The Cost Variance Analysis note was written to provide students with fundamental concepts and methods for the analysis of cost variances. This note focuses on the decomposition of cost variances into price, quantity and mix variance components, an approach that allows students to identify the root causes of differences between expected and actual costs.
One of the key roles of costing systems is to support the evaluation of performance and facilitate appropriate resource allocations. Through participation in a comparative cost study, management at Springfield Hospital, known for its heavy focus on operational excellence, become aware of opportunities for further improvement. Analysis of the differences in costs, uses, and allocations of resources will inform management in the decision and implementation of strategic plans. This case stimulates reflections on the importance of costing systems, in particular Time-Driven Activity Based Costing, and variance analysis as decision support mechanisms.
The United States stands at a crossroads in how to pay for health care. Fee for service, the dominant payment model in the U.S. and many other countries, is now widely recognized as perhaps the single biggest obstacle to improving health care delivery. A battle is currently raging, outside of the public eye, between the advocates of two radically different payment approaches: capitation and bundled payments. The stakes are high, and the outcome will define the shape of the health care system for many years to come, for better or for worse. In this article, the authors argue that although capitation may deliver modest savings in the short run, it brings significant risks and will fail to fundamentally change the trajectory of a broken system. The bundled payment model, in contrast, triggers competition between providers to create value where it matters--at the individual patient level--and puts health care on the right path. The authors provide robust proof-of-concept examples of bundled payment initiatives in the U.S. and abroad, address the challenges of transitioning to bundled payments, and respond to critics' concerns about obstacles to implementation.