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.

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.