How social business innovates health care: two cases of social value creation leading to high-quality services

  • Sabine Bohnet-JoschkoEmail author
  • Eugene C. Nelson
  • Claus Zippel
  • Tamara S. Morgan
  • John Øvretveit
Original Article



Health systems worldwide are experiencing increasing cost-cutting pressures with more intense competition and rising customer requirements. We aimed to find out and compare the characteristics and successes of two different sustainable business cases in healthcare delivery from an innovation-driven, organizational perspective.

Subject and methods

The data for the two cases were collected through structured literature research as well as personal interviews with the founders of the two healthcare business models. Data were analyzed using the business model canvas as a structured framework, as well as by cross-case analysis.


The two business models operate successfully, but pursue different approaches to healthcare innovation. We were able to show that one model pursues a very complex, network-based approach that is focused on one specific rural region, while the structure of the other is characterized by a scalable concept. In addition, we observed that the founders had a decisive influence on the development and success of the healthcare business models.


Our study highlights the multitude of complex relationships required to build and establish innovative and successful business models for providing high-quality and cost-effective services in two of the world’s largest healthcare systems. Moreover, it could be shown that the business model canvas offers a suitable methodological framework to compare and analyze in a structured manner the extent to which innovative care approaches also require an economically successful and sustainable business model. Results give a holistic, structured description of specific organizational features and environments, whch can then serve decision-makers in health and health economics as lessons learned and aid them in decision-making.


Business model innovation Case study Healthcare services Integrated care Population health system Primary care 



Accountable care organization


Allgemeine Ortskrankenkasse (German sickness fund)


Chief Executive Officer


Electronic health record


General practitioner


Information technology


Landwirtschaftliche Krankenkasse (German sickness fund)


Massachusetts Institute of Technology


Compliance with ethical standards

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sabine Bohnet-Joschko
    • 1
    Email author
  • Eugene C. Nelson
    • 2
  • Claus Zippel
    • 1
  • Tamara S. Morgan
    • 2
  • John Øvretveit
    • 3
  1. 1.Faculty of Management and EconomicsWitten-Herdecke UniversityWittenGermany
  2. 2.The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth CollegeHanoverUSA
  3. 3.Karolinska Institutet Medical UniversitySolnaSweden

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