Advertisement

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
  • 112 Downloads

Abstract

Background

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.

Results

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.

Conclusion

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.

Keywords

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

Abbreviations

ACO

Accountable care organization

AOK

Allgemeine Ortskrankenkasse (German sickness fund)

CEO

Chief Executive Officer

EHR

Electronic health record

GP

General practitioner

IT

Information technology

LKK

Landwirtschaftliche Krankenkasse (German sickness fund)

MIT

Massachusetts Institute of Technology

Notes

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.

References

  1. Alderwick H, Ham C, Buck D (2015) Population health systems: Going beyond integrated care. The King’s Fund:15–17Google Scholar
  2. Barnes AJ, Unruh L, Chukmaitov A, van Ginneken E (2014) Accountable care organizations in the USA: types, developments and challenges. Health Policy 118(1):1–7.  https://doi.org/10.1016/j.healthpol.2014.07.019 CrossRefPubMedGoogle Scholar
  3. Berwick DM, Nolan TW, Whittington J (2008) The triple aim: care, health, and cost. Health Aff 27:759–769.  https://doi.org/10.1377/hlthaff.27.3.759 CrossRefGoogle Scholar
  4. Busse R, Stahl J (2014) Integrated care experiences and outcomes in Germany, the Netherlands, and England. Health Aff 33:1549–1558.  https://doi.org/10.1377/hlthaff.2014.0419 CrossRefGoogle Scholar
  5. Cohen D, Vlaev I, Heitmueller A, Parston G, Schmidtke KA, Darzi A (2018) Validation of behavioral simulations: a case study on enhancing collaboration between partnership organizations. J Public Health (Berl).  https://doi.org/10.1007/s10389-018-0948-y
  6. Cutler DM (2011) Where are the health care entrepreneurs? The failure of organizational innovation in health care. Innovation Policy and the Economy 11:1–28.  https://doi.org/10.1086/655816 CrossRefGoogle Scholar
  7. Fernandopulle R (2013) Learning to fly: building de novo medical home practices to improve experience, outcomes, and affordability. J Ambul Care Manage 36:121–125.  https://doi.org/10.1097/JAC.0b013e3182871fac CrossRefPubMedGoogle Scholar
  8. Fernandopulle R (2014) Restoring humanity to health care. J Ambul Care Manage 37:189–191.  https://doi.org/10.1097/JAC.0000000000000013 CrossRefPubMedGoogle Scholar
  9. Gesundes Kinzigtal (2016) Jahresbericht 2015. Innovationen für eine gesunde Zukunft. Gesundes Kinzigtal, Hausen, GermanyGoogle Scholar
  10. Groene O, Hildebrandt H (2017) Germany: evolution and scaling up of the population-based integrated health care system “healthy Kinzigtal”. In: Amelung V, Stein V, Goodwin N, Balicer R, Nolte E, Suter E (eds) Handbook integrated care. Springer International Publishing, Cham, pp 511–524.  https://doi.org/10.1007/978-3-319-56103-5 CrossRefGoogle Scholar
  11. Hildebrandt H, Hermann C, Knittel R, Richter-Reichhelm M, Siegel A, Witzenrath W (2010) Gesundes Kinzigtal integrated care: improving population health by a shared health gain approach and a shared savings contract. Int J Integr Care 10:e046CrossRefGoogle Scholar
  12. Hildebrandt H, Kardel U, Wetzel M, Buntru K, Bachlein B (2011a) Electronic networking and the central electronic medical record as structural organizational elements of regional interdisciplinary health care in healthy Kinzigtal. Z Evid Fortbild Qual Gesundhwes 105:677–683 [article in German].  https://doi.org/10.1016/j.zefq.2011.10.008 CrossRefPubMedGoogle Scholar
  13. Hildebrandt H et al (2015) Pursuing the triple aim: evaluation of the integrated care system Gesundes Kinzigtal: population health, patient experience and cost-effectiveness. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 58:383–392 [in German, abstract available in English].  https://doi.org/10.1007/s00103-015-2120-y CrossRefPubMedGoogle Scholar
  14. Hildebrandt H, Schmitt G, Roth M, Stunder B (2011b) Implementing population-based integrated care for a region: a work-in-progress report on the project “Gesundes Kinzigtal”. Z Evid Fortbild Qual Gesundhwes 105:585–589 [article in German].  https://doi.org/10.1016/j.zefq.2011.09.003 CrossRefPubMedGoogle Scholar
  15. Hildebrandt H, Schulte T, Stunder B (2012) Triple aim in Kinzigtal, Germany: improving population health, integrating health care and reducing costs of care – lessons for the UK? J Integr Care 20:205–222.  https://doi.org/10.1108/14769011211255249 CrossRefGoogle Scholar
  16. Lang C, Kern EAM, Schulte T, Hildebrandt H (2017) Integrated diabetes care in Germany: triple aim in Gesundes Kinzigtal. In: Simmons D, Wenzel H, Zgibor JC (eds) Integrated diabetes care: a multidisciplinary approach. Springer International Publishing, Cham, pp 169–184. doi: https://doi.org/10.1007/978-3-319-13389-8_10
  17. Lupiañez-Villanueva F, Theben A (2014) Gesundes Kinzigtal (Germany) — Case Study Report. Strategic Intelligence Monitor on Personal Health: Systems Phase 3 (SIMPHS3). European Commission JRC, SevilleGoogle Scholar
  18. Nelson EC, Lazar J (2015) Mollie’s story: a case and a place that exemplify person-centered care. J Ambulatory Care Management 38:89–90CrossRefGoogle Scholar
  19. Nolte E, Knai C (eds) (2015) Assessing chronic disease management in european health systems — country reports vol 39. Observatory Studies Series. WHO, Copenhagen.  https://doi.org/10.1177/2053434516655626 CrossRefGoogle Scholar
  20. Osterwalder A, Pigneur Y (2010) Business model generation: a handbook for visionaries, game changers, and challengers. Wiley, Hoboken, NJGoogle Scholar
  21. Pimperl A, Schreyogg J, Rothgang H, Busse R, Glaeske G, Hildebrandt H (2015) Economic evaluation of integrated care systems - scientific standard specifications, challenges, best practice model. Gesundheitswesen 77:e184–e193 [Article in German].  https://doi.org/10.1055/s-0034-1381988 CrossRefPubMedGoogle Scholar
  22. Pimperl A et al. (2017) Evaluating the impact of an accountable care organization on population health: the quasi-experimental design of the German Gesundes Kinzigtal. Popul Health Manag 20(3):239–248.doi: https://doi.org/10.1089/pop.2016.0036 CrossRefPubMedGoogle Scholar
  23. Schubert I, Siegel A, Koster I, Ihle P (2016) Evaluation of the population-based ‘Integrated health care system Gesundes Kinzigtal’ (IHGK). Findings on health care quality based on administrative data. Z Evid Fortbild Qual Gesundhwes 117:27–37.  https://doi.org/10.1016/j.zefq.2016.06.003 CrossRefPubMedGoogle Scholar
  24. Schutzbank A, Fernandopulle R (2014) Doubling down: lessons learned from building a new electronic health record as part of primary care practice redesign. Healthc (Amst) 2:14–18.  https://doi.org/10.1016/j.hjdsi.2013.12.007 CrossRefGoogle Scholar
  25. Stake RE (1995) The art of case study research. Sage, Thousand Oaks CAGoogle Scholar
  26. Stenn TL (2016) Focus on the business model canvas. In: Stenn TL (ed) Social entrepreneurship as sustainable development. Palgrave Macmillan, Cham, pp 55–89. doi: https://doi.org/10.1007/978-3-319-48060-2
  27. Struckmann V, Boerma W, van Ginneken E (2015) The Gesundes Kinzigtal programme, Germany [case report]. ICARE4EU project, co-funded by the Health Programme of the European UnionGoogle Scholar
  28. Swart E, Thomas D, March S, Salomon T, Knesebeck OV (2011) Experience with the linkage of primary and secondary claims data in an intervention trial. Gesundheitswesen 73:e126–e132.  https://doi.org/10.1055/s-0031-1280754 CrossRefPubMedGoogle Scholar
  29. Yin RK (2014) Case study research: design and methods. 5th edition. Sage, Thousand Oaks CAGoogle Scholar
  30. Zuehlke E (2015) Is it fair to compare physicians’ Net Promoter Score to Apple’s? The Advisory Board Company. https://www.advisory.com/research/market-innovation-center/the-growth-channel/2015/09/pcp-consumer-loyalty-survey. Accessed 09/18/2018

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

Personalised recommendations