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.
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- ACO :
Accountable care organization
- AOK :
Allgemeine Ortskrankenkasse (German sickness fund)
- CEO :
Chief Executive Officer
- EHR :
Electronic health record
- GP :
- IT :
- LKK :
Landwirtschaftliche Krankenkasse (German sickness fund)
- MIT :
Massachusetts Institute of Technology
Alderwick H, Ham C, Buck D (2015) Population health systems: Going beyond integrated care. The King’s Fund:15–17
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
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
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
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
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
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
Fernandopulle R (2014) Restoring humanity to health care. J Ambul Care Manage 37:189–191. https://doi.org/10.1097/JAC.0000000000000013
Gesundes Kinzigtal (2016) Jahresbericht 2015. Innovationen für eine gesunde Zukunft. Gesundes Kinzigtal, Hausen, Germany
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
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:e046
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
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
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
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
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
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, Seville
Nelson EC, Lazar J (2015) Mollie’s story: a case and a place that exemplify person-centered care. J Ambulatory Care Management 38:89–90
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
Osterwalder A, Pigneur Y (2010) Business model generation: a handbook for visionaries, game changers, and challengers. Wiley, Hoboken, NJ
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
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
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
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
Stake RE (1995) The art of case study research. Sage, Thousand Oaks CA
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
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 Union
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
Yin RK (2014) Case study research: design and methods. 5th edition. Sage, Thousand Oaks CA
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
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Bohnet-Joschko, S., Nelson, E.C., Zippel, C. et al. How social business innovates health care: two cases of social value creation leading to high-quality services. J Public Health (Berl.) 28, 419–428 (2020). https://doi.org/10.1007/s10389-019-01026-y
- Business model innovation
- Case study
- Healthcare services
- Integrated care
- Population health system
- Primary care