gms | German Medical Science

Background: While health systems worldwide are struggling with rising costs, inadequate coordination of care and rising customer requirements, some innovative business models have started to create value in health services delivery by scoring on all three triple aim measures – better health outcomes, better patient experience, and lower per capita costs [1].

Research question: 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. The first case, Gesundes Kinzigtal (Healthy Kinzigtal), is a population-based health services model serving a region in southwestern Germany [2], [3]. The second case, Dartmouth Health Connect, is a primary care-based model offering personalized services for Dartmouth College, the King Arthur Flour company, and the Carpenters’ Union in rural New Hampshire. Both cases are based on a social business model and are broadly acknowledged as being both innovative and entrepreneurial [4].

Methods: We used a case study approach. 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 structurally analyzed using an adapted version of the business model canvas [5] as well as a cross-case analysis. The adapted canvas model focused on the following principles of value generation in health care delivery: (1) patient target group, (2) value proposition, (3) channels, (4) patient relationships, (5) revenue streams, (6) key resources, (7) key activities, (8) key partnerships, (9) cost structure.

Results: Both business models operate successfully but pursue different approaches to healthcare innovation. One model pursues a very complex network-based approach that is focused on one specific rural region, while the structure of the other is not site specific and shows a scalable approach. In addition, the founders have a decisive influence on the development and success of the healthcare business models. Our cases confirm the enormous potential for disease prevention and patient engagement and show ways to unfold it. They offer returns on health and on investment, and give examples that there is more than one way to activate it.

Discussion: Our study highlights the multitude of complex relationships required to build and successfully establish innovative business models for providing high-quality and cost-effective services in two of the world’s largest health care systems. Moreover, it can be shown that the 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 for health services delivers. However, although the two cases offer great potential for organizational learning it must be noted that single cases are not generalizable – especially when the specific characteristics and environmental factors of the highly-regulated health care environment are taken into consideration.

Practical implications: Our results show that the triple aim of lower costs for better health outcomes and patient experience can be met by innovative business models. Our case study approach can give a holistic, structured description of specific organizational features and environment that can then serve decision makers in health and health economics as lessons learned and for decision-making. While both business models work in different countries with different health systems and are different in structure and size, our analysis can provide some common lessons learned. These included, i.e., that investment in scalable technology is an important key to the business model and that medical doctors continue to be central for ambulatory care delivery, but delegation to other professionals with appropriate training can allow intensive patient support without costs exploding.

Author’s note: The results have partly been published in the Journal of Public Health [6].