Presentation from the 5th International Conference on Education and Information Management (ICEIM-2014), Durban, South Africa

1. Thesis Advisory Committee
Prof. Rekha Jain (Chairperson)
Prof. Kavitha Ranganathan
Prof. Rakesh Basant
Dr. Sudeep K. Krishnan
Open and Collaborative Innovation in US Healthcare:
The Case of Health Insurance Exchange (HIX)

2. Roadmap
INTRODUCTION – Literature Review and Gap Analysis
US HEALTHCARE AND HEALTH INSURANCE
OPEN INNOVATION
RESEARCH OBJECTIVES & METHODOLOGY
CASE STUDY – HEALTH INSURANCE EXCHANGE
IMPLICATIONS AND FUTURE RESEARCH
NETWORK AND COLLABORATION ANALYSIS

3. Introduction to Open Innovation
 Traditional/Closed Model – Emphasis on organizational control for
success of innovations
 Competitive advantage by funding large projects
 Open Innovation – A paradigm that assumes firms should use
internal as well as external ideas and paths to commercialize their
technology Chesbrough (2003)
 Current Research on Open Innovation
 Studies limited to conceptual foundation development based on limited
empirical evidence
 Current studies look at principles, individual drivers, and benefits of open
innovation
 Measures of Openness – Extent of Usage of External Sources
 Partner characteristics (Type and number)
 Phase openness
 Intensity of collaboration

4. Context of Open Innovation
 Required Conditions
 There exists co-operation between firms and other agents in the
network
 The objective of co-operation is creation, adoption or development of
something new to the organization that essentially involves a market.
 Open innovation refers to actual partnerships and is not limited to
cooperation (for longer periods normally, shorter periods may also
exist).
 There is a permanent or quasi-permanent investment in the
relationship by all partners.
 Current study analyzes degree of openness and understands
operationalization aspects of open innovation principles in US
Healthcare Sector
 Partnership as need of new reforms

5. Introduction to US Healthcare and Major Players
 HealthCare reforms in US
 Reduction of Cost and Quality of Care
 Obamacare – Affordable Care Act
 Major Players
5

6. Research Questions & Methodology
 What is open innovation in the US Healthcare Context and
how open innovation principles differ from the traditional
models of innovation?
 How open innovation principles are operationalized in
Healthcare projects?
 How does partner selection and opening up of organization
boundaries happen in such contexts?
 Case Analysis of Health Insurance Exchange (HIX)

7. HIX - Introduction
 HIX helps citizens
 compare health insurance plans online,
 select a plan,
 apply for subsidies intended to make health insurance more affordable, and
 receive verification of enrolment in a plan.
 Requirements
 Handle the needs of two distinct marketplaces—individuals and small employers
(businesses)
 Provide assistance to purchasers
 Facilitate applications for the premium tax credits and cost-sharing subsidies
offered under the ACA
 Provide individuals with access to other health benefit programs (such as
Medicaid) through a “no wrong door” approach to coverage
 Certify that health plans meet benefit standards

8. Network and Collaboration Analysis
 Rationale to Collaborate
 Formation Stage
 Exchange Characteristics – Basic structure itself calls for collaboration
(Federal and state government, insurers)
 Environmental Factors – Potential market, complementarity of partners,
transaction costs
 Reforms Characteristics – ACA calls for insurance and government
bodies are bound to create exchanges
Rationale to
Collaborate
Partner
Selection
Execution

9. Network and Collaboration Analysis
 Partner Selection
 Basic structure itself calls for partnership
 Insurance companies, federal and state government
 Payer and Patients
 Proposed New Partners
 Providers – provision to access insurance policy by provider directly
 Analytics Partners – help in plan selection, cost benefit analysis, online
platform support
Rationale to
Collaborate
Partner
Selection
Execution

10. Network and Collaboration Analysis
 Execution
 Development of online models, tools and platform for analysis and plan
selection
 Desired project management
 Identifying environmental risks
 Control over processes (investment requirement from partners and
identifying roles and responsibilities)
Rationale to
Collaborate
Partner
Selection
Execution

11. Contributions
 Contributions to Open Innovation Literature
 Understanding basic concepts in a new domain
 Exploring operationalization aspects of open innovation across a
project and identifying factors influencing its
 Guidelines for Practitioners
 Identification of prospective partners
 Results will have high impact on HIX implementation
 Future Research
 Simulation Model: US census data and predictive model for usage
statistics and exploring cost
 Influence of credit feature
 Linkages with other policies and coordination of benefits