“Given all that the world has endured this past year, it was important to us as organizers of this international event to center the year’s competition on telehealth — one of the most dramatic changes in health care delivery we’re seen in decades,” said Ingrid Nembhard. The associate professor of health care management at the Wharton School summed up the final day of a contest in April that brought together 21 teams of MBA students battling to devise the best new telehealth system for underserved communities here and abroad.

An annual event of the Business School Alliance for Health Management, the BAHM Case Competition engages students in real-world health challenges in a contest that offers winning acclaim, cash prizes, and potential connections to investors interested in backing viable new business ideas. Established 21 years ago, BAHM is an international consortium of 20 business schools with health management MBA programs, and is focused on collaborations that advance leadership and education in global health care education.

This 2021 Case Competition was different in that it was the first to be internationally collaborative in scope and participation. Co-sponsors of the event were the Wharton School in Philadelphia; Strathmore University Business School in Nairobi, Kenya; the Indian School of Business in Hyderabad, India; the Central American Institute of Business Administration (INCAE) in Managua, Nicaragua; and the IESE Business School at the University of Navarra in Pamplona, Spain.

The winning entries included a system to combat the sale of counterfeit pharmaceuticals in rural African communities, another to address female-centric health care needs in the poorest areas of India, a third to use an Uber-like, gig-economy system to dispatch local nurses to telehealth patients, and a fourth that deployed robots fitted with iPads to address physical and mental health care needs in the immediate chaotic aftermath of hurricanes.

A judging panel of fifteen top executives from health care companies, academia, government agencies, and investment firms specializing in health care technology selected the winners. The projects were anonymously submitted to the judges with no indication of which schools or students were involved.

“By asking the students to develop business models around telehealth for underserved populations,” said Wharton health care management professor Ingrid Nembhard, “we not only address one of the most significant, rapid transformations in health care, but also the important issue of delivering equitable care.”

Nembhard is the Wharton School faculty representative to BAHM, one of the organizers of this year’s worldwide program, and moderator of the April 9 expert panel discussion about telehealth that was the program’s crescendo event.

“By asking the students to develop business models around telehealth for underserved populations,” said Nembhard, “we not only address one of the most significant, rapid transformations in health care, but also the important issue of delivering equitable care, which COVID has highlighted as a continuing challenge in our health systems.”

The contest’s first-place winner was Nufaika Health by Vanessa Folkerts WG20 GEN24 and Penghui Jason Chen WG21 of the Wharton School and two teammates from Strathmore University. Aimed at Kenya’s highly fragmented retail drug distribution system, Nufaika is a digital B2B marketplace. It uses a central digital platform and networks of mobile phones to create a more secure communications, procurement and distribution environment for rural pharmaceutical retailers. One of the problems it addresses is the lack of efficient distribution infrastructure in remote areas; another is the current criminal activities that result in an estimated 30 percent of all patient pharmaceuticals sold in the Kenyan market being counterfeit. (For more about Nufaika Health and the winning team, see this Wharton Stories feature.)

Second-place winner was the TMJ Telehealth team at the Yale School of Management. It offered a comprehensive plan for a female-centric telehealth system focused on rural regions in India. Some 75 percent of the country’s 1.4 billion people live in underdeveloped, remote areas that have high levels of communicable and non-communicable diseases, along with widespread poverty, malnutrition and poor sanitation. The project is shaped by the fact that deeply embedded gender discrimination throughout Indian culture further hinders health care access for poor rural women.

The third-place winner was the Medela program at the University of North Carolina Kenan-Flagler Business School. The gig economy project offers an Uber-like way of connecting large-scale telehealth providers with networks of ultra-local nurses and nurse practitioners who can be dispatched as needed for in-person interventions with telehealth patients. The “last mile” system is aimed at improving overall health care services in rural areas of the U.S., particularly in southeastern states with large populations living in remote areas.

An honorable mention went to the “Spot on Health” project at the Baylor University Hankamer School of Business. It uses Boston Dynamics’ dog-shaped robots as telehealth connectors in the immediate aftermath of hurricanes in the Caribbean. “Health care needs are historically not often met because of the challenges to physically reach patients in the chaos following such storms,” said Baylor presenter Macy Scott. Her empathy for hurricane victims is rooted in her own experience. In 2005, when she was six years old, Hurricane Katrina stranded Scott and her family for three days on the roof of their New Orleans home.

“You can't just take a health system that is inherently inequitable and layer telehealth technology on top of it because that only causes a further divide,” said Joshua Williams of the Ministry of Health in Ontario, Canada.

In the panel immediately following the winning announcements, Nembhard, Wharton health care management lecturer Stephen Sammut WG84, and three experts heavily involved in the use of telehealth discussed the changing context for the technology in the U.S. and around the world. A major point of consensus was the inevitability of continued expansion of telehealth in the post-pandemic period.

“This recognition of telehealth’s utility is not new to us,” said panelist Carlos Nueno, president of international operations for Teladoc Health, one of the world’s largest telehealth companies. “Even before the pandemic, we saw the multiplier effect on the volumes that we manage. What is happening now is the widespread normalization of telehealth as the physician community and patients adopt it. This is not just in the U.S. We’re seeing governments around the world lifting the regulation barriers. Meanwhile, the technology itself continues to advance and accelerate dramatically. The impact is global, and its story is the future.”

Panelist Afsane Jetha W01, managing partner and CEO at the London-based Alta Semper Capital investment firm, agreed: “What underserved communities in emerging markets in sub-Saharan Africa and Asia need is a cost-effective solution that is accessible at the last mile, accessible in very small economic increments, that reliably provides good quality care, and is focused on primary care. That clearly defines a huge opportunity for telehealth. In many of these markets there isn’t a formal health care system at all. There’s just nothing. So you can actually build it in a better way from scratch.”

But there is also serious concern in how telehealth’s rapid expansion is applied to marginalized communities.

“We’ve seen through this pandemic how inequities have been further created and realized,” said panelist Joshua Williams, lead in the Planning, Evaluation and Results Project at Ministry of Health in Ontario, Canada. “You can’t just take a health system that is inherently inequitable and layer telehealth technology on top of it because that only causes a further divide. As we move out of the pandemic and look further down the road at our underserved communities, we need to quantify the principles on which we base our future health care systems and their digital technologies.”

Nembhard also asked the panel if there are specific considerations that should be addressed for telehealth in underserved communities, separate from more well-served populations.

“I don’t think we can segment by well-resourced economies versus less well-resourced economies because even in the well-resourced economies we see the same segmentation,” said Williams. “Some of the underlying infrastructure we take for granted, high speed Internet, mobile phones, are not as pervasive in some of those well-resourced economies’ underserved communities as we might think. Here in Ontario, over the last 12 months, we realized access to high speed Internet and broadband investments across our province are not equitable. And so if you live in a downtown metropolitan area, you’ll have great access and you can connect with your physician or your home care provider via video. But as soon as you move outside of those urban centers, the ability to connect is much more challenging.”

“We have seen a need to understand the lived experiences of those you are trying to serve, then design those programs with them,” Williams continued. “Whether it’s racialized communities, unemployed or underemployed people, individuals who are homeless, or Canada’s very large indigenous population, we need to get out and understand those lived experiences and build new programs to address them from the ground up.”


Hoag Levins is the managing editor for digital publications at the University of Pennsylvania’s Leonard Davis Institute of Health Economics.