case study interview financial services

Financial Services Case Interview: 4 Tips on How to Pass

• Last Updated December, 2021

A good case structure will get through any consulting case interview question. But some industries have specific issues that make it a lot easier to pass the case if you know what to expect. Financial services case interviews are like that.

Government regulation of financial institutions, their corporate structure, and business models are quite different from other industries, so it’s good to brush up on the financial services industry before facing a case.

In this article, we’ll discuss:

• Differences between financial services firms and other firms.
• Common types of financial services case interviews.
• A financial services case example.
• 4 Tips on acing your financial services case interview.

Let’s get started!

Differences Between Financial Services Firms & Other Firms

Financial services case interview example, common types of financial services case interviews.

5 Tips On Acing Your Financial Services Case Interview

Financial services firms don’t make cars or serve hamburgers to customers to generate revenue the way an auto company or a fast-food restaurant does. Instead, they provide retail customers (individual consumers – people like you and me) and businesses with loans, deposit accounts, or insurance policies. Or they help them invest their money in stocks, bonds, or other financial instruments.

Corporate Structure

There are many different types of financial institutions and they exist both on paper (e.g., online banks) and in actual brick-and-mortar form (e.g., retail bank branches with ATMs). Typical financial institutions include:

• Commercial banks (provide business loans, home mortgage loans, and savings/checking accounts)
• Investment banks and securities firms (help people buy and sell stocks and bonds and help companies issue them)
• Insurance companies (provide insurance for homes, cars, business risk, health, etc.)
• Mutual funds and pension funds (manage retirement savings or savings for other goals, e.g., education, health, etc., by investing it in stocks, bonds, and other assets)
• Microfinance companies (provide small loans to populations underserved by traditional financial institutions)

Businesses that “make stuff” have a factory where parts go in one end and cars or hamburgers go out the other. Financial institutions, on the other hand, have people who handle the bank accounts, stocks purchases/sales, or insurance products that they provide, and all the investment decisions and paperwork that go with that service.

Business Model

Unlike other sectors, the financial services industry’s business model is largely based on interest, fees, and premiums. Don’t get bogged down by the variety of products and services that a financial institution has to offer. You only need to remember:

• Key income sources: interest earned by selling retail and corporate loans, premiums earned on insurance policies, fees earned on financial advisory (e.g., stockbroking) or on deposit accounts, etc.
• Key costs: interest paid on deposits from retail investors and corporates, insurance claims/payouts, branch operations, manpower, SG&A, etc.

Always confirm and validate the drivers of revenue and cost with your interviewer before jumping to solving any financial services case.

Regulation and Risk

A well-functioning financial system is vital for the economy, businesses, and consumers. When a financial institution fails, it can create problems for the wider economy as the 2007-2009 financial crisis showed us. Financial services firms, therefore, attract high levels of scrutiny and oversight.

Government regulation helps make sure that these institutions have good management so they don’t make bad investments or become too risky. They require that financial institutions hold “shock absorbers” (i.e., capital) to help deal with bad investments. Each country has its own set of norms and regulations that create the framework and operating model for financial institutions.

In a financial services case, therefore, it’s always important to include regulation as a category in your issue tree. You can check with your interviewer on which aspects of financial regulation and risk are relevant to ensure that ideas you brainstorm in the case won’t break laws. Aligning on this upfront increases your credibility with the interviewer, but regulation is not typically the focus of the case.

Nail the case & fit interview with strategies from former MBB Interviewers that have helped 89.6% of our clients pass the case interview.

Financial services cases can include revenue growth, cost reduction, or new product introduction like they would for any other industry. They can also include managing the “back office” where financial account information is maintained or stock and bond trades are cleared.

Here are some financial services case interview examples:

• Disconsa – A McKinsey case on developing better financial service offerings for a not-for-profit entity serving remote Mexican communities.
• Internet Bank – An L.E.K. case on product diversification for a large insurance company in Europe.
• Big Bucks Bank – A Deloitte case on technology transformation for a large US-based bank.
• Bank of Zurich – A Deloitte case on developing a strategy to structure the organization’s data program.

We’ve also curated a list of case examples , to help you hone your business problem-solving skills. Head to Our Ultimate Guide to Case Interview Prep to learn what a case interview is and its various stages (i.e., opening, structure, analysis, and conclusion). The best way to get smarter about answering financial services case interview questions is to master this general four-part approach first and then apply financial services specifics as appropriate.

Let’s dive into a financial services case example.

Case Question

“Your client is Go-for-Growth bank, a large bank in a frontier market that wants to rapidly build its agent network to grow revenue for its payment and banking business. How should they go about it?”

First, repeat the main information in the prompt to the interviewer to make sure you got it right, and ask clarifying questions. If you don’t know what a frontier market is or who banking agents are, ask your interviewer.

Frontier market is a classification made by Standard & Poors, a financial rating agency, that’s used to classify less advanced economies in the developing world, e.g., Vietnam, Kenya, Nigeria, Cambodia, etc.

A banking agent is a retail or a postal outlet contracted out by a financial institution (in this case Go-for-Growth bank) to process clients’ transactions. Typically, in less advanced economies, the population has little access to banks but significantly higher interaction with establishments such as pharmacies, grocery stores, post offices, and beauty salons. The agents help the banks get new customers and typically make money on commissions.

Take a moment to develop your own hypothesis for the Go-for-Growth bank case.

Financial Services Case Hypothesis

Your hypothesis could be that a banking agent is a cost-efficient way for the bank to acquire customers and distribute financial products vs. having to set up their own branches across the country (including paying rent for office space and hiring staff in each location).

Next, validate your understanding of the bank’s business model, corporate structure, and applicable regulations. Here, the bank is a traditional commercial bank that wants to add agents as a channel to acquire retail customers and sell traditional financial products and services (e.g., loans, deposits, etc.) Building an agent network is allowed within the regulatory framework of the country.

A great candidate would also establish:

• The purpose of agent acquisition: “Why agents?” “Why now?” and “What is the size of the opportunity (or market) that the bank is chasing?” Here, the interviewer can confirm your hypothesis about agents being cost-efficient vs. Go-for-Growth Bank having to set up brick-and-mortar establishments.
• The size of the opportunity: Establishing an agent network is a big undertaking so it’s worth ensuring the opportunity size is big enough to justify the cost. In this case, the total opportunity size is $3 billion given the country is largely underpenetrated with only 10-20% of the total population of 100+ million having access to financial services, so the opportunity is worth it. (Note that to make this a short case or one that would be appropriate for undergrad summer interns, sizing the market could be the sole focus.)
• The client’s key success metrics : “What does success look like to Go-for-Growth Bank?” Here, you should clarify the target network size and the target timeframe to meet the client’s growth target. Say, your interviewer adds that they want to scale up to a size of 200,000 agents in 2 years to achieve the topline impact of $3+ billion.

You’d now ask for a minute to lay down your thoughts so that you can build your structure.

Take a moment to think about how you would structure this case before reading ahead. That will give you a sense of what business issues come naturally to you in a financial services case and where you need to push your thinking further.

Here’s a sample case structure:

• Which services/revenue streams should Go-for-Growth Bank market via the agents and to which end customers?
• Which of the existing products and services are most profitable?
• Which products and services don’t need extensive training for agents to sell?
• Which products and services best meet the needs of the customers who agents serve (e.g., payments and basic deposit accounts and loans, not more sophisticated financial products).
• Is there a segmentation of customers who should be targeted by the agents?
• Will the bank need to tweak their products to make them profitable to customers acquired through the agent network? (An A+ answer would note that clients with low incomes or lumpy earnings might need bank accounts with lower minimums.)
• Is there opportunity for cross-sell/ up-sell of products to customers?
• How to reach the agents? (sales force/feet on the ground vs. email campaign)
• How to get them interested in becoming a channel partner? Will one-time, up-front incentives be required?
• What is the process to get them on board?
• What cut can be given to the agents (so the bank continues to be profitable)?
• What will be meaningful for the agents?
• Can gamification reward schemes be introduced?
• Would certification or co-branding, such as a sticker to display the agent’s affiliation with Go-for-Growth Bank, appeal to potential agents?
• What banking products can be sold to the agents?
• Can the agents be offered discounted pricing on the products?
• What is the up-front effort/cost to acquire agents?
• What is the expected revenue or profit uplift per agent to the bank?
• How much should each agent sell annually/monthly to continue being profitable to the bank?
• What are the recurring costs to maintain the agent network?
• Which metrics should be used for tracking performance?
• Can low performers be segmented further based on their potential?
• What will be the plan of action for consistent low-performing agents?
• Which training(s) and products’ brochures should be offered to agents to keep the customer conversion rate high?
• How can we create a community within the agent network to provide product information updates and support agency retention (such as Facebook or WhatsApp groups)?
• How can we set up the right operating model for providing cash to agents as needed?
• How can we make sure the agents have the right processes in place to ensure Go-for-Growth Bank’s cash is safeguarded?

This structure is quite exhaustive. Don’t worry if you didn’t have every bullet point in your structure. In practice, since you only have about 2 minutes to lay this out, you don’t need to write full questions on your piece of paper but only a couple of keywords for each bucket and each sub-bucket.

We recommend going through our article on Issue Trees to learn more about how to create a case structure.

After you lay out your case structure, your interviewer would prompt you to brainstorm which agents to acquire and which products and services to sell, so if you’ve already alluded to it in your structure, that gives you a headstart.

Here, your interviewer would hand you a few exhibits that detail population density by region, classification of the retail stores with metrics on annual revenue, footfall, etc., a list of Go-for-Growth Bank’s products and the associated profitability of each product, and the results of a survey that details the wishlist of financial services and products by underserved consumers and small businesses.

On brainstorming ideas, you’ll be rated on both your structure and your creativity. Make sure to always articulate the logic behind your ideas, using your past experience, analogies, or your general knowledge.

Ideas for Increasing Go-for-Growth Bank’s Revenue

• Target the agents that receive the highest customer footfall (grocery stores) AND/OR agents that are well-versed in handling legal/administrative documentation (postal outlets). Let’s assume the bank can cover 60% of the untapped population by acquiring grocery stores and postal outlets as agents in the Tier 2 cities.
• Sell products that are profitable to the bank and at the same time relevant to the customers (payment transfer, insurance products, working capital loans, home loans, etc.)
• Onboard agents as customers first to establish other customers’ trust in the bank’s products. Given it’s a less advanced economy where customers rely on heavy interactions with retail stores for information on financial products, word-of-mouth from the agent will establish trust upfront and lead to longer lifetime value (LTV) for the bank.

Ideas on Incentives for Agents

• Provide commission to agents of 0.15% on each insurance/loan product.
• Organize monthly or quarterly leagues with leaderboards to recognize top performers, e.g., highest transaction value, highest growth, highest customer acquisition, etc.
• Leverage social media to build an agent community via Facebook or WhatsApp groups. These groups can create engagement and serve as an efficient mode of communication, allowing the bank to solicit agent referrals and publish leaderboards.
• Introduce friendly competitions like “Best shop-front display” to increase the visibility of Go-for-Growth Bank’s products.
• Test if affiliation with the Bank’s brand in the country is a motivator for agents.

You could classify “high performers” as agents with transaction volume and transaction value in the top 10%. Agent’s potential information (e.g., footfall, turnover, location potential) can also be collected to have a more nuanced segmentation for tracking and governance purposes.

Running the Numbers on Go-for-Growth’s Agent Strategy

Finally, you should consider pressure testing the unit economics of each agent to ensure the bank’s targets are met. To do this, you’ll need to leverage the information you were provided during the opening of the case as well as make some assumptions. A quick way to round this up would be:

• Total # of customers = % of population targeted * Annual conversion rate per agent = 60% of population targeted * 10% conversion rate = 60% * (80% [% of population currently underserved by financial institutions] * 100 million [total population]) * 10% [conversion rate]= 4.8 million customers
• Revenue per customer = Avg # of banking products sold per customer * Annual price per product = 1.5 avg # of products * $500 price 1 = $750 annual revenue per customer.

1 Based on data from interviewer.

• Therefore, Topline impact = 4.8 million * $750 = $3600 million = $3.6 billion (validated as this meets the $3+ billion target)

Keep drawing on the interviewer to test the assumptions and/or ask for industry benchmarks on conversion rates, average number of products, prices, etc. to make your analysis rigorous.

A great candidate would also establish bottom line impact for the bank:

• Total bottom line opportunity = Topline opportunity * Profit margin = $3.6 billion * (5-7% profit margin – 0.15% cut to agents) = $175 to $250 million.

“Go-for-Growth Bank’s CEO walks into the team room and asks you about your findings. What do you tell her?”

You should lead with your recommendation to the client and detail the key reasons supporting that recommendation. Then, mention any risks to consider which might impact the outcome and the next steps that you’d suggest to double down on the analysis. There is no need to repeat everything you covered during the case: be succinct and stick to the key arguments.

What would you say? Give it a try before reading ahead.

“We recommend acquiring the grocery stores and postal outlets in the Tier-2 cities as agents for the bank to help sell loan and insurance products at a profit margin of 5-7% to retail and small business clients with a 0.15% cut to the agents. This way, we cover 60%+ of the underpenetrated population with our highest profitability products and provide an additional source of income to the agents at no additional cost to them. The high perceived value in being affiliated with the Go-for-Growth Bank brand will attract agent interest. This will allow us to add $3 billion to the top line and $175-$250 million to the bottom line annually.

One concern we’d like to address next is whether competitors could potentially take away our first-mover advantage by luring away agents with better commissions, especially in densely populous areas. We should address this potential problem with contract terms and incentives in our agent agreements.”

Congrats, you made it through your first financial services case interview!

4 Tips On Acing Your Financial Services Case Interview

1. validate corporate structure and business model.

Always remember to validate the corporate structure and business model of the financial institution in your financial services case interview. You don’t want to end up confusing a commercial bank with an investment bank!

As a candidate, you’re not expected to know everything. Therefore, ask as many questions as possible to understand what you’re really dealing with. For instance, you could say, “Hey, I’m not familiar with the corporate structure and the business model of a pension fund, could you please explain that to me so I can start to understand the drivers of value for the business a bit better.”

2. Align on the Success Metrics

To be able to reach your destination, you must know what the destination is. This is especially relevant in the financial services case interview, where there could be dozens of metrics that can be solved for. Therefore, it’s critical to align on the North Star with your interviewer so you can solve for the target the client cares most about.

3. Apply First-Principles Thinking to Structure the Case

To navigate through a financial services case interview, you need to think on your toes. Chances are the corporate structure, business model, regulatory environment, and risk aspects will be unfamiliar to you. Instead of feeling bogged down by these nuances, take a big picture lens and apply first-principles thinking to structure the case.

You may not know the industry terms such as “net interest margin” or “dividend-adjusted return,” but you can always ask the first-principles question on “What drives value for the business?” and engage with your interviewer to identify the underlying sources of value.

Demonstrating intellectual curiosity in financial services cases will hold you in good stead. Start with “Why?” then get to the “What?” and only then solve for “How?”

4. Remain Calm and Confident

It’s easy to lose nerve when you’re out of your comfort zone. If financial services case interviews tend to throw you off, practice staying calm while solving the case. During your practice, monitor yourself for signs of nervousness. Pause, take a deep breath, smile, and then continue solving the case. The more practice you put in, the calmer your nerves will become. Also, include elements such as reading financial news, financial statements, etc., into your case prep so that you become familiar with industry terminologies. Incorporating these habits into your holistic practice will boost your confidence naturally.

– – – – –

In this article, we’ve covered:

• Key differences between financial services firms and other firms,
• Common types of financial services case interviews,
• A financial services case interview example, and
• 4 tips on acing your financial services case interview.

Still have questions?

If you have more questions about financial services case interviews, leave them in the comments below. One of My Consulting Offer’s case coaches will answer them.

Other people prepping for consulting case interviews found the following pages helpful:

• Our Ultimate Guide to Case Interview Prep
• Issue Trees
• Market-sizing Case Interview
• Supply Chain Case Interview

Help with Case Study Interview Prep

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3 Top Strategies to Master the Case Interview in Under a Week

We are sharing our powerful strategies to pass the case interview even if you have no business background, zero casing experience, or only have a week to prepare.

No thanks, I don't want free strategies to get into consulting.

We are excited to invite you to the online event., where should we send you the calendar invite and login information.

Case Interview PwC (Financial Services - Transaction Services)

My name is Marco and I am currently appyling for an internship (6 months) at PwC in Financial Services (within Transaction Services). I already had an online assessment and I have now been invited for an interview (Frankfurt) in about a weeks time. On the phone the recruiter told me, that I had to expect a case study and a "regular" interview with partners/senior managers of the team I am applying to.

It's my first interview of this type and I wanted to ask you: What kind of case study could I expect? What could it be about and how do I approach (suggestions or links very much appreciated).

Thanks a lot

Overview of answers

• Date ascending
• Date descending

PwC Corporate Finance Technical Case

Corporate finance interviews are different from consulting and are usually much more technical and detailed in financial part. Usually, they give you much more time to prepare and do the model on paper. Depending on the company you'll need to:

• Find the relevant information in P&L, Balance sheet, CF statement
• Do the simplified valuation using NPV: calculate cash flows and make assumptions about growth rate and discount rate
• Do the valuation using comps - you'll have to explain which comps you will use and why
• Do the valuation of the synergies
• Play with different scenarios (e.g. how the stock-price will change if the deal terms leak into media, or how should the companies behave in a bidding process)

There are two types of frameworks you may use:

• Commercial due-diligence of the target company
• Synergies calculation of two merging companies

Note also that it can be a mix of both.

1. For Due Diligence you can use the following structure:

• Growth rates
• Profitability
• Distribution channels

Competition

• Market shares of competitors and their segments (see the next point)
• Concentration / fragmentation (Fragmented market with lots of small players is less mature and easier to enter from a scratch. Concentrated market is hard to enter but has potential acquisition targets)
• Unit economics of the players (Margins, relative cost position)
• Key capabilities of the players (e.g. suppliers, assets, IP, etc)
• Unit economics (Margins, costs) in current or target markets
• Product mix
• Key capabilities

Feasibility of exit (in case of a PE company) :

• Exit multiples
• Existence of buyers

2. For Synergies Calculation you can use the following structure:

• Revenue synergies - here you calculate the synergies in price and quantity (depending on the case it may be new geographies, new products, new distribution channels, bigger share on shelves crosselling opportunities, etc.)
• Cost synergies - typically you use a value chain structure tailored to the industry (e.g. supply-production-distribution-marketing-after sales support)
• Financial synergies - working capital, capital structure, tax
• Risks - major risks that can decrease the synergies (tip: don't underestimate the merging companies culture factor)
• Total synergies potential in $, adjusted by risk (probability of failure)

While the b asic consulting services have mainly classic cases (Market sizing, profitability, market situation, etc), f inancial consulting may have specialized cases as well. For example, Transaction has M&A cases (Basic accounting, Due diligence, calculating NPV on paper, calculating Stock basis and earnings & profits, etc).

The cases will be much more detailed in financial part . Depending on the company you'll need to:

• Find the relevant information in P&L and Balance sheet
• Calculate the share splits and price per share

I recommend finding someone from that practice and check the details of the interview in the particular department

Here are some good frameworks you may use:

1. For commercial DD you can use the following structure:

Feasibility of exit :

• Financial s ynergies - access to capital, restructuring, etc

Congratulations on reaching the interview stage with PwC! Having been there myself I am happy to share some insights. In a case study for an internship in Transaction Services, you might encounter a scenario related to financial analysis, valuation, or due diligence. Warm regards, Frederic 

Understand the Basics:

• Brush up on fundamental financial concepts: financial statements, valuation methods, and accounting principles.

Case Study Format:

• The case might involve analyzing financial statements, assessing investment opportunities, or conducting due diligence on a company.

Industry Research:

• Familiarize yourself with the financial services industry, especially transaction-related activities.

Practice Financial Modeling:

• Practice creating a simple financial model. Focus on forecasting, valuation, and cash flow analysis.

Review Previous Transactions:

• Look into recent mergers or acquisitions in the financial services sector. Understand the financial implications and rationales behind these transactions.

Problem-Solving Approach:

• Break down the case into manageable components.
• Clearly articulate your thought process and assumptions.
• Be ready to discuss the implications of your analysis.

Communication Skills:

• Practice presenting your findings in a clear and concise manner.
• Be prepared to discuss your reasoning with the interviewers.

There are a few set of questions, which you might be asked:

CV questions. Walk me through your resume OR tell me about yourself.

Why did you choose your university?

Why did you choose your faculty?

How you showed your social activity, and why this exactly?

Why do you have these hobbies? 2. Motivational questions are designed to understand your internal drivers to be a consultant

Why consulting?

Why this region?

Why X firm? 3. Behavioral questions

by being prepared for this kind of questions, you can crack similar questions in any other company:

The Entrepreneurial Drive / Drive and Achieving Question

The Personal Impact / Persuasion / Conflict Resolution Question

The Leadership / Teamwork Question

Regarding the case-solving, Here is a good preplounge article:

https://www.preplounge.com/en/bootcamp.php/interview-first-aid/crack-the-case-interview/approaching-a-case

Start by studying this one but don't waste your time studying plain theory because case solving is all about PRACTICE.

Here are some cases you might want to check out:

For Beginner level:  

Laundry Chain - Revenue Increase 

https://www.preplounge.com/en/management-consulting-cases/interviewer-led-mckinsey-style/beginner/laundry-chain-revenue-increase-215

Launching Caskets in North Africa

https://www.preplounge.com/en/management-consulting-cases/interviewer-led-mckinsey-style/beginner/launching-caskets-in-north-africa-1st-round-bain-case-225

For Intermediate level:

Grain Co-operative – Brand Launch

https://www.preplounge.com/en/management-consulting-cases/interviewer-led-mckinsey-style/intermediate/grain-co-operative-brand-launch-217

Case with a twist: Chinese Alloy Wheels – US Market Entry

https://www.preplounge.com/en/management-consulting-cases/candidate-led-usual-style/intermediate/case-with-a-twist-chinese-alloy-wheels-us-market-entry-226

I suggest you start with the intermediate level after you are confident with the beginner ones.

Hope it was helpful,

i came across your post and i just want to know what Kind of questions did you had at the online test and how do you prepare for it

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Case interviews: what finance concepts do I need to know?

Consultants use a wide range of financial concepts on their projects. Case interviews reflect real life examples and you will therefore come across financial concepts when you interview. These concepts range from fairly basic (E.g.: fixed costs) to more advanced (E.g.: return on investment).

The difficulty is that there is an endless list of financial concepts you could learn. But you do not have time to learn and master all of them and doing so should not be the objective of your preparation.

When you prepare for case interviews , you therefore need to ask yourself the following key question: What are the financial concepts I need to master to ace case interviews?

Click here to practise 1-on-1 with MBB ex-interviewers

The answer depends on the position you are applying for. In this blog post, we assume that you are interviewing for a general consultant, associate or manager role at a typical strategy firm (E.g.: McKinsey, BCG, Bain, etc). If you apply specifically to the financial services practice of the firms above, you will need to know more advanced financial concepts than we list below. But for general positions, here is the list of financial concepts you need to master:

• Fixed and variable costs

More advanced

• Return on investment
• Payback period

There is a very small chance that you might come across more exotic financial concepts in your case interviews. But in these cases you will not be expected to know the concept at hand. Instead, your interviewer will expect you to ask clarifying questions about the concept and will help you understand it.

There are three reasons why you do not need to know more financial concepts than the ones listed above:

• First, in our experience, these concepts will enable you to tackle 99% of the cases you will come across in your interviews
• Second, learning more concepts than this would be very time consuming. Instead you should use your time practicing on real case interviews
• Third, consultants themselves usually do not know more financial concepts than the ones we have listed. As a consequence if a more advanced concept is required for your case it is almost certain that your interviewer will help you understand it

Let us now define the concepts you need to know one by one.

We’ve already defined some basic financial concepts the video below. While McKinsey no longer uses the PST, these concepts are still useful to review.

Revenues, sales, or turnover (the three terms are synonyms) are the total amount of money that the company receives from customers by selling its products.

Let’s take an example. Imagine you work for an airline, such as British Airways. You sell plane tickets to your customers. The total amount of money you collect from customers in exchange for plane tickets (and any additional services you provide) is your company’s revenues.

There are two main ways you could be asked to calculate revenues for a company:

You might be given the number of products the company sold (the volume) and the average price of the products. From this, you can obtain revenues using the following formula: Revenues = Volume x Average Price.

Alternatively, you could be given the total sales in an industry (total market sales), and the share of the industry’s revenues represented by the company (the market share). The company’s sales would then be given by: Revenues = Total Market Sales x Market Share.

Either way, remember that revenues or sales are measured in terms of money (Dollar, Pound Sterling, Euro, etc.).

Costs, or expenses, are the total amount of money that the company pays to its various suppliers. In the case of the airline above, this will be the money that the company pays for fuel, leasing airplanes, the salaries of the crew, as well as expenses such as the cost of running their headquarters, their website, or even taxes and interest on loans.

As you can see, the term ‘costs’ covers many different items. Companies will be interested in tracking costs closely.

Fixed and variable costs: Businesses incur two types of costs. Variable costs are the costs that increase with higher sales or higher production. Fixed costs are the costs that would have to be paid regardless of how much is produced. In other words, variable costs change with the level of business activity, while fixed costs don’t.

Let’s imagine you are the CEO of a handbag manufacturer. The cost of the material you use to manufacture the bags is a variable cost: the more bags you produce, the more leather you will need. If one day you produce no handbag, then you don’t have to pay for any extra material. By contrast, the rent you pay for the store has to be paid every month, regardless of whether you sell or produce any bags that month.

As you may already appreciate, the distinction between fixed and variable costs is not always straightforward. For instance, labour costs can be either fixed or variable. As a CEO, your salary is a fixed cost as it will be paid independently of how many bags the company produces. However, during periods of peak production you might hire extra workers at your factory and their salary will therefore be a variable cost.

Even though these difficulties might arise, your interviewer will always allow you to determine easily from the context which cost is fixed and which is variable.

The most important relationship in business analysis is probably the following:

Profits = Revenues – Costs

Profits, also known as net income or net earnings, represents the money left to the owners or managers of the business after all expenses have been paid. Many questions in case interviews revolve around whether or not a company is profitable and what it should do to become more profitable.

Profits are always calculated over a certain period of time – either a quarter or a full year. If you are given fixed and variable costs, you would first have to calculate total costs over the period of time studied, before being able to calculate profits. For instance, in our handbag manufacturing example you would take all fixed costs for one year and add all variable costs for the production of that year to calculate total costs. Annual profits would then be given by subtracting total costs from annual revenues.

Given this definition of profits, there are two ways companies can increase their profits: increase revenues, or decrease costs. You can also see why it might not always be completely straightforward to compare the performance of two companies: one might have higher revenues but higher costs than the other.

4. Return on investment

Return on investment (ROI), or return on capital invested (ROCI), measures how much profits are generated by $100 invested in a given project or business. Let’s say you set up a lemonade stand with an initial investment of $1,000 to pay for a stand, a lemon press, etc. Let’s now assume that you sell $500 worth of lemonade throughout the year and that you incurred $400 in costs to make those sales (E.g.: lemons, sugar, electricity, etc). Your profit for the year is $100 and your return on investment is $100 / $1,000 = 10%.

The formula for return on investment is therefore given by:

Return on investment = Profits over given period / Initial investment

Returns on investment are expressed in percentages and calculated over a given period of time, usually one year. But nothing prevents you from calculating a daily or monthly return on investment. To do so, you just need to divide a day’s worth of profits or a month’s worth of profits by the initial investment. For a given project, profits made in a day are lower than profits made in a month or year, and the daily return on investment is therefore lower. In our example, assuming we make $100 / 365 = $0.27 of profits in a day, the daily return on investment is $0.27 / $1,000 = 0.027% which is lower than 10%.

Let’s focus on the initial investment part of the equation. In your case interviews , you will most likely have to calculate ROIs when a company is investing in a new project. Here, the initial investment will be the upfront expenses the company needs to make to start the business. For instance, if the company wants to start producing cars, building the car factory will be the main initial investment. Similarly, if the company wants to start a supermarket, the main initial investment will be the building, fridges and shelves to set up the supermarket (assuming it buys the building). Initial investments are typically only incurred once, at the beginning of the project.

Finally, there are two ways to increase ROIs: growing profits or decreasing the initial investment. Sometimes, the return on investment for a project will be negative. This indicates that profits are negative and that the project is losing money.

5. Payback period

Payback period measures how much time it takes to earn back your initial investment. In our lemonade stand example, it takes 10 years of profits at $100 per year to pay back the initial investment of $1,000. The payback period is 10 years.

The formula for payback period is therefore given by:

Payback period = Initial investment / Profits over a given period

Payback periods are usually expressed in years by dividing the initial investment by the profits per year . But notice that they can also be expressed in days or months too simply by dividing the initial investment by the profits per day or the profits per month .

Finally, notice that the payback period is simply the inverse of the return on investment. In our lemonade stand example, the yearly return on investment was 10%. To calculate the payback period we could have simply done 1 / 10% = 10 years. Again, in some cases the payback period will be negative which indicates negative profits and that the project is losing money.

Mock interviews

The best way to improve at case interviews is to practise interviewing out loud, and you can do that in three main ways:

• Interview yourself (out loud)
• Practise interviewing with friends or family
• Practise interviewing with ex-interviewers

Practising by yourself is a great way to get started, and can help you get more comfortable with the flow of a case interview. However, this type of practice won’t prepare you for realistic interview conditions. 

After getting some practice on your own, you should find someone who can do a mock interview with you, like a friend or family member.

We’d also recommend that you practise 1-1 with ex-interviewers from top consulting firms . This is the best way to replicate the conditions of a real case interview, and to get feedback from someone who understands the process extremely well.

Click here to book your mock case interview.

Secrets to a successful case-study interview

January 9, 2023

Prepping for (and maybe fretting) the case-study interview?

While this kind of interview may appear intimidating, consider this: The interviewer really wants you to do well.

So, shake off the nerves, relax and have fun.

Tips for standing out in the case-study interview: 

• Take your time; don't rush it.  Talk through the problem. If you can't make sense of it, take a moment and allow yourself some time to process what you've been missing. If you get stuck, get creative. Don't let yourself get bogged down; rely on your ingenuity. 
• Ask questions.  You can always ask your interviewer to define an acronym or to repeat or confirm details. If the interviewer asks, “How do we achieve success?”, don’t be afraid to ask, “What does ‘success’ mean to you? Is it turning a profit? Raising the company’s profile?” When you work on a client project, you need to ask questions to figure out what the problems might be, and the same applies here. The interviewer is your biggest asset in the room. They have the information you need to “solve the case” successfully. Use them wisely!
• Be flexible.  The focus of a case-study interview may vary. So, be prepared to participate in whatever discussion the interviewer has in mind. They may spend the first half of the interview asking about your previous experience, or they may dive right into the case study at the start. The bottom line: Be flexible, and be ready to discuss the work you do and how you do it.
• Use visual aids.  Don’t be afraid to use pen and paper, sketch out your thoughts, and talk through the problem at hand if it helps you get your ideas across. What matters most is demonstrating that you can solve problems.
• Focus on impact.  Inventory the information you have, and then dive in where you can have the most impact. Don’t forget to discuss your thought process and explain your assumptions.
• Tell a story.  Your experience has helped you progress in your career and education; use that experience. For example, in a business case study, you could bring your experience as a traveler to a case about a hypothetical airline. Your individuality is important. Your unique insights will serve you well when you’re interviewing.
• Pay attention to cues.  If the interviewer says something, it probably means something. Don’t dismiss seemingly extraneous details. For example, the interviewer might say, “The case is about a retailer who wants to increase the value of a company it purchased, and the owner loved the brand when growing up.” The purpose of that detail is to indicate that turning around and selling the asset is not an option for making it profitable, because the owner is attached to it.

Preparing for the job you want can take time, but it’s a worthwhile investment—especially when you receive an offer.

Your ideas, ingenuity and determination make a difference. 

Find your fit  with Accenture. 

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RECRUITING ASSOCIATE MANAGER, HOUSTON, TEXAS

Financial Due Diligence Case Study Interview

How to ace the Transaction Advisory (TAS) case study

Table of contents

• Intro to the financial due diligence case study interview

Why is the FDD case study interview important?

• What to expect

How to prepare

Note: There are many different names and acronyms for “financial due diligence” including FDD, transaction advisory (TAS), deal advisory, accounting diligence, and M&A due diligence. These terms are used interchangeably throughout the article.

Intro to the financial due diligence case study

The financial due diligence case study is an important part of the interview process. The idea of having to complete a case study during the interview process often causes anxiety among interviewees. 

The case study interview is often a difficult part of the interview process because it tests your ability to think critically about a business and articulate your findings in a time-sensitive environment. Additionally, this portion of the interview process is difficult due to its variability. There are a number of different scenarios that can be presented. For example, the exercise could just be a review and subsequent discussion/presentation or could test your understanding of accounting and your ability to perform key excel skills. 

The case study is often the most nerve-racking part of the transaction advisory interview process because it represents the “unknown”. Luckily, Financialduediligenceinterview.com is here to help calm your nerves. 

The financial due diligence case study is an important step in the interview process because it tests a candidate’s ability to think critically about a business in a time-sensitive environment, basic accounting knowledge, understanding of the financial due diligence process, and key excel skills. 

If a candidate does not understand the basics, then companies will have to spend extra time teaching new hires in an already busy/stressful job. 

However, don’t let this scare you. If you aren’t an experienced hire, then the interviewers will not expect you to perform like one. As stated above, the goal of the case study interview (for non-experienced hires) is to make sure the candidate understands the basics, which financialduediligenceinterview.com can teach you. Additionally, a candidate’s understanding of the basics proves that he or she has done their research and is serious about the opportunity. 

What to expect from a transaction advisory case study?

There are a few different forms of case studies that can be presented in a transaction advisory interview. Generally, the case study will fall into one of the below categories (by order or probability):

• Review of a ~5-10 page business scenario/overview and presentation of findings
• Review of a ~5-10 page business scenario, basic excel model, and subsequent presentation of findings

You will have ~1-2 hours to complete the case study and will present for ~30 minutes. The typical case study will include a 5-10 page business scenario/summary as well as one page of instructions. 

First, the business scenario will be a fictional M&A transaction (i.e., your client is buying a business). The business scenario will include a detailed summary of the transaction, a summary of the business type and operating model, a summary of the business performance and history, and monthly trended financial statements. Buried throughout the summary (similar to a real-world project) and financial statements will be items to consider in the financial due diligence process. Specifically, you will be instructed to focus on the potential quality of earnings adjustments and red flags that should be brought up to your client. 

If the case study involves a modeling test, this will generally require you to leverage trial balance data to build a basic income statement and balance sheet that tie together via equity. From there you will be asked to build a basic adjusted EBITDA table. See our complete financial due diligence interview guide for a full example case study and excel model to help you prepare.

Practice makes perfect. The best way to prepare for the case study interview is to practice. First, you will need to nail down your understanding of the process and goals of financial due diligence. Next, you will need to learn how to analyze a business with an eye toward identifying red flags and potential quality of earnings adjustments. Finally, you will need to work on your ability to present your findings in a clear, concise, and confident manner. 

Leverage our free resources or complete financial due diligence interview guide to help you prepare for all of these items.

Full interview guide

Learn how to master the interview process for for roles at big 4 and other elite FDD firms.​

Free resources

Leverage our free resources to help you prepare for the FDD interview process.

The transaction advisory case study can feel like a daunting task, but there is no reason to be worried. The goal of the case study is not to stump you, but to confirm that the candidate has the basic skillsets needed for the job. If you prepare adequately then there should be no problem. 

Major Financial Services Client Case Study

This major financial services provider is a public, full-service, consumer finance company focused on vehicle finance and third-party servicing. The company manages accounts for more than 2 million customers across all credit profiles. They are headquartered in the southern USA and is one of the fastest-growing companies in the automotive finance sector.

CLIENT CHALLENGE

This client needed a solution that would help process their high-volume candidate pool faster and more efficiently while keeping costs down.

The company struggled with early-stage turnover rates due to low-quality hires where personal skills were essential, costing them additional money. As a result, they needed a system that would allow recruiters to assess cultural compatibility and soft skills at an earlier stage in the hiring process.

CLIENT RESULTS

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Top 10 FinTech Case Studies [A Detailed Exploration] [2024]

In the dynamic realm of financial technology—often abbreviated as FinTech—groundbreaking innovations have revolutionized how we interact with money, democratizing access to myriad financial services. No longer confined to traditional banking and financial institutions, today’s consumers can easily invest, transact, and manage their finances at their fingertips. Through a deep dive into the top five FinTech case studies, this article seeks to illuminate the transformative power of financial technology. From trailblazing start-ups to industry disruptors, we will unravel how these companies have reshaped the financial landscape, offering invaluable lessons for consumers and future FinTech leaders.

Top 10 FinTech case studies [A Detailed Exploration] [2024]

Case study 1: square – democratizing payment processing.

Launched in 2009 by Twitter co-founder Jack Dorsey, Square sought to fill a gaping hole in the financial services market—accessible payment processing for small businesses. In an industry overshadowed by high costs and complexity, Square introduced a game-changing point-of-sale (POS) system, using a tiny card reader that could be plugged into a smartphone.

Key Challenges

1. High Costs: The financial burden of traditional payment systems made it difficult for small businesses to participate, affecting their growth and market reach.

2. Complexity: Legacy systems were cumbersome, requiring hefty upfront investments in specialized hardware and software, with a steep learning curve for users.

3. Limited Accessibility: Many small businesses had to resort to cash-only operations, losing potential customers who preferred card payments.

Related: Important FinTech KPIs Explained

Strategies Implemented

1. User-Friendly Hardware: Square’s portable card reader was revolutionary. Easy to use and set up, it integrated seamlessly with smartphones.

2. Transparent Pricing: A flat-rate fee structure eliminates hidden costs, making budgeting more predictable for businesses.

3. Integrated Business Solutions: Square went beyond payment processing to offer additional services such as inventory management, analytics, and loans.

Results Achieved

1. Market Penetration: As of 2023, Square boasted over 4 million sellers using its platform, solidifying its market position.

2. Revenue Growth: Square achieved significant financial gains, reporting $4.68 billion in revenue in Q2 2021—a 143% year-over-year increase.

3. Product Diversification: Expanding its ecosystem, Square now offers an array of services from payroll to cryptocurrency trading through its Cash App.

Key Learnings

1. Simplicity is Key: Square’s user-centric design proved that simplifying complex processes can open new markets and encourage adoption.

2. Holistic Ecosystems: Offering integrated services can foster customer loyalty and increase lifetime value.

3. Transparency Builds Trust: A clear, straightforward fee structure can differentiate a FinTech solution in a market known for its opaqueness.

4. Accessibility: Providing easy-to-use and affordable services can empower smaller businesses, contributing to broader economic inclusion.

Related: Benefits of Green FinTech for Businesses

Case Study 2: Robinhood – Democratizing Investment

Founded in 2013, Robinhood burst onto the financial scene with a disruptive promise—commission-free trading. Unlike traditional brokerage firms that charged a fee for every trade, Robinhood allowed users to buy and sell stocks at no direct cost. The platform’s user-friendly interface and sleek design made it particularly appealing to millennials and Gen Z, demographics often underrepresented in the investment world.

1. High Commissions: Traditional brokerages often had fee structures that discouraged individuals, especially younger investors, from participating in the stock market.

2. Complex User Interfaces: Many existing trading platforms featured clunky, complicated interfaces that were intimidating for novice investors.

3. Limited Access: Entry-level investors often felt the investment landscape was an exclusive club beyond their financial and technical reach.

1. Commission-Free Trading: Robinhood’s flagship offering eliminated the financial barriers that commissions presented, inviting a new cohort of individual investors into the market.

2. User-Friendly Design: A sleek, intuitive interface made stock trading less intimidating, broadening the platform’s appeal.

3. Educational Resources: Robinhood provides educational content to help novice investors understand market dynamics, equipping them for more informed trading.

1. Market Disruption: Robinhood’s model has pressured traditional brokerage firms to rethink their fee structures, with several following suit by offering commission-free trades.

2. User Growth: As of 2023, Robinhood has amassed over 23.2 million users, a testament to its market penetration.

3. Public Scrutiny: Despite its success, Robinhood has not been without controversy, especially regarding its revenue model and lack of transparency. These issues have sparked widespread debate about ethical practices in fintech.

1. User-Centricity Drives Adoption: Robinhood’s easy-to-use platform illustrates that reducing friction encourages higher user engagement and diversifies the investor base.

2. Transparency is Crucial: The controversies surrounding Robinhood serve as a cautionary tale about the importance of transparent business practices in building and maintaining consumer trust.

3. Disruption Spurs Industry Change: Robinhood’s entry forced a reevaluation of longstanding industry norms, underscoring the influence a disruptive FinTech company can wield.

Related: How to Get an Internship in the FinTech Sector?

Case Study 3: Stripe – Simplifying Online Payments

Founded in 2010 by Irish entrepreneurs Patrick and John Collison, Stripe set out to solve a significant problem—simplifying online payments. During that time, businesses looking to accept payments online had to navigate a complex labyrinth of banking relationships, security protocols, and regulatory compliance. Stripe introduced a straightforward solution—APIs that allow businesses to handle online payments, subscriptions, and various other financial transactions with ease.

1. Complex Setup: Traditional online payment methods often require cumbersome integration and extensive documentation.

2. Security Concerns: Handling financial transactions online raised issues about data safety and compliance with financial regulations.

3. Limited Flexibility: Most pre-existing payment solutions were not adaptable to specific business needs, particularly for start-ups and SMEs.

1. Simple APIs: Stripe’s suite of APIs allowed businesses to integrate payment gateways effortlessly, removing barriers to entry for online commerce.

2. Enhanced Security: Stripe implemented robust security measures, including tokenization and SSL encryption, to protect transaction data.

3. Customization: Stripe’s modular design gave businesses the freedom to tailor the payment experience according to their specific needs.

1. Broad Adoption: Stripe’s intuitive and secure payment solutions have attracted a diverse client base, from start-ups to Fortune 500 companies.

2. Global Reach: As of 2023, Stripe operates in over 46 countries, testifying its global appeal and functionality.

3. Financial Milestone: Stripe’s valuation skyrocketed to $50 billion in 2023, making it one of the most valuable FinTech companies globally.

1. Ease of Use: Stripe’s success proves that a user-friendly, straightforward approach can go a long way in attracting a wide range of customers.

2. Security is Paramount: Handling financial data requires stringent security measures, and Stripe’s focus on secure transactions sets an industry standard.

3. Scalability and Flexibility: Providing a modular, customizable solution allows businesses to scale and adapt, increasing customer satisfaction and retention.

Related: FinTech Skills to Add in Your Resume

Case Study 4: Coinbase – Mainstreaming Cryptocurrency

Founded in 2012, Coinbase set out to make cryptocurrency trading as simple and accessible as using an email account. At the time, the world of cryptocurrency was a wild west of complicated interfaces, murky regulations, and high-risk investments. Coinbase aimed to change this by offering a straightforward, user-friendly platform to buy, sell, and manage digital currencies like Bitcoin, Ethereum, and many others.

1. User Complexity: Before Coinbase, cryptocurrency trading required high technical know-how, making it inaccessible to the average person.

2. Security Risks: The lack of centralized governance in the crypto world led to various security concerns, including hacking and fraud.

3. Regulatory Uncertainty: The absence of clear regulations concerning cryptocurrency created a hesitant environment for both users and investors.

1. User-Friendly Interface: Coinbase developed a sleek, easy-to-use platform with a beginner-friendly approach, which allowed users to start trading with just a few clicks.

2. Enhanced Security: The platform incorporated advanced security features such as two-factor authentication (2FA) and cold storage for digital assets to mitigate risks.

3. Educational Content: Coinbase offers guides, tutorials, and other educational resources to help demystify the complex world of cryptocurrency.

1. Mass Adoption: As of 2023, Coinbase had over 150 million verified users, contributing significantly to mainstreaming cryptocurrencies.

2. Initial Public Offering (IPO): Coinbase went public in April 2021 with a valuation of around $86 billion, highlighting its commercial success.

3. Regulatory Challenges: While Coinbase has succeeded in democratizing crypto trading, it continues to face scrutiny and regulatory hurdles, emphasizing the sector’s evolving nature.

1. Accessibility Drives Adoption: Coinbase’s user-friendly design has played a pivotal role in driving mass adoption of cryptocurrencies, illustrating the importance of making complex technologies accessible to everyday users.

2. Security is a Selling Point: In an ecosystem rife with security concerns, robust safety measures can set a platform apart and attract a broader user base.

3. Regulatory Adaptability: The ongoing regulatory challenges highlight the need for adaptability and proactive governance in the fast-evolving cryptocurrency market.

Related: Top FinTech Interview Questions and Answers

Case Study 5: Revolut – All-In-One Financial Platform

Founded in 2015, Revolut started as a foreign currency exchange service, primarily focusing on eliminating outrageous foreign exchange fees. With the broader vision of becoming a financial super-app, Revolut swiftly expanded its services to include digital banking, stock trading, cryptocurrency exchange, and other financial services. This rapid evolution aimed to provide users with an all-encompassing financial solution on a single platform.

1. Fragmented Services: Before Revolut, consumers had to use multiple platforms for various financial needs, leading to a fragmented user experience.

2. High Costs: Traditional financial services, particularly foreign exchange and cross-border payments, often have hefty fees.

3. Slow Adaptation: Conventional banking systems were slow to integrate new financial technologies, leaving a gap in the market for more agile solutions.

1. Unified Platform: Revolut combined various financial services into a single app, offering users a seamless experience and a one-stop solution for their financial needs.

2. Competitive Pricing: By leveraging FinTech efficiencies, Revolut offered competitive rates for services like currency exchange and stock trading.

3. Rapid Innovation: The platform continually rolled out new features, staying ahead of consumer demand and forcing traditional institutions to catch up.

1. User Growth: As of 2023, Revolut has amassed over 30 million retail customers, solidifying its reputation as a financial super-app.

2. Revenue Increase: In 2021, Revolut’s revenues climbed to approximately $765 million, indicating its business model’s viability.

3. Industry Influence: Revolut’s multi-functional capabilities have forced traditional financial institutions to reconsider their offerings, pushing the industry toward integrated, user-friendly solutions.

1. User-Centric Design: Revolut’s success stems from its focus on solving real-world consumer problems with an easy-to-use, integrated platform.

2. Agility Wins: In the fast-paced world of fintech, the ability to innovate and adapt quickly to market needs can be a significant differentiator.

3. Competitive Pricing is Crucial: Financial services have always been a cost-sensitive sector. Offering competitive pricing can draw users away from traditional platforms.

Related: Surprising FinTech Facts and Statistics

Case Study  6 : Chime – Revolutionizing Personal Banking

Essential term: digital banking.

Digital banking represents the digitization of all traditional banking activities, where financial services are delivered predominantly through the internet. This innovation caters to a growing demographic of tech-savvy users seeking efficient and accessible banking solutions.

Founded in 2013, Chime entered the financial market with a bold mission: to redefine personal banking through simplicity, transparency, and customer-centricity. At a time when traditional banks were mired in fee-heavy structures and complex service models, Chime introduced a revolutionary no-fee model complemented by a streamlined digital experience, challenging the status quo of personal banking.

1. Fee-Heavy Structure: Traditional banks heavily relied on various fees, including overdraft and maintenance charges, alienating a significant portion of potential customers, particularly those seeking straightforward banking solutions.

2. Complexity and Inaccessibility: Conventional banking systems were often marred by cumbersome procedures and lacked user-friendly interfaces, making them less appealing, especially to younger, more tech-savvy generations.

3. Customer Service: The traditional banking sector frequently struggled with providing proactive and responsive customer service, creating a gap in customer satisfaction and engagement.

1. No-Fee Model: By eliminating common banking fees such as overdraft fees, Chime positioned itself as a customer-friendly alternative, significantly attracting customers frustrated with traditional banking penalties.

2. User-Friendly App: Chime’s app was designed with user experience at its core, offering an intuitive and accessible platform for everyday banking operations, thereby enhancing overall customer experience.

3. Automatic Savings Tools: Chime innovated with features like automatic savings round-up and early paycheck access, designed to empower customers in their financial management.

1. Expansive Customer Base: Chime successfully captured a broad market segment, particularly resonating with millennials and Gen Z, evidenced by its rapid accumulation of millions of users.

2. Catalyst for Innovation: The company’s growth trajectory and model pressured traditional banks to reassess and innovate their fee structures and service offerings.

3. Valuation Surge: Reflecting its market impact and success, Chime’s valuation experienced a substantial increase, marking its significance in the banking sector.

1. Customer-Centric Approach: Chime’s journey underscores the importance of addressing customer pain points, such as fee structures, and offering a seamless digital banking experience, which can be instrumental in rapid user base growth.

2. Innovation in Features: The introduction of genuinely helpful financial management tools can significantly differentiate a FinTech company in a competitive market.

3. Disruptive Influence: Chime’s success story illustrates how a digital-first approach can disrupt and challenge traditional banking models, paving the way for new, innovative banking experiences.

Related: Is FinTech Overhyped?

Case Study  7 : LendingClub – Pioneering Peer-to-Peer Lending

Essential term: peer-to-peer (p2p) lending.

Peer-to-Peer (P2P) lending is a method of debt financing that enables individuals to borrow and lend money without using an official financial institution as an intermediary. This model directly connects borrowers and lenders through online platforms.

LendingClub, founded in 2006, emerged as a trailblazer in the lending industry by introducing a novel P2P lending model. This innovative approach offered a substantial departure from the traditional credit system, typically dominated by banks and credit unions, aiming to democratize access to credit.

1. High-Interest Rates: Traditional loans were often synonymous with high-interest rates, rendering them inaccessible or financially burdensome for many borrowers.

2. Limited Access to Credit: Conventional lending mechanisms frequently sidelined individuals with lower credit scores, creating a significant barrier to credit access.

3. Intermediary Costs: The traditional lending process involves numerous intermediaries, leading to additional costs and inefficiencies for borrowers and lenders.

1. Direct Platform: LendingClub’s platform revolutionized lending by directly connecting borrowers with investors, reducing the overall cost of obtaining loans.

2. Risk Assessment Tools: The company employed advanced algorithms for assessing the risk profiles of borrowers, which broadened the spectrum of loan accessibility to include individuals with diverse credit histories.

3. Streamlined Process: LendingClub’s online platform streamlined the loan application and disbursement processes, enhancing transparency and efficiency.

1. Expanded Credit Access: LendingClub significantly widened the avenue for credit, particularly benefiting those with less-than-perfect credit scores.

2. Influencing the Market: The P2P lending model introduced by LendingClub prompted traditional lenders to reconsider their rates and processes in favor of more streamlined, borrower-friendly approaches.

3. Navigating Regulatory Hurdles: The journey of LendingClub highlighted the intricate regulatory challenges of financial innovation, underscoring the importance of adaptive compliance strategies.

1. Efficiency of Direct Connections: Eliminating intermediaries in the lending process can lead to substantial cost reductions and process efficiency improvements.

2. Broadening Credit Accessibility: FinTech can play a pivotal role in democratizing access to financial services by implementing innovative risk assessment methodologies.

3. Importance of Regulatory Compliance: Sustainable innovation in the FinTech sector necessitates a keen awareness and adaptability to the evolving regulatory landscape.

Related: Who is a FinTech CTO?

Case Study  8 : Brex – Reinventing Business Credit for Startups

Essential term: corporate credit cards.

Corporate credit cards are specialized financial tools designed for business use. They offer features like higher credit limits, rewards tailored to business spending, and, often, additional tools for expense management.

Launched in 2017, Brex emerged with a bold vision to transform how startups access and manage credit. In a financial landscape where traditional corporate credit cards posed steep requirements and were often misaligned with the unique needs of burgeoning startups, Brex introduced an innovative solution. Their model focused on the company’s cash balance and spending patterns rather than relying on personal credit histories.

1. Inaccessibility for Startups: Traditional credit systems, with their reliance on extensive credit history, were largely inaccessible to new startups, which typically lacked this background.

2. Rigid Structures: Conventional corporate credit cards were not designed to accommodate rapidly evolving startups’ fluid and dynamic financial needs.

3. Personal Guarantee Requirement: A common stipulation in business credit involves personal guarantees, posing a significant risk for startup founders.

1. No Personal Guarantee: Brex innovated by offering credit cards without needing a personal guarantee, basing creditworthiness on business metrics.

2. Tailored Financial Solutions: Understanding the unique ecosystem of startups, Brex designed its services to be flexible and in tune with their evolving needs.

3. Technology-Driven Approach: Utilizing advanced algorithms and data analytics, Brex could assess the creditworthiness of startups in a more nuanced and comprehensive manner.

1. Breaking Barriers: Brex made corporate credit more accessible to startups, removing traditional barriers.

2. Market Disruption: By tailoring its product, Brex pressures traditional financial institutions to innovate and rethink its credit card offerings.

3. Rapid Growth: Brex’s unique approach led to rapid adoption within the startup community, significantly growing its customer base and market presence.

1. Adapting to Market Needs: Brex’s success underscores the importance of understanding and adapting to the specific needs of your target market.

2. Innovative Credit Assessment: Leveraging technology for credit assessment can open new avenues and democratize access to financial products.

3 Risk and Reward: The move to eliminate personal guarantees, while riskier, positioned Brex as a game-changer, highlighting the balance between risk and innovation in FinTech.

Related: Is FinTech a Dying Career Industry?

Case Study  9 : SoFi – Transforming Personal Finance

Essential term: financial services platform.

A financial services platform offers a range of financial products and services, such as loans, investment options, and banking services, through a unified digital interface.

SoFi, short for Social Finance, Inc., was founded in 2011 to revolutionize personal finance. Initially focused on student loan refinancing, SoFi quickly expanded its offerings to include a broad spectrum of financial services, including personal loans, mortgages, insurance, investment products, and a cash management account. This expansion was driven by a vision to provide a one-stop financial solution for consumers, particularly catering to the needs of early-career professionals.

1. Fragmented Financial Services: Consumers often had to navigate multiple platforms and institutions to manage their various financial needs, leading to a disjointed financial experience.

2. Student Loan Debt: Many graduates needed more flexible and affordable refinancing options with student debt escalating.

3. Accessibility and Education: A significant segment of the population lacked access to comprehensive financial services and the knowledge to navigate them effectively.

1. Diverse Financial Products: SoFi expanded its product range beyond student loan refinancing to include a suite of financial services, offering more holistic financial solutions.

2. Tech-Driven Approach: Utilizing technology, SoFi provided streamlined, user-friendly experiences across its platform, simplifying the process of managing personal finances.

3. Financial Education and Advice: SoFi offered educational resources and personalized financial advice, positioning itself as a partner in its customers’ financial journey.

1. Expanding Consumer Base: SoFi succeeded in attracting a broad customer base, especially among young professionals looking for integrated financial services.

2. Innovation in Personal Finance: The company’s expansion into various financial services positioned it as a leader in innovative personal finance solutions.

3. Brand Recognition and Trust: With its comprehensive approach and focus on customer education, SoFi built a strong brand reputation and trust among its users.

1. Integrated Services Appeal: Offering a broad array of financial services through a single platform can attract customers seeking a unified financial management experience.

2. Leveraging Technology for Ease: Using technology to simplify and streamline financial services is key to enhancing customer experience and satisfaction.

3. Empowering Through Education: Providing users with financial education and advice can foster long-term customer relationships and trust.

Related: FinTech vs Investment Banking

Case Study  10 : Apple Pay – Redefining Digital Payments

Essential term: mobile payment system.

A mobile payment system allows consumers to make payments for goods and services using mobile devices, typically through apps or integrated digital wallets.

Launched in 2014, Apple Pay marked Apple Inc.’s foray into the digital payment landscape. It was introduced with the aim of transforming how consumers perform transactions, focusing on enhancing the convenience, security, and speed of payments. Apple Pay allows users to make payments using their Apple devices, employing Near Field Communication (NFC) technology. This move was a strategic step in leveraging the widespread use of smartphones for financial transactions.

1. Security Concerns: The rising incidences of data breaches and fraud in digital payments made consumers skeptical about the security of mobile payment systems.

2. User Adoption: Convincing consumers to shift from traditional payment methods like cash and cards to a digital platform requires overcoming ingrained habits and perceptions.

3. Merchant Acceptance: For widespread adoption, a large number of merchants needed to accept and support Apple Pay.

1. Enhanced Security Features: Apple Pay uses a combination of device-specific numbers and unique transaction codes, ensuring that card numbers are not stored on devices or servers, thereby enhancing transaction security.

2. Seamless Integration: Apple Pay was designed to work seamlessly with existing Apple devices, offering an intuitive and convenient user experience.

3. Extensive Partnership with Banks and Retailers: Apple forged partnerships with numerous banks, credit card companies, and retailers to ensure widespread acceptance of Apple Pay.

1. Widespread Adoption: Apple Pay quickly gained a significant user base, with millions of transactions processed shortly after its launch.

2. Market Leadership: Apple Pay became one of the leading mobile payment solutions globally, setting a standard in the digital payment industry.

3. Influence on Payment Behaviors: The introduction of Apple Pay substantially accelerated the shift towards contactless payments and mobile wallets.

1. Trust Through Security: The emphasis on security can be a major driving force in user adoption of new financial technologies.

2. Integration and Convenience: A system that integrates seamlessly with users’ daily lives and provides tangible convenience can successfully change long-standing consumer habits.

3. Strategic Partnerships: Building a network of partnerships is key to the widespread acceptance and success of a new payment system.

These stories of globally renowned FinTech trailblazers offer invaluable insights, providing a must-read blueprint for anyone looking to make their mark in this rapidly evolving industry.

1. Square shows that focusing on user needs, especially in underserved markets, can drive innovation and market share.

2. Robinhood serves as both an inspiration and a cautionary tale, advocating for democratization while emphasizing the importance of ethical practices.

3. Stripe proves that simplifying complex processes through customizable, user-friendly solutions can redefine industries.

4. Coinbase highlights the transformative potential of making new financial instruments like cryptocurrency accessible while reminding us of regulatory challenges.

5. Revolut sets the bar high with its user-centric, all-in-one platform, emphasizing the need for agility and competitive pricing in the sector.

The key to FinTech success lies in simplicity, agility, user focus, and ethical considerations. These case studies serve as guiding lights for future innovation, emphasizing that technological superiority must be balanced with customer needs and ethical responsibilities.

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• Published: 10 April 2024

“So at least now I know how to deal with things myself, what I can do if it gets really bad again”—experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study

• Anne Müller   ORCID: orcid.org/0000-0002-2456-2492 1 ,
• Fabian Hebben   ORCID: orcid.org/0009-0003-6401-3433 1 ,
• Kim Dillen 1 ,
• Veronika Dunkl 1 ,
• Yasemin Goereci 2 ,
• Raymond Voltz 1 , 3 , 4 ,
• Peter Löcherbach 5 ,
• Clemens Warnke   ORCID: orcid.org/0000-0002-3510-9255 2 &
• Heidrun Golla   ORCID: orcid.org/0000-0002-4403-630X 1

on behalf of the COCOS-MS trial group represented by Martin Hellmich

BMC Health Services Research volume  24 , Article number:  453 ( 2024 ) Cite this article

80 Accesses

Metrics details

Persons with severe Multiple Sclerosis (PwsMS) face complex needs and daily limitations that make it challenging to receive optimal care. The implementation and coordination of health care, social services, and support in financial affairs can be particularly time consuming and burdensome for both PwsMS and caregivers. Care and case management (CCM) helps ensure optimal individual care as well as care at a higher-level. The goal of the current qualitative study was to determine the experiences of PwsMS, caregivers and health care specialists (HCSs) with the CCM.

In the current qualitative sub study, as part of a larger trial, in-depth semi-structured interviews with PwsMS, caregivers and HCSs who had been in contact with the CCM were conducted between 02/2022 and 01/2023. Data was transcribed, pseudonymized, tested for saturation and analyzed using structuring content analysis according to Kuckartz. Sociodemographic and interview characteristics were analyzed descriptively.

Thirteen PwsMS, 12 caregivers and 10 HCSs completed interviews. Main categories of CCM functions were derived deductively: (1) gatekeeper function, (2) broker function, (3) advocacy function, (4) outlook on CCM in standard care. Subcategories were then derived inductively from the interview material. 852 segments were coded. Participants appreciated the CCM as a continuous and objective contact person, a person of trust (92 codes), a competent source of information and advice (on MS) (68 codes) and comprehensive cross-insurance support (128 codes), relieving and supporting PwsMS, their caregivers and HCSs (67 codes).

Conclusions

Through the cross-sectoral continuous support in health-related, social, financial and everyday bureaucratic matters, the CCM provides comprehensive and overriding support and relief for PwsMS, caregivers and HCSs. This intervention bears the potential to be fine-tuned and applied to similar complex patient groups.

Trial registration

The study was approved by the Ethics Committee of the University of Cologne (#20–1436), registered at the German Register for Clinical Studies (DRKS00022771) and in accordance with the Declaration of Helsinki.

Peer Review reports

Introduction

Multiple sclerosis (MS) is the most frequent and incurable chronic inflammatory and degenerative disease of the central nervous system (CNS). Illness awareness and the number of specialized MS clinics have increased since the 1990s, paralleled by the increased availability of disease-modifying therapies [ 1 ]. There are attempts in the literature for the definition of severe MS [ 2 , 3 ]. These include a high EDSS (Expanded disability Status Scale [ 4 ]) of ≥ 6, which we took into account in our study. There are also other factors to consider, such as a highly active disease course with complex therapies that are associated with side effects. These persons are (still) less disabled, but may feel overwhelmed with regard to therapy, side effects and risk monitoring of therapies [ 5 , 6 ].

Persons with severe MS (PwsMS) develop individual disease trajectories marked by a spectrum of heterogeneous symptoms, functional limitations, and uncertainties [ 7 , 8 ] manifesting individually and unpredictably [ 9 ]. This variability can lead to irreversible physical and mental impairment culminating in complex needs and daily challenges, particularly for those with progressive and severe MS [ 5 , 10 , 11 ]. Such challenges span the spectrum from reorganizing biographical continuity and organizing care and everyday live, to monitoring disease-specific therapies and integrating palliative and hospice care [ 5 , 10 ]. Moreover, severe MS exerts a profound of social and economic impact [ 9 , 12 , 13 , 14 ]. PwsMS and their caregivers (defined in this manuscript as relatives or closely related individuals directly involved in patients’ care) often find themselves grappling with overwhelming challenges. The process of organizing and coordinating optimal care becomes demanding, as they contend with the perceived unmanageability of searching for, implementing and coordinating health care and social services [ 5 , 15 , 16 , 17 ].

Case management (CM) proved to have a positive effect on patients with neurological disorders and/or patients with palliative care needs [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, a focus on severe MS has been missed so far Case managers primarily function as: (1) gatekeeper involving the allocation of necessary and available resources to a case, ensuring the equitable distribution of resources; as (2) broker assisting clients in pursuing their interests, requiring negotiation to provide individualized assistance that aligns as closely as possible with individual needs and (3) advocate working to enhance clients’ individual autonomy, to advocate for essential care offers, and to identify gaps in care [ 25 , 26 , 27 , 28 , 29 ].

Difficulties in understanding, acting, and making decisions regarding health care-related aspects (health literacy) poses a significant challenge for 54% of the German population [ 30 ]. Additionally acting on a superordinate level as an overarching link, a care and case management (CCM) tries to reduce disintegration in the social and health care system [ 31 , 32 ]. Our hypothesis is that a CCM allows PwsMS and their caregivers to regain time and resources outside of disease management and to facilitate the recovery and establishment of biographical continuity that might be disrupted due to severe MS [ 33 , 34 ].

Health care specialists (HCSs) often perceive their work with numerous time and economic constraints, especially when treating complex and severely ill individuals like PwsMS and often have concerns about being blamed by patients when expectations could not be met [ 35 , 36 ]. Our hypothesis is that the CCM will help to reduce time constraints and free up resources for specialized tasks.

To the best of our knowledge there is no long-term cross-sectoral and outreaching authority or service dedicated to assisting in the organization and coordination of the complex care concerns of PwsMS within the framework of standard care addressing needs in health, social, financial, every day and bureaucratic aspects. While some studies have attempted to design and test care programs for persons with MS (PwMS), severely affected individuals were often not included [ 37 , 38 , 39 ]. They often remain overlooked by existing health and social care structures [ 5 , 9 , 15 ].

The COCOS-MS trial developed and applied a long-term cross-sectoral CCM intervention consisting of weekly telephone contacts and monthly re-assessments with PwsMS and caregivers, aiming to provide optimal care. Their problems, resources and (unmet) needs were assessed holistically including physical health, mental health, self-sufficiency and social situation and participation. Based on assessed (unmet) needs, individual care plans with individual actions and goals were developed and constantly adapted during the CCM intervention. Contacts with HCSs were established to ensure optimal care. The CCM intervention was structured through and documented in a CCM manual designed for the trial [ 40 , 41 ].

Our aim was to find out how PwsMS, caregivers and HCSs experienced the cross-sectoral long-term, outreaching patient advocacy CCM.

This study is part of a larger phase II, randomized, controlled clinical trial “Communication, Coordination and Security for people with severe Multiple Sclerosis (COCOS-MS)” [ 41 ]. This explorative clinical trial, employing a mixed-method design, incorporates a qualitative study component with PwsMS, caregivers and HCSs to enrich the findings of the quantitative data. This manuscript focuses on the qualitative data collected between February 2022 and January 2023, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [ 42 ].

Research team

Three trained authors AM, KD and FH (AM, female, research associate, M.A. degree in Rehabilitation Sciences; KD, female, researcher, Dr. rer. medic.; FH, male, research assistant, B.Sc. degree in Health Care Management), who had no prior relationship with patients, caregivers or HCSs conducted qualitative interviews. A research team, consisting of clinical experts and health services researchers, discussed the development of the interview guides and the finalized category system.

Theoretical framework

Interview data was analyzed with the structuring content analysis according to Kuckartz. This method enables a deductive structuring of interview material, as well as the integration of new aspects found in the interview material through the inductive addition of categories in an iterative analysis process [ 43 ].

Sociodemographic and interview characteristics were analyzed descriptively (mean, median, range, SD). PwsMS, caregivers and HCSs were contacted by the authors AM, KD or FH via telephone or e-mail after providing full written informed consent. Participants had the option to choose between online interviews conducted via the GoToMeeting 10.19.0® Software or face-to-face. Peasgood et al. (2023) found no significant differences in understanding questions, engagement or concentration between face-to-face and online interviews [ 44 , 45 ]. Digital assessments were familiar to participants due to pandemic-related adjustments within the trial.

Out of 14 PwsMS and 14 caregivers who were approached to participate in interviews, three declined to complete interviews, resulting in 13 PwsMS (5 male, 8 female) and 12 caregiver (7 male, 5 female) interviews, respectively (see Fig.  1 ). Thirty-one HCSs were contacted of whom ten (2 male, 8 female) agreed to be interviewed (see Fig.  2 ).

Flowchart of PwsMS and caregiver participation in the intervention group of the COCOS-MS trial. Patients could participate with and without a respective caregiver taking part in the trial. Therefore, number of caregivers does not correspond to patients. For detailed inclusion criteria see also Table  1 in Golla et al. [ 41 ]

Flowchart of HCSs interview participation

Setting and data collection

Interviews were carried out where participants preferred, e.g. at home, workplace, online, and no third person being present. In total, we conducted 35 interviews whereof 7 interviews face-to-face (3 PwsMS, 3 caregivers, 1 HCS).

The research team developed a topic guide which was meticulously discussed with research and clinical staff to enhance credibility. It included relevant aspects for the evaluation of the CCM (see Tables  1 and 2 , for detailed topic guides see Supplementary Material ). Patient and caregiver characteristics (covering age, sex, marital status, living situation, EDSS (patients only), subgroup) were collected during the first assessment of the COCOS-MS trial and HCSs characteristics (age, sex, profession) as well as interview information (length and setting) were collected during the interviews. The interview guides developed for this study addressed consistent aspects both for PwsMS and caregivers (see Supplementary Material ):

For HCSs it contained the following guides:

Probing questions were asked to get more specific and in-depth information. Interviews were carried out once and recorded using a recording device or the recording function of the GoToMeeting 10.19.0® Software. Data were pseudonymized (including sensitive information, such as personal names, dates of birth, or addresses), audio files were safely stored in a data protection folder. The interview duration ranged from 11 to 56 min (mean: 23.9 min, SD: 11.1 min). Interviews were continued until we found that data saturation was reached. Audio recordings were transcribed verbatim by an external source and not returned to participants.

Data analysis

Two coders (AM, FH) coded the interviews. Initially, the first author (AM) thoroughly reviewed the transcripts to gain a sense of the interview material. Using the topic guide and literature, she deductively developed a category system based on the primary functions of CM [ 25 , 26 , 27 , 28 , 29 ]. Three interviews were coded repeatedly for piloting, and inductive subcategories were added when new themes emerged in the interview material. This category system proved suitable for the interview material. The second coder (FH) familiarized himself with the interview material and category system. Both coders (AM, FH) independently coded all interviews, engaging in discussions and adjusting codes iteratively. The finalized category system was discussed and consolidated in a research workshop and within the COCOS-MS trial group and finally we reached an intercoder agreement of 90% between the two coders AM and FH, computed by the MAXQDA Standard 2022® software.

We analyzed sociodemographic and interview characteristics using IBM SPSS Statistics 27® and Excel 2016®. Transcripts were managed and analyzed using MAXQDA Standard 2022®.

Participants were provided with oral and written information about the trial and gave written informed consent. Ethical approvals were obtained from the Ethics Committee of the University of Cologne (#20–1436). The trial is registered in the German Register for Clinical Studies (DRKS) (DRKS00022771) and is conducted under the Declaration of Helsinki.

Characteristics of participants and interviews

PwsMS participating in an interview were mainly German (84.6%), had a mean EDSS of 6.8 (range: 6–8) and MS for 13.5 years (median: 14; SD: 8.1). For detailed characteristics see Table  3 .

Most of the interviewed caregivers (9 caregivers) were the partners of the PwsMS with whom they lived in the same household. For further details see Table  3 .

HCSs involved in the study comprised various professions, including MS-nurse (3), neurologist (2), general physician with further training in palliative care (1), physician with further training in palliative care and pain therapist (1), housing counselling service (1), outpatient nursing service manager (1), participation counselling service (1).

Structuring qualitative content analysis

The experiences of PwsMS, caregivers and HCSs were a priori deductively assigned to four main categories: (1) gatekeeper function, (2) broker function, (3) advocacy function [ 25 , 26 , 27 , 28 , 29 ] and (4) Outlook on CCM in standard care, whereas the subcategories were developed inductively (see Fig.  3 ).

Category system including main and subcategories of the qualitative thematic content analysis

The most extensive category, housing the highest number of codes and subcodes, was the “ Outlook on CCM in standard care ” (281 codes). Following this, the category “ Advocacy Function ” contained 261 codes. The “ Broker Function ” (150 codes) and the “ Gatekeeper Function ” (160 codes) constituted two smaller categories. The majority of codes was identified in the caregivers’ interviews, followed by those of PwsMS (see Table  4 ). Illustrative quotes for each category and subcategory can be found in Table  5 .

Persons with severe multiple sclerosis

In the gatekeeper function (59 codes), PwsMS particularly valued the CCM as a continuous contact person . They appreciated the CCM as a person of trust who was reliably accessible throughout the intervention period. This aspect, with 41 codes, held significant importance for PwsMS.

Within the broker function (44 codes), establishing contact was most important for PwsMS (22 codes). This involved the CCM as successfully connecting PwsMS and caregivers with physicians and therapists, as well as coordinating and arranging medical appointments, which were highly valued. Assistance in authority and health and social insurance matters (10 codes) was another subcategory, where the CCM encompassed support in communication with health insurance companies, such as improving the level of care, assisting with retirement pension applications, and facilitating rehabilitation program applications. Optimized care (12 codes) resulted in improved living conditions and the provision of assistive devices through the CCM intervention.

The advocacy function (103 codes) emerged as the most critical aspect for PwsMS, representing the core of the category system. PwsMS experienced multidimensional, comprehensive, cross-insurance system support from the CCM. This category, with 43 statements, was the largest within all subcategories. PwsMS described the CCM as addressing their concerns, providing help, and assisting with the challenges posed by the illness in everyday life. The second-largest subcategory, regaining, maintaining and supporting autonomy (25 codes), highlighted the CCM’s role in supporting self-sufficiency and independence. Reviving personal wellbeing (17 codes) involved PwsMSs’ needs of regaining positive feelings, improved quality of life, and a sense of support and acceptance, which could be improved by the CCM. Temporal relief (18 codes) was reported, with the CCM intervention taking over or reducing tasks.

Within the outlook on CCM in standard care (84 codes), eight subcategories were identified. Communications was described as friendly and open (9 codes), with the setting of communication (29 codes) including the frequency of contacts deemed appropriate by the interviewed PwsMS, who preferred face-to-face contact over virtual or telephone interactions. Improvement suggestions for CCM (10 codes) predominantly revolved around the desire for the continuation of the CCM beyond the trial, expressing intense satisfaction with the CCM contact person and program. PwsMS rarely wished for better cooperation with the CCM. With respect to limitations (7 codes), PwsMS distinguished between individual limitations (e.g. when not feeling ready for using a wheelchair) and overriding structural limitations (e.g. unsuccessful search for an accessible apartment despite CCM support). Some PwsMS mentioned needing the CCM earlier in the course of the disease and believed it would beneficial for anyone with a chronic illness (6 codes).

In the gatekeeper function (75 codes), caregivers highly valued the CCM as a continuous contact partner (33 codes). More frequently than among the PwsMS interviewed, caregivers valued the CCM as a source of consultation/ information on essential individual subjects (42 codes). The need for basic information about the illness, its potential course, treatment and therapy options, possible supportive equipment, and basic medical advice/ information could be met by the CCM.

Within the broker function (63 codes), caregivers primarily experienced the subcategory establish contacts (24 codes). They found the CCM as helpful in establishing and managing contact with physicians, therapists and especially with health insurance companies. In the subcategory assistance in authority and health and social insurance matters (22 codes), caregivers highlighted similar aspects as the PwsMS interviewed. However, there was a particular emphasis on assistance with patients' retirement matters. Caregivers also valued the optimization of patients’ care and living environment (17 codes) in various life areas during the CCM intervention, including improved access to assistive devices, home modification, and involvement of a household support and/ or nursing services.

The advocacy function, with 115 codes, was by far the broadest category . The subcategory multidimensional, comprehensive, cross-insurance system support represented the largest subcategory of caregivers, with 70 statements. In summary, caregivers felt supported by the CCM in all domains of life. Regaining, maintaining and supporting autonomy (11 codes) and reviving personal wellbeing (8 codes) in the form of an improved quality of life played a role not only for patients but also for caregivers, albeit to a lower extend. Caregivers experienced temporal relief (26 codes) as the CCM undertook a wide range of organizational tasks, freeing up more needed resources for their own interests.

For the Outlook on CCM in standard care , caregivers provided various suggestions (81 codes). Similar to PwsMS, caregivers felt that setting (home based face-to-face, telephone, virtual) and frequency of contact were appropriate (10 codes, communication setting ) and communications (7 codes) were recognized as open and friendly. However, to avoid conflicts between caregiver and PwsMS, caregivers preferred meeting the CCM separately from the PwsMS in the future. Some caregivers wished the CCM to specify all services it might offer at the beginning, while others emphasized not wanting this. Like PwsMS, caregivers criticized the CCM intervention being (trial-related) limited to one year, regardless of whether further support was needed or processes being incomplete (13 codes, improvement suggestions ). After the CCM intervention time had expired, the continuous contact person and assistance were missed and new problems had arisen and had to be managed with their own resources again (9 codes, effects of CCM discontinuation ), which was perceived as an exhausting or unsolvable endeavor. Caregivers identified analogous limitations (8 codes), both individual and structural. However, the largest subcategory, was the experienced potential of CCM (27 codes), reflected in extremely high satisfaction with the CCM intervention. Like PwsMS, caregivers regarded severe chronically ill persons in general as target groups for a CCM (7 codes) and would implement it even earlier, starting from the time of diagnosis. They considered a CCM to be particularly helpful for patients without caregivers or for caregivers with limited (time) resources, as it was true for most caregivers.

Health care specialists

In the gatekeeper function (26 codes) HCSs particularly valued the CCM as a continuous contact partner (18 codes). They primarily described their valuable collaboration with the CCM, emphasizing professional exchange between the CCM and HCSs.

Within the broker function (43 codes), the CCM was seen as a connecting link between patients and HCSs, frequently establishing contacts (18 codes). This not only improved optimal care on an individual patient level (case management) but also at a higher, superordinate care level (care management). HCSs appreciated the optimized care and living environment (18 codes) for PwsMS, including improved medical and therapeutic access and the introduction of new assistive devices. The CCM was also recognized as providing assistance in authority and health and social matters (7 codes) for PwsMS and their caregivers.

In the advocacy function (43 codes), HCSs primarily reported temporal relief through CCM intervention (23 codes). They experienced this relief, especially as the CCM provided multidimensional, comprehensive, and cross-insurance system support (15 codes) for PwsMS and their caregivers. Through this support, HCSs felt relieved from time intensive responsibilities that may not fall within their area of expertise, freeing up more time resources for their actual professional tasks.

The largest category within the HCSs interviews was the outlook on CCM in standard care (116 codes). In the largest subcategory, HCSs made suggestions for further patient groups who could benefit (38 codes) from a CCM. Chronic neurological diseases like neurodegenerative diseases (e.g. amyotrophic lateral sclerosis), typical and atypical Parkinson syndromes were mentioned. HCSs considered the enrollment of the CCM directly after the diagnosis of these complex chronic diseases. Additionally, chronic progressive diseases in general or oncological diseases, which may also run chronically, were regarded worthwhile for this approach. HCSs also provided suggestions regarding improvement (21 codes). They wished e.g. for information or contact when patients were enrolled to the CCM, regular updates, exchange and collaborative effort. On the other hand, HCSs reported, that their suggestions for improvement would hardly be feasible due to their limited time resources. Similar to patients and caregivers, HCSs experienced structural limits (13 codes), which a CCM could not exceed due to overriding structural limitations (e.g. insufficient supply of (household) aids, lack of outreach services like psychotherapists, and long processing times on health and pension insurers' side). HCSs were also asked about their opinions on financial resources (14 codes) of a CCM in standard care. All interviewed HCSs agreed that CCM would initially cause more costs for health and social insurers, but they were convinced of cost savings in the long run. HCSs particularly perceived the potential of the CCM (20 codes) through the feedback of PwsMS, highlighting the trustful relationship enabling individualized help for PwsMS and their caregivers.

Persons with severe multiple sclerosis and their caregivers

The long-term cross-sectoral CCM intervention implemented in the COCOS-MS trial addressed significant unmet needs of PwsMS and their caregivers which previous research revealed as burdensome and hardly or even not possible to improve without assistance [ 5 , 6 , 9 , 10 , 33 , 35 , 46 ]. Notably, the CCM service met the need for a reliable, continuous contact partner, guiding patients through the complexities of regulations, authorities and the insurance system. Both, PwsMS and their caregivers highly valued the professional, objective perspective provided by the CCM, recognizing it as a source of relief, support and improved care in line with previous studies [ 37 , 47 ]. Caregivers emphasized the CCM’s competence in offering concrete assistance and information on caregiving and the fundamentals of MS, including bureaucratic, authority and insurances matters. On the other hand, PwsMS particularly appreciated the CCMs external reflective and advisory function, along with empathic social support tailored to their individual concerns. Above all, the continuous partnership of trust, available irrespective of the care sector, was a key aspect that both PwsMS and their caregivers highlighted. This consistent support was identified as one of the main components in the care of PwsMS in previous studies [ 5 , 33 , 35 ].

As the health literacy is inadequate or problematic for 54% of the German population and disintegration in the health and social care system is high [ 30 , 31 , 32 ], the CCM approach serves to enhance health literacy and reduce disintegration of PwsMS and their caregivers by providing cross-insurance navigational guidance in the German health and social insurance sector on a superordinate level. Simultaneously PwsMS and caregivers experienced relief and gained more (time) resources for all areas of life outside of the disease and its management, including own interests and establishing biographical continuity. This empowerment enables patients to find a sense of purpose beyond their illness, regain autonomy, and enhance social participation, reducing the feeling of being a burden to those closest to them. Such feelings are often experienced as burdensome and shameful by PwsMS [ 6 , 48 , 49 , 50 ]. Finding a sense of purpose beyond the illness also contributes to caregivers perceiving their loved ones not primarily as patient but as individuals outside of the disease, reinforcing valuable relationships such as partners, siblings, or children, strengthening emotional bonds. These factors are also highly relevant and well-documented in a suicide-preventive context, as the suicide rate is higher in persons diagnosed with neurological disorders [ 19 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] and the feeling of being a burden to others, loss of autonomy, and perceived loss of dignity are significant factors in patients with severe chronic neurological diseases for suicide [ 50 , 57 ].

The temporal relief experienced by the CCM was particularly significant for HCSs and did not only improve the satisfaction of HCSs but also removed unfulfilled expectations and concerns about being blamed by patients when expectations could not be met, which previous studied elaborated [ 35 , 36 ]. Moreover, the CCM alleviated the burden on HCSs by addressing patients’ concerns, allowing them to focus on their own medical responsibilities. This aspect probably reduced the dissatisfaction that arises when HCSs are expected to address issues beyond their medical expertise, such as assistive devices, health and social insurance, and the organization and coordination of supplementary therapies, appointments, and contacts [ 35 , 36 , 61 ]. Consequently, the CCM reduced difficulties of HCSs treating persons with neurological or chronical illnesses, which previous research identified as problematic.

HCSs perceive their work as increasingly condensed with numerous time and economic constraints, especially when treating complex and severely ill individuals like PwsMS [ 36 ]. This constraint was mentioned by HCSs in the interviews and was one of the main reasons why they were hesitant to participate in interviews and may also be an explanation for a shorter interview duration than initially planned in the interview guides. The CCM’s overarching navigational competence in the health and social insurance system was particularly valued by HCSs. The complex and often small-scale specialties in the health and social care system are not easily manageable or well-known even for HCSs, and dealing with them can exceed their skills and time capacities [ 61 ]. The CCM played a crucial role in keeping (temporal) resources available for what HCSs are professionally trained and qualified to work on. However, there remains a challenge in finding solutions to the dilemma faced by HCSs regarding their wish to be informed about CCM procedures and linked with each other, while also managing the strain of additional requests and contact with the CCM due to limited (time) resources [ 62 ]. Hudon et al. (2023) suggest that optimizing time resources and improving exchange could involve meetings, information sharing via fax, e-mail, secure online platforms, or, prospectively, within the electronic patient record (EPR). The implementation of an EPR has shown promise in improving the quality of health care and time resources, when properly implemented [ 63 , 64 ]. The challenge lies ineffective information exchange between HCSs and CCM for optimal patient care. The prospect of time saving in the long run and at best for a financial incentive, e.g., when anchoring in the Social Security Code, will help best to win over the HCSs.If this crucial factor can be resolved, there is a chance that HCSs will thoroughly accept the CCM as an important pillar, benefiting not only PwsMS but also other complex patient groups, especially those with long-term neurological or complex oncological conditions that might run chronically.

Care and case management and implications for the health care system

The results of our study suggest that the cross-sectoral long-term advocacy CCM in the COCOS-MS trial, with continuous personal contacts at short intervals and constant reevaluation of needs, problems, resources and goals, is highly valued by PwsMS, caregivers, and HCSs. The trial addresses several key aspects that may have been overlooked in previous studies which have shown great potential for the integration of case management [ 17 , 47 , 62 , 65 , 66 ]. However, they often excluded the overriding care management, missed those patient groups with special severity and complexity who might struggle to reach social and health care structures independently or the interventions were not intended for long-term [ 22 , 37 ]. Our results indicate that the CCM intervention had a positive impact on PwsMS and caregivers as HCSs experienced them with benefits such as increased invigoration, reduced demands, and enhanced self-confidence. However, there was a notable loss experienced by PwsMS and caregivers after the completion of the CCM intervention, even if they had stabilized during the intervention period. The experiences of optimized social and health care for the addressed population, both at an individual and superordinate care level, support the integration of this service into standard care. Beyond the quantitatively measurable outcomes and economic considerations reported elsewhere [ 16 , 20 , 21 ], our results emphasize the importance of regaining control, self-efficacy, self-worth, dignity, autonomy, and social participation. These aspects are highlighted as preventive measures in suicidal contexts, which is particularly relevant for individuals with severe and complex illnesses [ 19 , 50 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Our findings further emphasize the societal responsibilities to offer individuals with severe and complex illnesses the opportunity to regain control and meaningful aspects of life, irrespective of purely economic considerations. This underscores the need for a comprehensive evaluation that not only takes into account quantitative measures but also the qualitative aspects of well-being and quality of life when making recommendations of a CCM in standard care.

The study by J. Y. Joo and Huber (2019) highlighted that CM interventions aligned with the standards of the Case Management Society of America varied in duration, ranging from 1 month to 15.9 years, and implemented in community- or hospital-based settings. However, they noted a limitation in understanding how CM processes unfold [ 67 ]. In contrast, our trial addressed this criticism by providing transparent explanations of the CCM process, which also extends to a superordinate care management [ 40 , 41 ]. Our CCM manual [ 40 ] outlines a standardized and structured procedure for measuring and reevaluating individual resources, problems, and unmet needs on predefined dimensions. It also identifies goals and actions at reducing unmet needs and improving the individual resources of PwsMS and caregivers. Importantly, the CCM manual demonstrates that the CCM process can be structured and standardized, while accounting for the unique aspects of each individual’s serious illness, disease courses, complex needs, available resources, and environmental conditions. Furthermore, the adaptability of the CCM manual to other complex chronically ill patient groups suggests the potential for a standardized approach in various health care settings. This standardized procedure allows for consistency in assessing and addressing the individual needs of patients, ensuring that the CCM process remains flexible while maintaining a structured and goal-oriented framework.

The discussion about the disintegration in the social and health care system and the increasing specialization dates back to 2009 [ 31 , 32 ]. Three strategies were identified to address this issue: (a) “driver-minimizing” [Treiberminimierende], (b) “effect-modifying” [Effektmodifizierende] and (c) “disintegration-impact-minimizing” [Desintegrationsfolgenminimierende] strategies. “Driver-minimizing strategies” involve comprehensive and radical changes within the existing health and social care system, requiring political and social pursuit. “Disintegration-impact-minimizing strategies” are strategies like quality management or tele-monitoring, which are limited in scope and effectiveness. “Effect-modifying strategies”, to which CCM belongs, acknowledges the segmentation within the system but aims to overcome it through cooperative, communicative, and integrative measures. CCM, being an “effect-modifying strategy”, operates the “integrated segmentation model” [Integrierte Segmentierung] rather than the “general contractor model” [Generalunternehmer-Modell] or “total service provider model” [Gesamtdienstleister-Modell] [ 31 , 32 ]. In this model, the advantage lies in providing an overarching and coordinating service to link different HCSs and services cross-sectorally. The superordinate care management aspect of the CCM plays a crucial role in identifying gaps in care, which is essential for future development strategies within the health and social care system. It aims to find or develop (regional) alternatives to ensure optimal care [ 17 , 23 , 24 , 68 , 69 ], using regional services of existing health and social care structures. Therefore, superordinate care management within the CCM process is decisive for reducing disintegration in the system.

Strengths and limitations

The qualitative study results of the explorative COCOS-MS clinical trial, which employed an integrated mixed-method design, provide valuable insights into the individual experiences of three leading stakeholders: PwsMS, caregivers and HCSs with a long-term cross-sectoral CCM. In addition to in-depth interviews, patient and caregiver reported outcome measurements were utilized and will be reported elsewhere. The qualitative study’s strengths include the inclusion of patients who, due to the severity of their condition (e.g. EDSS mean: 6.8, range: 6–8, highly active MS), age (mean: 53.9 years, range: 36–73 years) family constellations, are often underrepresented in research studies and often get lost in existing social and health care structures. The study population is specific to the wider district region of Cologne, but the broad inclusion criteria make it representative of severe MS in Germany. The methodological approach of a deductive and inductive structuring content analysis made it possible to include new findings into an existing theoretical framework.

However, the study acknowledges some limitations. While efforts were made to include more HCSs, time constraints on their side limited the number of interviews conducted and might have biased the results. Some professions are underrepresented in the interviews. Complex symptoms (e.g. fatigue, ability to concentrate), medical or therapeutic appointments and organization of the everyday live may have been reasons for the patients’ and caregivers’ interviews lasting shorter than initially planned.

The provision of functions of a CCM, might have pre-structured the answers of the participants.

At current, there is no support system for PwsMS, their caregivers and HCSs that addresses their complex and unmet needs comprehensively and continuously. There are rare qualitative insights of the three important stakeholders: PwsMS, caregivers and HCSs in one analysis about a supporting service like a CCM. In response to this gap, we developed and implemented a long-term cross-sectoral advocacy CCM and analyzed it qualitatively. PwsMS, their caregivers and HCSs expressed positive experiences, perceiving the CCM as a source of relief and support that improved care across various aspects of life. For patients, the CCM intervention resulted in enhanced autonomy, reviving of personal wellbeing and new established contacts with HCSs. Caregivers reported a reduced organizational burden and felt better informed, and HCSs experienced primarily temporal relief, allowing them to concentrate on their core professional responsibilities. At a higher level of care, the study suggests that the CCM contributed to a reduction in disintegration within the social and health care system.

The feedback from participants is seen as valuable for adapting the CCM intervention and the CCM manual for follow-up studies, involving further complex patient groups such as neurological long-term diseases apart from MS and tailoring the duration of the intervention depending on the complexity of evolving demands.

Availability of data and materials

Generated and/or analyzed datasets of participants are available from the corresponding author on reasonable request to protect participants. Preliminary partial results have been presented as a poster during the EAPC World Congress in June 2023 and the abstract has been published in the corresponding abstract booklet [ 70 ].

Abbreviations

Amyotrophic lateral sclerosis

• Care and case management

Case management

Central nervous system

Communication, Coordination and security for people with multiple sclerosis

Consolidated criteria for reporting qualitative research

German register for clinical studies

Extended disability status scale

Electronic patient record

Quality of life

Multiple sclerosis

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Acknowledgements

We would like to thank all the patients, caregivers and health care specialists who volunteered their time to participate in an interview and the trial, Carola Janßen for transcribing the interviews, Fiona Brown for translating the illustrative quotes and Beatrix Münzberg, Kerstin Weiß and Monika Höveler for data collection in the quantitative study part.

COCOS-MS Trial Group

Anne Müller 1 , Fabian Hebben 1 , Kim Dillen 1 , Veronika Dunkl 1 , Yasemin Goereci 2 , Raymond Voltz 1,3,4 , Peter Löcherbach 5 , Clemens Warnke 2 , Heidrun Golla 1 , Dirk Müller 6 , Dorthe Hobus 1 , Eckhard Bonmann 7 , Franziska Schwartzkopff 8 , Gereon Nelles 9 , Gundula Palmbach 8 , Herbert Temmes 10 , Isabel Franke 1 , Judith Haas 10 , Julia Strupp 1 , Kathrin Gerbershagen 7 , Laura Becker-Peters 8 , Lothar Burghaus 11 , Martin Hellmich 12 , Martin Paus 8 , Solveig Ungeheuer 1 , Sophia Kochs 1 , Stephanie Stock 6 , Thomas Joist 13 , Volker Limmroth 14

1 Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

2 Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

3 Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany

4 Center for Health Services Research (ZVFK), University of Cologne, Cologne, Germany

5 German Society of Care and Case Management e.V. (DGCC), Münster, Germany

6 Institute for Health Economics and Clinical Epidemiology (IGKE), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

7 Department of Neurology, Klinikum Köln, Cologne, Germany

8 Clinical Trials Centre Cologne (CTCC), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

9 NeuroMed Campus, MedCampus Hohenlind, Cologne, Germany

10 German Multiple Sclerosis Society Federal Association (DMSG), Hannover, Germany

11 Department of Neurology, Heilig Geist-Krankenhaus Köln, Cologne, Germany

12 Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

13 Academic Teaching Practice, University of Cologne, Cologne, Germany

14 Department of Neurology, Klinikum Köln-Merheim, Cologne, Germany

Open Access funding enabled and organized by Projekt DEAL. This work was supported by the Innovation Funds of the Federal Joint Committee (G-BA), grant number: 01VSF19029.

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Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

Anne Müller, Fabian Hebben, Kim Dillen, Veronika Dunkl, Raymond Voltz & Heidrun Golla

Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

Yasemin Goereci & Clemens Warnke

Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany

Raymond Voltz

Center for Health Services Research, University of Cologne, Cologne, Germany

German Society of Care and Case Management E.V. (DGCC), Münster, Germany

Peter Löcherbach

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• Anne Müller
• , Fabian Hebben
• , Kim Dillen
• , Veronika Dunkl
• , Yasemin Goereci
• , Raymond Voltz
• , Peter Löcherbach
• , Clemens Warnke
• , Heidrun Golla
• , Dirk Müller
• , Dorthe Hobus
• , Eckhard Bonmann
• , Franziska Schwartzkopff
• , Gereon Nelles
• , Gundula Palmbach
• , Herbert Temmes
• , Isabel Franke
• , Judith Haas
• , Julia Strupp
• , Kathrin Gerbershagen
• , Laura Becker-Peters
• , Lothar Burghaus
• , Martin Hellmich
• , Martin Paus
• , Solveig Ungeheuer
• , Sophia Kochs
• , Stephanie Stock
• , Thomas Joist
•  & Volker Limmroth

Contributions

HG, KD, CW designed the trial. HG, KD obtained ethical approvals. HG, KD developed the interview guidelines with help of the CCM (SU). AM was responsible for collecting qualitative data, developing the code system, coding, analysis of the data and writing the first draft of the manuscript, thoroughly revised and partly rewritten by HG. FH supported in collecting qualitative data, coding and analysis of the interviews. KD supported in collecting qualitative data. AM, FH, KD, VD, YG, RV, PL, CW, HG discussed and con-solidated the finalized category system. AM, FH, KD, VD, YG, RV, PL, CW, HG read and commented on the manuscript and agreed to the final version.

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Correspondence to Anne Müller .

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Ethics approval and consent to participate.

Participants were provided with oral and written information about the trial and provided written informed consent. Ethical approval was obtained from the Ethics Committee of the University of Cologne (#20–1436). The trial is registered in the German Register for Clinical Studies (DRKS) (DRKS00022771) and is conducted under the Declaration of Helsinki.

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Competing interests.

Clemens Warnke has received institutional support from Novartis, Alexion, Sanofi Genzyme, Janssen, Biogen, Merck and Roche. The other authors declare that they have no competing interests.

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Müller, A., Hebben, F., Dillen, K. et al. “So at least now I know how to deal with things myself, what I can do if it gets really bad again”—experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study. BMC Health Serv Res 24 , 453 (2024). https://doi.org/10.1186/s12913-024-10851-1

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Received : 23 November 2023

Accepted : 11 March 2024

Published : 10 April 2024

DOI : https://doi.org/10.1186/s12913-024-10851-1

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