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[Title—up to 12 words on 1–2 lines]
[Author Names—First M. Last; omit titles and degrees]
[Institutional Affiliation(s)]
[Title—up to 12 words on 1–2 lines]
[Indent all paragraphs; use double-spaced, 12-point font. An
abstract is not required for this assignment.]
[Introduction: The introduction paragraph should include a
“hook” to grab the reader, some contextual information about
your topic, and your thesis statement as the last sentence of the
paragraph. The wording in red is an example of an introduction;
delete the red text and all of the information in brackets before
beginning your assignment.] In the year 2016, Americans
purchased approximately 17.5 million vehicles; less than 1% of
these sales were electric or hydrogen fuel cell vehicles.
Meanwhile, other nations, like China and Norway, have eclipsed
the United States in electric vehicle market share (Sperling,
2018). These is no doubt from the international scientific
community that carbon emissions from traditional internal
combustion engine vehicles contribute significantly to climate
change, and that electric vehicles represent a viable strategy to
curb the automotive industry’s negative impact on the
environment. Why then do electric vehicle (EV) sales still lag in
the United States and what can be done to increase sales? The
US government should increase the incentives for the
production and consumption of electric cars because the United
States is falling behind other nations in market share of electric
cars, they are still too expensive for most consumers, and
research demonstrates that electric cars are effective at reducing
carbon emissions, which contribute to climate change.
[Transition sentence from thesis. Body paragraph 1 should
include the first component of your argument and paraphrased
or quoted evidence from your sources to support it with in-text
citations after any information that comes from a source (last
name, year). The wording in red is an example of a body
paragraph; delete the red text and all of the information in
brackets before beginning your assignment.] The United States,
once a world leader in automotive innovation, is quickly falling
behind other nations in electric vehicle market share. While US
consumers purchase one-fifth of the world’s EVs, that
represents just a tiny fraction of the American vehicle market.
The largest EV market is China, with more than half of world’s
EV sales. Many countries in Europe are likewise adopting EVs
at much higher rates per capita, including Norway, where EVs
represent 30% of vehicle sales (Sperling, 2018). The European
Parliament and European Union have paved the way for greater
EV consumption by setting 2020 targets for EVs and charging
stations in all EU member states (Noori & Tatari, 2016). In
addition, Japan’s government and private sector have also
displayed a commitment to the shift toward EVs, by committing
to adding 6,000 new fast chargers across the country by 2016
(Sperling, 2018). In comparison to these nations, the United
States’ public and private commitment to the shift to electric
vehicles has flagged. The US auto market is much larger and
more diverse, with a complicated history of automakers, the oil
and gasoline industry, and lobbyists impacting the public’s
perception of different types of vehicles. However, in
considering the United States’ long history as a global leader in
the auto industry, it is problematic that the United States is
becoming a follower rather than a leader in the newest shift in
the industry. Electric vehicles are ultimately the direction that
the automobile market will shift, so the United States should
take additional steps to keep up with its global peers.
[Transition sentence from paragraph above. You may have more
than one body paragraph on each of the 3 components for your
argument. Each body paragraph should include the paraphrased
or quoted evidence from your sources to support your argument
with in-text citations after any information that comes from a
source (last name, year).]
[etc.]
[Transition sentence from paragraph above. Your final body
paragraph should include opposing perspectives on your topic
and paraphrased or quoted evidence from your sources to refute
it with in-text citations after any information that comes from a
source (last name, year).]
[Conclusion: The concluding paragraph should provide a short
review of the main ideas presented in the body and make a
connection back to the thesis statement. It should also offer
some concluding thoughts related to the topic and the future.]
The evidence from experts is clear: Electric vehicles are not
only beneficial to the fight against climate change, but they are
the future of the auto industry. However, the price of electric
vehicles still puts them out of reach for most American
consumers, resulting in the US falling behind its international
peers in electric vehicle adoption per capita. The United States
government must take steps today and tomorrow to pave the
way forward for American electric vehicle consumption through
increased incentives provided to both consumers and producers.
Climate change is not a problem we can tackle alone; only
through concerted efforts in specific areas can the United
States, and the world, combat global warming. Shifting from
gasoline-powered to electric vehicles is an important part of
that fight, and we must take steps to assure it.
References
Noori, M., & Tatari, O. (2016). Development of an agent-based
model for regional market penetration projections of electric
vehicles in the United States. Energy, 96, 215–230.
https://doi.org/10.1016/j.energy.2015.12.018
Sperling, D. (2018). Electric vehicles: Approaching the tipping
point. Bulletin of the AtomicScientists, 74(1), 11–18.
https://doi.org/10.1080/00963402.2017.1413055
Title
ABC/123 Version X
1
Market Plan Template
MHA/506 Version 2
1
Marketing Plan Template
Executive Summary
· Introduction
· Situation Overview
· Goal
· Action Overview
· Conclusions
Situation Overview
· The big picture
· Company overview
· Market overview
Goal/Objectives
· Goal focus
· Performance benchmarks
· Market objectives
Marketing Strategy
· Target market
· Target customers
· Company
· Collaborators
· Competitors
· Value Proposition
· Customer value
· Collaborator value
· Company value
Tactics
· Product
· Service
· Brand
· Price
· Incentives
· Communication
Implementation
· Defining the business infrastructure
· Physical infrastructure
· Organizational infrastructure
· The business process
· Strategic plan implications
· Resource management
· Product and service management
· Brand management
· Communication management
· Distribution management
· Set the schedule for implementation
Control
· Performance evaluation of the plan
· Adequate goal progress
· Performance gap management
· Environmental Analysis
· Opportunities
· Threats
Exhibits
· Market data exhibits
· Value analysis exhibits
· Marketing mix exhibits
· Organizing the exhibits
· Label
· Title
· Overview
· Body
· Notes
· Source
Additional Considerations in a Marketing Plan
· Brand Management
· Communication Plans
Copyright © XXXX by University of Phoenix. All rights
reserved.
Copyright © 2018 by University of Phoenix. All rights reserved.
Title
ABC/123 Version X
1
Case Study: East Chestnut Regional Health System
MHA/506 Version 2
1
CASE STUDY: EAST CHESTNUT REGIONAL HEALTH
SYSTEM
History
Within the last 10 years, East Chestnut Regional Health System
(ECRH) was formed from the merger of three organizations: the
East River Medical Center, the Northern Mountain Hospital
Consortium, and the Archway Hospital.
East River Medical Center (ERMC)
ERMC is the anchor hospital for the system. The medical center
resides along the east side of the Chestnut River. Historically,
ERMC was recognized as the location of choice for medical
care. However, this reputation has deteriorated over the last 3 to
5 years. As the city of Chestnut has grown, ERMC has found
itself on the edge of an urban blight. Safety has been a concern
for patients, visitors, and physicians who use and serve the
medical center. The technology offered at the medical center
has been maintained at an excellent level of proficiency. At the
same time, the medical staff is aging with the average age of the
physicians being 57. There are younger primary care physicians
who serve the specialists, but the specialists are aging as well.
ERMC boasts a Level 1 Trauma Center with an air service. The
total number of licensed beds for ERMC is 550. On any given
day, the occupancy rate is 300 heads on the beds.
Northern Mountain Hospital Consortium (NMHC)
NMHC was originally formed in response to the migration of
patients to Chestnut. Due to the rather aggressive strategies
carried out by the hospitals in Chestnut, these rural hospitals
decided to create a consortium of rural hospitals so that they
could gain economies of scale in a number of areas, which
include group purchasing, benefit administration, and physician
and staff recruitment. Additionally, they worked together to
stem any further deterioration of their market share. Patients
were selecting to go to the larger community for services and
leaving the smaller communities that collared the Chestnut
metropolitan area. NMHC represented individual hospitals in
four counties that circled Chestnut County: Walnut, Butternut,
Oak, and Maple. Walnut and Butternut Counties had good
employment with Oak and Maple Counties being mostly rural.
In each county, the inpatient facilities averaged about 20 years
of age. The upkeep of these facilities has been sketchy. No
facility needs any major upgrades, but modernization is needed.
The state does not have a Certificate of Need (CON) process.
The medical staff makeup varies each location. The hospitals in
Oak and Maple Counties are critical access hospitals. Further
details will be provided regarding these organizations later in
the case study.
Archway Hospital (AH)
AH is located directly in the community of Chestnut. It fully
resides in the urban area of the community. The hospital has
200 registered beds, but on any given day there are only 50 to
75 patients in this facility. This hospital was a Doctor of
Osteopathy (DO) hospital; therefore, most of the physicians that
worked out of this facility were DOs. The payer mix for this
hospital was heavily burdened with Medicare and Medicaid.
This payer mix composed nearly 85% of the reimbursement. The
facility is aging and needs considerable repairs. It is
questionable if it will be worth the investment in this facility.
Leadership and Organizational Culture
The original merger that created the East Chestnut Regional
Health System (ECRH) occurred 10 years ago. This merger was
between ERMC and AH. AH had a rather dynamic leader who
was about 57 years old at the time of the merger. The AH CEO
became the new President and Chief Executive Officer of ECRH
after the merger. Since this CEO had only worked in a smaller
organization, he had not experienced the cultural changes and
demands that occur after the merging of a large organization.
Additionally, he began to change the culture of the organization
such that decisions were made on a decentralized basis. He
trusted the management team at AH to do the right things and
make the right decisions with low supervision. However, the
Chief Operating Officer (COO) who was put in charge was
originally from AH but left 2 years after the merger with a new
COO being put in place. This COO developed a rather poor
reputation and was known to want to build his own empire at
AH and to be dishonest at times. This reputation created a
culture within the traditional AH that lacked a cohesive team
effort to create a system. This positioning of the COO was left
unattended by the President and CEO of ECRH since he was
actively pursuing the acquisition of NMHC. The hospitals of
NMHC were doing okay, but those in the consortium realized
that their ability to stand alone was becoming difficult in
today’s market. When the leadership of the consortium assessed
the market as to a partnership, they decided that ECRH would
be the best choice. The other option was to develop a for-profit
hospital that also resided in Chestnut. The leadership was
attracted to what they saw happen with AH. They liked that the
central leadership of the system allowed AH to continue on as
their own entity without a lot of centralized control.
By the time all of this was put together, the President and CEO
of ECRH was near retirement. He retired about three years after
all of the merger activity was complete. During those three
years, he became lax in his leadership role. ECRH deteriorated
in market share and profitability during this time. Upon his
retirement, the Board of ECRH performed a national search for
a replacement. They employed Hunter Brown as the new
President and CEO. Mr. Brown was the CEO of a smaller health
system and had been in that position for nearly 10 years.
Therefore, he had limited experience from other markets in the
art of strategic implementation. However, he was also well
trained, bright, and articulate in expressing his knowledge. He
has now been the President/CEO of ECRH for nine months.
As for the remainder of the leadership team for ECRH, there is
a newly hired corporate counsel. She has 15 years of experience
and is extremely competent in the work that she does.
The CEO also hired a new Chief Financial Officer. He has taken
good strides in managing the accounts receivable throughout the
system as well as extracting exceptional dollars from high
quality supply chain management.
The Chief Operating Officer (COO) is new and has three years
of previous experience from the same organization where the
CEO departed.
The Chief Medical Officer (CMO) has been retained from the
old leadership team. His reputation is excellent, and he works
well with other physicians, including the medical staff and the
employed physicians.
The Chief Nursing Officer (CNO) is three years away from
retirement. She is known for not getting along with the medical
staff and will always defend nursing when at times this is not
appropriate.
The Senior Vice President for Human Resources is competent
and respected by management and staff throughout the
organization.
The remainder of the leadership team was retained from the old
regime. This included information technology, employed
physician group leadership, marketing, human resources, and
other vice presidents or directors responsible for varying
service lines. It should be noted that the IT leadership is just
completing the implementation of the EPIC system. The future
for this team depends on how well the overall implementation of
the system goes. Likewise those in the marketing department
will need to be stellar in senior leadership advisement regarding
the marketing of complex issues that will be encountered ahead.
They have been told if marketing misses the target, then
replacements will occur within this department.
The new CEO inherited the management team of AH and
NMHC. For NMHC the organizational structure was left intact
with the COOs for each of the individual hospitals being
retained. It was agreed that this traditional structure would be
left intact for at least five years. This agreement was near its
end and the new CEO had plans to change the existing structure
as well as management. This change was being considered for
this year’s strategic plan development. Even if the structure of
NMHC was going to be changed to a more direct relationship
with corporate leadership, all of the existing COO’s would be
retained as they have performed well since the merger. As for
the COO of AH, he had been recently terminated. An interim
COO is now in place pending the board approved closure of this
hospital.
Competitive Assessment
ECRH was not the only provider of care in the community.
There was a for-profit hospital, Banford Medical Center (BMC),
that had been purchased by a large publicly traded for-profit
health system about 10 years ago. The for-profit health system
was the largest in the country. The CEO of this hospital was
good at optimizing performance as a result of the weaknesses of
ECRH and its leadership. He was an effective opportunist.
BMC has 400 registered beds with a current occupancy rate of
85%. They have been effective at taking market share away
from ECRH. For each loss of service line market share by
ECRH, BMC has shown proportional gains. After the
acquisition of BMC, the for-profit immediately moved to build a
new facility. This new facility is located on the growing
wealthy edge of the community. Additionally, at the time that
this new facility was developed, the for-profit syndicated
ownership to the physicians. The highest level of syndication
occurred with the obstetrics and gynecology physicians in the
community. Therefore, women’s services deteriorated at ECRH.
It should be noted that this physician syndication occurred
before the Affordable Care Act was passed, which precluded
hospital ownership by physicians.
It is important that additional information is provided regarding
ECRH. ECRH recently purchased 100 acres of land across the
interstate from BMC. This land is located northwest of Chester.
The intention is to eventually build a new medical center on this
location. The initial planning of this land has occurred and it
has been approved to build a regional oncology center on this
site. The construction of the project is already underway with an
anticipated completion in 6 months.
In addition, ECRH has an orthopedic hospital attached to the
current ERMC site and a behavioral health hospital at this same
location. ECRH also has two ambulatory surgical centers that
are conveniently located on the growing northwest and
southwest side in the community. The one surgical center is
located on the 100 acre development site. The orthopedic
hospital has done well and has been listed in the top 100
orthopedic hospitals. However, the behavioral health hospital is
losing significant dollars, so the Board of Directors for ECRH
has decided to close down this hospital. ECRH has also
developed a joint venture imaging center with the radiologists.
This center resides across from a major shopping area in the
community. It is conveniently located near heavily populated
neighborhoods and shopping. The only downside is the location
is not close to physician offices that would refer to this center.
However, if a new facility is built on the 100 acres, which
would include physician offices, the imaging center will be in
an ideal location. Leadership is developing a free standing
emergency center on the 100 acre site, which is on the
northwest side of Chestnut.
The last competitive issue is the location of a medical school
and hospital in the city of Chestnut. The facility resides in a
downtown location. This medical school had been established
by the state nearly 45 years ago and is associated with
Greenbranch University. It mostly serves the indigent
community in Chestnut and the surrounding area. This academic
center has a rather negative reputation in the surrounding area.
There are four other medical academic centers in the state as
well as a medical center with a world renowned reputation.
There have been ongoing rumors that this world renowned
organization was planning on assuming the responsibility of the
Chestnut academic center. This change would substantially alter
the complexion of the local medical community if it were to
occur. Speed in ECRH dealing with some of its market issues is
an imperative.
Additional Market Information: Population
DemographicsChestnut County
· With 433,689 people, Chestnut County is the 6th most
populated county in the state.
· The largest Chestnut County racial/ethnic groups are
Caucasian (70.1%), African American (18.5%), and Hispanic
(6.5%).
· In 2015, the median household income of Chestnut County
residents was $41,777. However, 21.1% of Chestnut County
residents live in poverty.
· The median age for Chestnut County residents is 37.7 years
old.
· Employment is strong in Chestnut County. Unemployment
resides at 4.5%. Employer diversity is strong since the
community is not dependent on singular large employers.
Employment includes some high-tech jobs, general
manufacturing to support the automobile industry, and there is a
large university, Greenbranch University, located in the
community. The university has 25,000 students and offers most
majors, which includes engineering and nursing.
Walnut County
· With 42,537 people, Walnut County is the 57th most populated
county in the state.
· The largest Walnut County racial/ethnic groups are Caucasian
(89.8%), followed by Hispanic (7.2%) and African American
(3%).
· In 2015, the median household income of Walnut County
residents was $55,120. However, 10.8% of Walnut County
residents live in poverty.
· The median age for Walnut County residents is 39.8 years old.
Butternut County
· With 38,352 people, Butternut County is the 65th most
populated county in the state.
· The largest Butternut County racial/ethnic groups are White
(87.0%), Hispanic (9.5%), and African American (1.7%).
· In 2015, the median household income of Butternut County
residents was $50,663. However, 13.4% of Butternut County
residents live in poverty.
· The median age for Butternut County residents is 39.7 years
old.
Oak County
· With 37,120 people, Oak County is the 66th most populated
county in the state.
· The largest Oak County racial/ethnic groups are Caucasian
(93.3%), Hispanic (4.0%), and African American (1.1%).
· In 2015, the median household income of Oak County
residents was $42,492. However, 14.9% of Oak County
residents live in poverty.
· The median age for Oak County residents is 46.6 years old.
Maple County
· With 27,816 people, Maple County is the 79th most populated
county in the state.
· The largest Maple County racial/ethnic groups are Caucasian
(90.8%), Hispanic (7.1%), and African American (1.0%).
· In 2015, the median household income of Maple County
residents was $39,353. However, 15.4% of Maple County
residents live in poverty.
· The median age for Maple County residents is 48.2 years old.
· Both Oak and Maple Counties are rural with an older
population. Many patients have Medicare and Medicaid that
come from these two counties. Likewise the hospitals located in
each of these counties have been designated as critical access.
Like many rural counties, Oak and Maple have been blighted
with younger people using drugs, including methamphetamine.
Employed Physicians
ECRH employs 400 physicians throughout its system. The
breakdown for each location is as follows:Chestnut County
· 135 primary care
· 100 specialistsWalnut County
· 40 primary care
· 10 specialistsButternut County
· 30 primary care
· 12 specialistsOak County
· 27 primary care
· 10 specialistsMaple County
· 25 primary care
· 11 specialists
There have been ongoing complaints from the newly recruited
physicians that their practices have not been marketed well;
thus, their patient volumes have been slow to grow.
Service Line Performance Information
The following is a list of bullet points regarding service line
performance by ECRH and issues of operational concern.
1. Women’s health services deteriorated significantly since the
syndication by Banford Medical Center. Obstetrical deliveries
are down 20% across the system. BMC has done an excellent
job of creating attractive facility and services for women. This
includes nurse navigation, women’s breast center, and a series
of other amenities. BMC has also started a neonatal intensive
care unit, which rivals the services of ECRH.
2. The cardiologists at ECRH are aging. This has been a
traditionally strong service for ECRH, but 50% of the
cardiologists will be retiring within the next 3 to 5 years. All
cardiologists who serve ERCH are employed by the health
system. Cardiology is a service that is gaining strength within
the Greenbranch Medical Center, particularly since they brought
in a renowned cardiologist to rebuild their program.
3. The orthopedic volumes are down 7%. ECRH does jointly
operate an orthopedic hospital with an independent orthopedic
group located in the community. There have been some internal
problems within the orthopedic group where the old guard of
orthopedic surgeons has forced a low retention with younger,
and to some degree better trained, surgeons. Retention is
becoming a growing concern regarding the status of this group
with consideration of ECRH hiring their own surgeons. The
joint venture hospital does not exclude other surgeons from
working in this hospital.
4. Emergency department (ED) volumes are down 5%. The
hospital uses an emergency physician group to supply
physicians to cover all of the EDs within ERCH. These
physicians are known for poor customer service and making
rude comments to patients who are self-pay or Medicaid.
5. The ambulatory visits and services are up 3%. This volume
increase is from the younger primary care physicians who have
been employed by ECRH. This young group of physicians has
become great support for ECRH and refer patients loyally to the
organization.
6. General surgery cases are down 4%. The aging surgeons are
starting to retire and it is difficult to recruit new surgeons to
replace past demand. Some of this work is going to Greenbranch
since they have good general surgeons.
7. The oncology services for ECRH have increased in volume
and revenue by 4%. ECRH’s development of the new oncology
center has created a magnet for referrals to the oncologists. The
oncologists are very enthusiastic about the development of this
new center and have begun to shift work to ECRH.
8. ECRH has the regional burn center. ECRH works with
Greenbranch Medical Center for training residence in the burn
setting. This includes the plastic and general surgeons. The
downside of this service is that it is losing money. A decision
has been made to close down this service with Greenbranch
starting their burn center.
9. ECRH is a Level 1 Trauma Center, and this designation has
been a historical positive for the system. The helicopter service
is well recognized by the community as well as first responder
professionals found in the region. They historically have been
top of mind for major trauma cases. The usage of this service is
down 5% since the for-profit has established a similar service.
BMC however only has a Level 2 Trauma Center. They have
worked diligently to acquire ambulance services in some of the
outlying communities. This has helped feed patients to BMC.
10. The ECRH Board of Directors decided to close down the
behavioral health hospital. It is uncertain where patients will be
able to receive inpatient care. An active out-patient service will
still be provided by ECRH.
Payer Mix
The payer mix for ECRH has deteriorated. The current inpatient
payer mix for the entire system is as follows:
· 55% Medicare
· 15% Medicaid
· 30% Commercial
There has been a long standing joint venture relationship with a
national insurance company for commercial insurance.
Administratively this venture has not developed as anticipated;
however, in some of the regional markets, the Chestnut Care
insurance has a strong presence. Of the 30% commercial pay,
20% is Chestnut Care based. The national insurance company in
the venture is Aetna. The next strongest product is Anthem. It is
the expectation of the CEO that Chestnut Care be leveraged and
positioned for growth.
The 15% Medicaid has helped the hospital gain additional
disproportionate share dollars, which does help the bottom line
of the hospital.
Historical Strategic InitiativesAccountable Care Organization
When the Affordable Care Act was passed in 2010, ECRH
decided to get into the one-sided model of an accountable care
organization (ACO). This venture has not gone well, and ECRH
has decided to leave the ACO business. However, they are
concerned about the public image of this decision. The details
of the termination are under discussion with a need to determine
how to minimize the public perception of termination,
particularly since there was so much marketing of their getting
in this venture. The regulatory requirements of the government
regarding the timing of terminating an ACO venture further
complicate this decision.
Primary Care Medical Home
The employed primary care group has been active in
establishing accredited primary care medical homes within all
of the primary care offices throughout the ECRH system. This
initiative is a positive emerging strategy for ECRH. It has also
been an attractive draw for the family practitioners from
Greenbranch Medical Center residency program since
Greenbranch has established an accredited medical home for
their family practice residency program.
American Nursing Credential Center Status (ANCC)
ECRH has been working on becoming a magnet status for
ERMC. This work has stalled out as an initiative. Some of this
is due to the nursing leadership within ERMC. The CEO intends
to move this priority up in the organization’s goals.
Information Technology
ECRH has invested heavily in their information technology
infrastructure. This investment became a requirement just to be
able to gather the data needed for the ACO development. This
cost has become significantly greater than anticipated. ECRH
fully implemented EPIC as their core information technology
system. There have been implementation problems since the
ECRH was operating off of multiple systems before the decision
to consolidate to one platform. The implementation of EPIC
required considerable retraining for the staff and physicians.
Data conversions have gone well. The difficulties have been
more human-related relative to the effective use of the system.
One of the major issues has been the lack of ECRH not meeting
meaningful use requirements which has cost ECRH significant
lost revenue from not meeting these goals.
Legal Actions Pending for ECRHFederal Trade Commission
Investigation
With the merger and acquisition of NMHC, questions of
antitrust have been raised. In the service lines of cardiology and
oncology it has been found that ECRH controls 60% of the
cardiology market and 52% of the oncology market. Chestnut
Care in some markets has been strong in steering patient
volumes to ERMC. Union leaders for the varying trades were
instrumental in precipitating this investigation. At the time that
this issue was raised, the President and Executive Branch of the
federal government were very pro-labor, thus, their interest in
pursuing this matter.
As to the projected disposition of this case, it is anticipated that
a negative determination will be made due to the market share
control in oncology and cardiology. This could force ECRH to
divest their ownership in the Chestnut Care insurance venture.
Another option might be that certain hospitals of NMHC be
divested. It is not anticipated that both determinations would
occur. This case has cost ECRH considerable money to stave off
investigation of this allegation.
Predatory Collections and the Loss of Not-for-profit Tax Status
for NMHC
NMHC negotiated that they would continue to act
independently. The consortium leadership set policies that
included predatory collections for the patients that would be
served in the NMHC hospitals. In a recent evening news report,
an investigative reporter interviewed an elderly patient that had
her home taken from her to pay for her medical bills. This home
had been in her family for over 100 years. This story prompted
the state’s Attorney General’s Office to investigate the
predatory collection policies of ECRH and NMHC.
The state has already taken an aggressive stance to investigate
the status of not-for-profits not fulfilling requirements (e.g.,
charity care, research, and education). The state is in economic
trouble and is seeking revenue from wherever they can find it.
The outlook is dim regarding the anticipated final decision of
the Attorney General’s Office. If NMHC is required to pay
taxes, this would wipe out the bottom line for these hospitals
and many of the needed services supplied to the indigent
population by ECRH would be reduced or eliminated.
Faith & Main Consultants Report
Within the last year, ECRH contracted with Faith & Main to
study the market perception of their women’s services. The
following is a summation of the findings of Faith & Main.
Interest in a Women’s Center Crosses County Lines
· 36% of women in the service area would travel across county
lines to receive excellent women’s health services
· 72% of women in Chestnut County would consider using the
women’s services of East Chestnut Regional Medical Center
· Women in all counties were most interested in these services:
· Breast care
· General gynecology services
· Female doctors
· Services in one area
· Physicals for women
Interest in a Heart Care and a Health Information Line
· A physician approved source of information
· A nurse help line that could be a resource for women’s care in
heart health as well be a source for health navigation.
Clear Expectations Regarding Getting Appointments with Their
Primary Care Physician
· Women expect same-day appointments
· In the collar counties to Chestnut County, women ranked this
in the top 28.7%
· Chestnut County women ranked this in the top 37.7%
· Expectation of same-day appointments ranked highest for
women of childbearing age
· Percent expecting same-day appointments
· 42.9 % of Chestnut County women of childbearing age
· 31.3% of collar county women of childbearing age
· Willingness to be Seen by a Nurse Practitioner
Overwhelmingly “Yes”
· 75.7% of Chestnut County women of childbearing age
· 76.1% of collar county women of childbearing age
Respondents Expressed How Health Care Could Be Improved
· 24% of all Chestnut County women, and 26% of all collar
county women named adding more primary care doctors and
more children’s care with urgent care outranking any other
single topic.
Respondents of Childbearing Age Widely Represented in Study:
· 86% of women respondents of childbearing age in Chestnut
County had children under the age of 18
· 76% of women respondents of childbearing age in the collar
counties had children under the age of 18
Willingness to be seen by nurse practitioner was viewed as
favorable by those in this study.
This data from Faith & Main will be used to ramp up
improvements in the women’s services for ECRH.
Strategic Plan Goals for the Upcoming Year
· Women’s service line improvement
· Increase obstetrical deliveries by 20% over 3 years
· Establish nurse navigation system for the entire system
· Facility improvement and development for women’s services
· Improve access standards for women’s care
· Assist in the marketing of the implementation of the
consultant’s report regarding women’s services
· Oncology Center grand opening
· Mature the retail strategy with the primary care employed
physician group
· Assess the market impact of the lawsuits and develop
marketing strategy to counteract the negative impact if
decisions are made against ECRH
· Aggressively recruit new physicians to reduce the average age
of the medical staff and strategically enhance service line
development
· Use lean management processes to correct service issues found
in the ED. Improve ED visits by 6%.
· Review physician contracts to enhance physician service
performance
· Investigate the fast track ED concept
· Implement the free standing ED strategy
· Abandon the Accountable Care Organization (ACO)
· Re-establish relationships with regional emergency medical
services to raise the utilization of the medical air service.
Growth goal is to get back to the previous level of utilization
within 18 months
· Decision to close the regional burn unit and let those cases go
to the academic medical center
· Implement the decision to close the behavioral health services
of ECRH
· Implement the decision to close AH
CEO Instruction to Marketing Team
The marketing department for East Chestnut Regional Health
System will be asked to step up their game to develop a
marketing plan for the regional health system. The CEO has had
some concerns regarding the ability of the marketing department
to keep up with the rapidly moving strategic environment that
he has created. So he established a time line for the department
to develop a system wide marketing plan over the next six
weeks. The VP of marketing has been in all of the senior
leadership cabinet meetings so she is aware of all of …
IND301 Course Project – Final Project Grading Rubric
Criteria A+ (100) A (95) B (85) C (75) D (65) F (55) F (0)
Possible Points: 15 15 14.25 12.75 11.25 9.75 8.25 0
Thesis Statement:
The work includes a
concise, specific,
one sentence thesis
statement relevant
to the student’s
topic, located in the
introduction and
reiterated in the
conclusion.
The thesis
statement is
clear, concise,
and specific to
the topic,
including a
unique
perspective that
is broad enough
to make a case,
but narrow
enough so that
the case can be
made feasibly.
Located in the
introduction
paragraph and
reiterated in the
conclusion.
The thesis
statement is
clear, concise,
and specific to
the topic, and is
broad enough to
make a case, but
narrow enough
so that the case
can be made
feasibly. Located
in the
introduction
paragraph and
reiterated in the
conclusion.
The thesis
statement is
specific and
appropriate to the
topic but may be
either so narrow
that there is little
room to make a
case, or so broad
that the case
cannot be feasibly
made within the
scope of the
paper. Located in
the introduction
paragraph and
somewhat
reiterated in the
conclusion.
The thesis
statement is
provided, but
the connection
with the topic is
unclear. The
statement is too
broad or too
narrow to make
a case. May not
be clearly
located in the
introduction
paragraph or
reiterated in the
conclusion.
The thesis
statement is too
broad or too
narrow and is
irrelevant or
inappropriate to
the topic. Not
located in the
introduction
paragraph or
reiterated in the
conclusion.
The thesis
statement is
vague, unclear,
and difficult to
locate.
No
submission.
Possible Points: 30 30 28.5 25.5 22.5 19.5 16.5 0
Analysis,
Argument, and
Discussion: The
body paragraphs of
the paper
demonstrate
original and
effective argument
analysis and
The argument is
analyzed and
discussed
critically in each
body paragraph,
using multiple
perspectives,
with significant
evidence from
The argument is
analyzed and
discussed
critically in most
body paragraphs,
using evidence.
Supporting
details and
evidence to
The argument is
analyzed and
discussed critically
in some body
paragraphs using
some evidence.
Supporting details
and evidence to
justify claims are
The argument is
adequately
analyzed and
discussed in
some body
paragraphs,
with some
evidence that
may be weak or
The argument is
rarely analyzed
or discussed in
the body
paragraphs, and
evidence is
rarely present or
relevant.
Supporting
No coherent
argument,
analysis, and
discussion
present in the
body paragraphs.
No
submission.
discussion using
evidence and are
related to the
thesis statement.
the different
perspectives.
Supporting
details and
evidence to
justify claims are
relevant,
accurate, and
specific to the
thesis.
justify claims are
relevant,
accurate, and
specific to the
thesis.
mostly relevant,
accurate, and
specific to the
thesis.
unclear.
Supporting
details and
evidence to
justify claims are
sometimes
irrelevant to the
thesis,
inaccurate, or
missing
specificity.
details and
evidence are
often missing,
inaccurate, or
tangential to the
argument.
Possible Points: 15 15 14.25 12.75 11.25 9.75 8.25 0
Writing Skills:
Grammar, spelling,
and syntax are
appropriate for
college writing.
The work
contains no
errors in spelling
or grammar;
choice of words
demonstrates a
deep
understanding of
the topic, always
using relevant
key terms
appropriately.
The work
contains no
errors in spelling
or grammar;
choice of words
demonstrates a
good
understanding of
the topic, using
relevant terms
appropriately.
The work contains
a few spelling
and/or grammatical
errors; choice of
words
demonstrates
proficiency on the
topic using relevant
terms for the most
part.
The work
contains a few
minor
spelling and
grammatical
errors; choice of
words
demonstrates
basic
understanding
of the topic,
sometimes
using relevant
and appropriate
terms.
The work
exhibits
consistently poor
spelling and
grammar; choice
of words
demonstrates a
lack of
understanding of
the topic, often
using irrelevant
or inappropriate
terms.
The work
exhibits extremely
poor writing skills;
incorrect spelling
and grammar
limits the reader’s
ability to follow
ideas or thoughts.
Choice of words
demonstrates a
lack of
understanding of
the topic, with
many irrelevant
or inappropriate
terms.
No
submission.
Possible points: 10 10 9.5 8.5 7.5 6.5 5.5 0
Structure and
Organization: The
work has a well-
crafted structure
The work is built
around a clearly
identifiable
structure and
The work follows
an easily
identifiable
structure and
The work is well
structured and
organized, with an
adequate
The work shows
an acceptable
structure and
organization,
The work shows
a basic attempt
to organize the
material,
The work shows
no obvious
organization,
lacking a clear
No
submission.
and organization,
including
introduction, body,
and conclusion
paragraphs that
reinforce and build
upon the thesis.
Each paragraph
contains effective
transitions. Length
of the submission is
appropriate.
organization,
which brings a
better
understanding for
the reader with a
fully articulated
introduction,
body, and
conclusion.
Transitions are
smooth and fully
support the
theme/thesis.
Meets length
requirements.
organization,
with a clearly
articulated
introduction,
body, and
conclusion.
Transitions are
appropriate and
all link to the
theme/thesis.
Meets length
requirements.
introduction, body,
and conclusion.
Transitions often
link to the
theme/thesis.
Meets length
requirements.
with an
identifiable
introduction,
body, and
conclusion.
Transitions are
somewhat
related to the
theme/thesis.
Meets length
requirements.
struggling to
differentiate the
introduction,
body, and
conclusion.
Transitions often
show little or no
relationship to
the
theme/thesis.
May not meet
length
requirements.
introduction,
body, and
conclusion. Does
not meet length
requirements.
Possible points: 20 20 14.25 12.75 11.25 9.75 8.25 0
Use of Sources and
APA Citations: The
work demonstrates
the selection and
use of high-quality,
relevant, and
credible academic
sources as evidence
in support of the
analysis and
argument. In-text
citations and
reference list are
formatted
appropriately in
APA style.
The work uses
high-quality,
relevant, and
credible
academic sources
effectively as
evidence in all
paragraphs.
There are no
errors in in-text
citations or
reference list
formatting.
The work uses
relevant and
credible
academic
sources
effectively as
evidence in all
paragraphs.
There are only a
few, minor
errors in the in-
text citations or
reference list
formatting.
The work uses
relevant and
credible academic
sources mostly
effectively as
evidence in almost
all paragraphs.
There are minor
errors in the in-text
citations or
reference list
formatting.
The work uses
academic
sources
adequately as
evidence in
most
paragraphs.
Sources may not
be the most
credible,
relevant, and
high-quality
options
available. There
are some
significant
errors in the in-
The work uses
sources,
however these
sources are too
few, mostly not
academic, high-
quality, credible,
or relevant.
Sources are not
used effectively
as evidence in
most
paragraphs.
There are many
significant errors
in in-text
citations or
The work does
not use sources as
evidence or
contains entirely
inappropriate
sources. In-text
citations and
reference list are
not attempted in
APA format or not
present.
No
submission.
text citations or
reference list
formatting.
reference list
formatting.
Possible Points: 10 10 9.5 8.5 7.5 6.5 5.5 0
Incorporation of
Feedback: The
student integrated
feedback from the
instructor on
previous
Milestones to
revise their work
for the final paper.
Feedback was
effectively
integrated from
previous
Milestones. The
revisions greatly
enhanced the
final paper and
showed
substantial
growth over the
term.
Feedback was
integrated from
previous
Milestones. The
revisions
enhanced the
final paper.
Feedback was
somewhat
integrated from a
few of the previous
Milestones. The
revisions
adequately
enhanced the
paper from
previous work.
Some additional
detail and clarity
needed.
Attempt was
made to
integrate the
feedback from
previous
Milestones but
did not
effectively
enhance the
paper overall
from previous
work. More
details and
clarity of
concepts are
needed to
effectively
enhance the
paper.
Minor changes
made based on
the feedback
from previous
Milestones
without success,
more extensive
changes
expected based
on the feedback.
Little to no
attempt was
made to improve
upon the
submission based
on prior feedback.
No
submission.
[Title—up to 12 words on 1–2 lines][Author Names—First M. Last; .docx

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[Title—up to 12 words on 1–2 lines][Author Names—First M. Last; .docx

  • 1. [Title—up to 12 words on 1–2 lines] [Author Names—First M. Last; omit titles and degrees] [Institutional Affiliation(s)] [Title—up to 12 words on 1–2 lines] [Indent all paragraphs; use double-spaced, 12-point font. An abstract is not required for this assignment.] [Introduction: The introduction paragraph should include a “hook” to grab the reader, some contextual information about your topic, and your thesis statement as the last sentence of the paragraph. The wording in red is an example of an introduction; delete the red text and all of the information in brackets before beginning your assignment.] In the year 2016, Americans purchased approximately 17.5 million vehicles; less than 1% of these sales were electric or hydrogen fuel cell vehicles. Meanwhile, other nations, like China and Norway, have eclipsed the United States in electric vehicle market share (Sperling, 2018). These is no doubt from the international scientific community that carbon emissions from traditional internal combustion engine vehicles contribute significantly to climate change, and that electric vehicles represent a viable strategy to curb the automotive industry’s negative impact on the environment. Why then do electric vehicle (EV) sales still lag in the United States and what can be done to increase sales? The US government should increase the incentives for the production and consumption of electric cars because the United States is falling behind other nations in market share of electric cars, they are still too expensive for most consumers, and research demonstrates that electric cars are effective at reducing carbon emissions, which contribute to climate change. [Transition sentence from thesis. Body paragraph 1 should include the first component of your argument and paraphrased or quoted evidence from your sources to support it with in-text citations after any information that comes from a source (last name, year). The wording in red is an example of a body
  • 2. paragraph; delete the red text and all of the information in brackets before beginning your assignment.] The United States, once a world leader in automotive innovation, is quickly falling behind other nations in electric vehicle market share. While US consumers purchase one-fifth of the world’s EVs, that represents just a tiny fraction of the American vehicle market. The largest EV market is China, with more than half of world’s EV sales. Many countries in Europe are likewise adopting EVs at much higher rates per capita, including Norway, where EVs represent 30% of vehicle sales (Sperling, 2018). The European Parliament and European Union have paved the way for greater EV consumption by setting 2020 targets for EVs and charging stations in all EU member states (Noori & Tatari, 2016). In addition, Japan’s government and private sector have also displayed a commitment to the shift toward EVs, by committing to adding 6,000 new fast chargers across the country by 2016 (Sperling, 2018). In comparison to these nations, the United States’ public and private commitment to the shift to electric vehicles has flagged. The US auto market is much larger and more diverse, with a complicated history of automakers, the oil and gasoline industry, and lobbyists impacting the public’s perception of different types of vehicles. However, in considering the United States’ long history as a global leader in the auto industry, it is problematic that the United States is becoming a follower rather than a leader in the newest shift in the industry. Electric vehicles are ultimately the direction that the automobile market will shift, so the United States should take additional steps to keep up with its global peers. [Transition sentence from paragraph above. You may have more than one body paragraph on each of the 3 components for your argument. Each body paragraph should include the paraphrased or quoted evidence from your sources to support your argument with in-text citations after any information that comes from a source (last name, year).] [etc.] [Transition sentence from paragraph above. Your final body
  • 3. paragraph should include opposing perspectives on your topic and paraphrased or quoted evidence from your sources to refute it with in-text citations after any information that comes from a source (last name, year).] [Conclusion: The concluding paragraph should provide a short review of the main ideas presented in the body and make a connection back to the thesis statement. It should also offer some concluding thoughts related to the topic and the future.] The evidence from experts is clear: Electric vehicles are not only beneficial to the fight against climate change, but they are the future of the auto industry. However, the price of electric vehicles still puts them out of reach for most American consumers, resulting in the US falling behind its international peers in electric vehicle adoption per capita. The United States government must take steps today and tomorrow to pave the way forward for American electric vehicle consumption through increased incentives provided to both consumers and producers. Climate change is not a problem we can tackle alone; only through concerted efforts in specific areas can the United States, and the world, combat global warming. Shifting from gasoline-powered to electric vehicles is an important part of that fight, and we must take steps to assure it. References Noori, M., & Tatari, O. (2016). Development of an agent-based model for regional market penetration projections of electric vehicles in the United States. Energy, 96, 215–230. https://doi.org/10.1016/j.energy.2015.12.018 Sperling, D. (2018). Electric vehicles: Approaching the tipping point. Bulletin of the AtomicScientists, 74(1), 11–18. https://doi.org/10.1080/00963402.2017.1413055 Title ABC/123 Version X 1
  • 4. Market Plan Template MHA/506 Version 2 1 Marketing Plan Template Executive Summary · Introduction · Situation Overview · Goal · Action Overview · Conclusions Situation Overview · The big picture · Company overview · Market overview Goal/Objectives · Goal focus · Performance benchmarks · Market objectives Marketing Strategy · Target market · Target customers · Company · Collaborators · Competitors · Value Proposition · Customer value · Collaborator value · Company value Tactics · Product · Service · Brand · Price · Incentives
  • 5. · Communication Implementation · Defining the business infrastructure · Physical infrastructure · Organizational infrastructure · The business process · Strategic plan implications · Resource management · Product and service management · Brand management · Communication management · Distribution management · Set the schedule for implementation Control · Performance evaluation of the plan · Adequate goal progress · Performance gap management · Environmental Analysis · Opportunities · Threats Exhibits · Market data exhibits · Value analysis exhibits · Marketing mix exhibits · Organizing the exhibits · Label · Title · Overview · Body · Notes · Source Additional Considerations in a Marketing Plan · Brand Management · Communication Plans Copyright © XXXX by University of Phoenix. All rights reserved.
  • 6. Copyright © 2018 by University of Phoenix. All rights reserved. Title ABC/123 Version X 1 Case Study: East Chestnut Regional Health System MHA/506 Version 2 1 CASE STUDY: EAST CHESTNUT REGIONAL HEALTH SYSTEM History Within the last 10 years, East Chestnut Regional Health System (ECRH) was formed from the merger of three organizations: the East River Medical Center, the Northern Mountain Hospital Consortium, and the Archway Hospital. East River Medical Center (ERMC) ERMC is the anchor hospital for the system. The medical center resides along the east side of the Chestnut River. Historically, ERMC was recognized as the location of choice for medical care. However, this reputation has deteriorated over the last 3 to 5 years. As the city of Chestnut has grown, ERMC has found itself on the edge of an urban blight. Safety has been a concern for patients, visitors, and physicians who use and serve the medical center. The technology offered at the medical center has been maintained at an excellent level of proficiency. At the same time, the medical staff is aging with the average age of the physicians being 57. There are younger primary care physicians who serve the specialists, but the specialists are aging as well. ERMC boasts a Level 1 Trauma Center with an air service. The total number of licensed beds for ERMC is 550. On any given day, the occupancy rate is 300 heads on the beds.
  • 7. Northern Mountain Hospital Consortium (NMHC) NMHC was originally formed in response to the migration of patients to Chestnut. Due to the rather aggressive strategies carried out by the hospitals in Chestnut, these rural hospitals decided to create a consortium of rural hospitals so that they could gain economies of scale in a number of areas, which include group purchasing, benefit administration, and physician and staff recruitment. Additionally, they worked together to stem any further deterioration of their market share. Patients were selecting to go to the larger community for services and leaving the smaller communities that collared the Chestnut metropolitan area. NMHC represented individual hospitals in four counties that circled Chestnut County: Walnut, Butternut, Oak, and Maple. Walnut and Butternut Counties had good employment with Oak and Maple Counties being mostly rural. In each county, the inpatient facilities averaged about 20 years of age. The upkeep of these facilities has been sketchy. No facility needs any major upgrades, but modernization is needed. The state does not have a Certificate of Need (CON) process. The medical staff makeup varies each location. The hospitals in Oak and Maple Counties are critical access hospitals. Further details will be provided regarding these organizations later in the case study. Archway Hospital (AH) AH is located directly in the community of Chestnut. It fully resides in the urban area of the community. The hospital has 200 registered beds, but on any given day there are only 50 to 75 patients in this facility. This hospital was a Doctor of Osteopathy (DO) hospital; therefore, most of the physicians that worked out of this facility were DOs. The payer mix for this hospital was heavily burdened with Medicare and Medicaid. This payer mix composed nearly 85% of the reimbursement. The facility is aging and needs considerable repairs. It is questionable if it will be worth the investment in this facility.
  • 8. Leadership and Organizational Culture The original merger that created the East Chestnut Regional Health System (ECRH) occurred 10 years ago. This merger was between ERMC and AH. AH had a rather dynamic leader who was about 57 years old at the time of the merger. The AH CEO became the new President and Chief Executive Officer of ECRH after the merger. Since this CEO had only worked in a smaller organization, he had not experienced the cultural changes and demands that occur after the merging of a large organization. Additionally, he began to change the culture of the organization such that decisions were made on a decentralized basis. He trusted the management team at AH to do the right things and make the right decisions with low supervision. However, the Chief Operating Officer (COO) who was put in charge was originally from AH but left 2 years after the merger with a new COO being put in place. This COO developed a rather poor reputation and was known to want to build his own empire at AH and to be dishonest at times. This reputation created a culture within the traditional AH that lacked a cohesive team effort to create a system. This positioning of the COO was left unattended by the President and CEO of ECRH since he was actively pursuing the acquisition of NMHC. The hospitals of NMHC were doing okay, but those in the consortium realized that their ability to stand alone was becoming difficult in today’s market. When the leadership of the consortium assessed the market as to a partnership, they decided that ECRH would be the best choice. The other option was to develop a for-profit hospital that also resided in Chestnut. The leadership was attracted to what they saw happen with AH. They liked that the central leadership of the system allowed AH to continue on as their own entity without a lot of centralized control. By the time all of this was put together, the President and CEO of ECRH was near retirement. He retired about three years after all of the merger activity was complete. During those three years, he became lax in his leadership role. ECRH deteriorated
  • 9. in market share and profitability during this time. Upon his retirement, the Board of ECRH performed a national search for a replacement. They employed Hunter Brown as the new President and CEO. Mr. Brown was the CEO of a smaller health system and had been in that position for nearly 10 years. Therefore, he had limited experience from other markets in the art of strategic implementation. However, he was also well trained, bright, and articulate in expressing his knowledge. He has now been the President/CEO of ECRH for nine months. As for the remainder of the leadership team for ECRH, there is a newly hired corporate counsel. She has 15 years of experience and is extremely competent in the work that she does. The CEO also hired a new Chief Financial Officer. He has taken good strides in managing the accounts receivable throughout the system as well as extracting exceptional dollars from high quality supply chain management. The Chief Operating Officer (COO) is new and has three years of previous experience from the same organization where the CEO departed. The Chief Medical Officer (CMO) has been retained from the old leadership team. His reputation is excellent, and he works well with other physicians, including the medical staff and the employed physicians. The Chief Nursing Officer (CNO) is three years away from retirement. She is known for not getting along with the medical staff and will always defend nursing when at times this is not appropriate. The Senior Vice President for Human Resources is competent and respected by management and staff throughout the organization.
  • 10. The remainder of the leadership team was retained from the old regime. This included information technology, employed physician group leadership, marketing, human resources, and other vice presidents or directors responsible for varying service lines. It should be noted that the IT leadership is just completing the implementation of the EPIC system. The future for this team depends on how well the overall implementation of the system goes. Likewise those in the marketing department will need to be stellar in senior leadership advisement regarding the marketing of complex issues that will be encountered ahead. They have been told if marketing misses the target, then replacements will occur within this department. The new CEO inherited the management team of AH and NMHC. For NMHC the organizational structure was left intact with the COOs for each of the individual hospitals being retained. It was agreed that this traditional structure would be left intact for at least five years. This agreement was near its end and the new CEO had plans to change the existing structure as well as management. This change was being considered for this year’s strategic plan development. Even if the structure of NMHC was going to be changed to a more direct relationship with corporate leadership, all of the existing COO’s would be retained as they have performed well since the merger. As for the COO of AH, he had been recently terminated. An interim COO is now in place pending the board approved closure of this hospital. Competitive Assessment ECRH was not the only provider of care in the community. There was a for-profit hospital, Banford Medical Center (BMC), that had been purchased by a large publicly traded for-profit health system about 10 years ago. The for-profit health system was the largest in the country. The CEO of this hospital was
  • 11. good at optimizing performance as a result of the weaknesses of ECRH and its leadership. He was an effective opportunist. BMC has 400 registered beds with a current occupancy rate of 85%. They have been effective at taking market share away from ECRH. For each loss of service line market share by ECRH, BMC has shown proportional gains. After the acquisition of BMC, the for-profit immediately moved to build a new facility. This new facility is located on the growing wealthy edge of the community. Additionally, at the time that this new facility was developed, the for-profit syndicated ownership to the physicians. The highest level of syndication occurred with the obstetrics and gynecology physicians in the community. Therefore, women’s services deteriorated at ECRH. It should be noted that this physician syndication occurred before the Affordable Care Act was passed, which precluded hospital ownership by physicians. It is important that additional information is provided regarding ECRH. ECRH recently purchased 100 acres of land across the interstate from BMC. This land is located northwest of Chester. The intention is to eventually build a new medical center on this location. The initial planning of this land has occurred and it has been approved to build a regional oncology center on this site. The construction of the project is already underway with an anticipated completion in 6 months. In addition, ECRH has an orthopedic hospital attached to the current ERMC site and a behavioral health hospital at this same location. ECRH also has two ambulatory surgical centers that are conveniently located on the growing northwest and southwest side in the community. The one surgical center is located on the 100 acre development site. The orthopedic hospital has done well and has been listed in the top 100 orthopedic hospitals. However, the behavioral health hospital is losing significant dollars, so the Board of Directors for ECRH
  • 12. has decided to close down this hospital. ECRH has also developed a joint venture imaging center with the radiologists. This center resides across from a major shopping area in the community. It is conveniently located near heavily populated neighborhoods and shopping. The only downside is the location is not close to physician offices that would refer to this center. However, if a new facility is built on the 100 acres, which would include physician offices, the imaging center will be in an ideal location. Leadership is developing a free standing emergency center on the 100 acre site, which is on the northwest side of Chestnut. The last competitive issue is the location of a medical school and hospital in the city of Chestnut. The facility resides in a downtown location. This medical school had been established by the state nearly 45 years ago and is associated with Greenbranch University. It mostly serves the indigent community in Chestnut and the surrounding area. This academic center has a rather negative reputation in the surrounding area. There are four other medical academic centers in the state as well as a medical center with a world renowned reputation. There have been ongoing rumors that this world renowned organization was planning on assuming the responsibility of the Chestnut academic center. This change would substantially alter the complexion of the local medical community if it were to occur. Speed in ECRH dealing with some of its market issues is an imperative. Additional Market Information: Population DemographicsChestnut County · With 433,689 people, Chestnut County is the 6th most populated county in the state. · The largest Chestnut County racial/ethnic groups are Caucasian (70.1%), African American (18.5%), and Hispanic
  • 13. (6.5%). · In 2015, the median household income of Chestnut County residents was $41,777. However, 21.1% of Chestnut County residents live in poverty. · The median age for Chestnut County residents is 37.7 years old. · Employment is strong in Chestnut County. Unemployment resides at 4.5%. Employer diversity is strong since the community is not dependent on singular large employers. Employment includes some high-tech jobs, general manufacturing to support the automobile industry, and there is a large university, Greenbranch University, located in the community. The university has 25,000 students and offers most majors, which includes engineering and nursing. Walnut County · With 42,537 people, Walnut County is the 57th most populated county in the state. · The largest Walnut County racial/ethnic groups are Caucasian (89.8%), followed by Hispanic (7.2%) and African American (3%). · In 2015, the median household income of Walnut County residents was $55,120. However, 10.8% of Walnut County residents live in poverty. · The median age for Walnut County residents is 39.8 years old. Butternut County · With 38,352 people, Butternut County is the 65th most populated county in the state. · The largest Butternut County racial/ethnic groups are White (87.0%), Hispanic (9.5%), and African American (1.7%). · In 2015, the median household income of Butternut County residents was $50,663. However, 13.4% of Butternut County residents live in poverty. · The median age for Butternut County residents is 39.7 years old. Oak County · With 37,120 people, Oak County is the 66th most populated
  • 14. county in the state. · The largest Oak County racial/ethnic groups are Caucasian (93.3%), Hispanic (4.0%), and African American (1.1%). · In 2015, the median household income of Oak County residents was $42,492. However, 14.9% of Oak County residents live in poverty. · The median age for Oak County residents is 46.6 years old. Maple County · With 27,816 people, Maple County is the 79th most populated county in the state. · The largest Maple County racial/ethnic groups are Caucasian (90.8%), Hispanic (7.1%), and African American (1.0%). · In 2015, the median household income of Maple County residents was $39,353. However, 15.4% of Maple County residents live in poverty. · The median age for Maple County residents is 48.2 years old. · Both Oak and Maple Counties are rural with an older population. Many patients have Medicare and Medicaid that come from these two counties. Likewise the hospitals located in each of these counties have been designated as critical access. Like many rural counties, Oak and Maple have been blighted with younger people using drugs, including methamphetamine. Employed Physicians ECRH employs 400 physicians throughout its system. The breakdown for each location is as follows:Chestnut County · 135 primary care · 100 specialistsWalnut County · 40 primary care · 10 specialistsButternut County · 30 primary care · 12 specialistsOak County · 27 primary care · 10 specialistsMaple County · 25 primary care
  • 15. · 11 specialists There have been ongoing complaints from the newly recruited physicians that their practices have not been marketed well; thus, their patient volumes have been slow to grow. Service Line Performance Information The following is a list of bullet points regarding service line performance by ECRH and issues of operational concern. 1. Women’s health services deteriorated significantly since the syndication by Banford Medical Center. Obstetrical deliveries are down 20% across the system. BMC has done an excellent job of creating attractive facility and services for women. This includes nurse navigation, women’s breast center, and a series of other amenities. BMC has also started a neonatal intensive care unit, which rivals the services of ECRH. 2. The cardiologists at ECRH are aging. This has been a traditionally strong service for ECRH, but 50% of the cardiologists will be retiring within the next 3 to 5 years. All cardiologists who serve ERCH are employed by the health system. Cardiology is a service that is gaining strength within the Greenbranch Medical Center, particularly since they brought in a renowned cardiologist to rebuild their program. 3. The orthopedic volumes are down 7%. ECRH does jointly operate an orthopedic hospital with an independent orthopedic group located in the community. There have been some internal problems within the orthopedic group where the old guard of orthopedic surgeons has forced a low retention with younger, and to some degree better trained, surgeons. Retention is becoming a growing concern regarding the status of this group with consideration of ECRH hiring their own surgeons. The joint venture hospital does not exclude other surgeons from
  • 16. working in this hospital. 4. Emergency department (ED) volumes are down 5%. The hospital uses an emergency physician group to supply physicians to cover all of the EDs within ERCH. These physicians are known for poor customer service and making rude comments to patients who are self-pay or Medicaid. 5. The ambulatory visits and services are up 3%. This volume increase is from the younger primary care physicians who have been employed by ECRH. This young group of physicians has become great support for ECRH and refer patients loyally to the organization. 6. General surgery cases are down 4%. The aging surgeons are starting to retire and it is difficult to recruit new surgeons to replace past demand. Some of this work is going to Greenbranch since they have good general surgeons. 7. The oncology services for ECRH have increased in volume and revenue by 4%. ECRH’s development of the new oncology center has created a magnet for referrals to the oncologists. The oncologists are very enthusiastic about the development of this new center and have begun to shift work to ECRH. 8. ECRH has the regional burn center. ECRH works with Greenbranch Medical Center for training residence in the burn setting. This includes the plastic and general surgeons. The downside of this service is that it is losing money. A decision has been made to close down this service with Greenbranch starting their burn center. 9. ECRH is a Level 1 Trauma Center, and this designation has been a historical positive for the system. The helicopter service is well recognized by the community as well as first responder professionals found in the region. They historically have been
  • 17. top of mind for major trauma cases. The usage of this service is down 5% since the for-profit has established a similar service. BMC however only has a Level 2 Trauma Center. They have worked diligently to acquire ambulance services in some of the outlying communities. This has helped feed patients to BMC. 10. The ECRH Board of Directors decided to close down the behavioral health hospital. It is uncertain where patients will be able to receive inpatient care. An active out-patient service will still be provided by ECRH. Payer Mix The payer mix for ECRH has deteriorated. The current inpatient payer mix for the entire system is as follows: · 55% Medicare · 15% Medicaid · 30% Commercial There has been a long standing joint venture relationship with a national insurance company for commercial insurance. Administratively this venture has not developed as anticipated; however, in some of the regional markets, the Chestnut Care insurance has a strong presence. Of the 30% commercial pay, 20% is Chestnut Care based. The national insurance company in the venture is Aetna. The next strongest product is Anthem. It is the expectation of the CEO that Chestnut Care be leveraged and positioned for growth. The 15% Medicaid has helped the hospital gain additional disproportionate share dollars, which does help the bottom line of the hospital.
  • 18. Historical Strategic InitiativesAccountable Care Organization When the Affordable Care Act was passed in 2010, ECRH decided to get into the one-sided model of an accountable care organization (ACO). This venture has not gone well, and ECRH has decided to leave the ACO business. However, they are concerned about the public image of this decision. The details of the termination are under discussion with a need to determine how to minimize the public perception of termination, particularly since there was so much marketing of their getting in this venture. The regulatory requirements of the government regarding the timing of terminating an ACO venture further complicate this decision. Primary Care Medical Home The employed primary care group has been active in establishing accredited primary care medical homes within all of the primary care offices throughout the ECRH system. This initiative is a positive emerging strategy for ECRH. It has also been an attractive draw for the family practitioners from Greenbranch Medical Center residency program since Greenbranch has established an accredited medical home for their family practice residency program. American Nursing Credential Center Status (ANCC) ECRH has been working on becoming a magnet status for ERMC. This work has stalled out as an initiative. Some of this is due to the nursing leadership within ERMC. The CEO intends to move this priority up in the organization’s goals. Information Technology ECRH has invested heavily in their information technology infrastructure. This investment became a requirement just to be able to gather the data needed for the ACO development. This cost has become significantly greater than anticipated. ECRH fully implemented EPIC as their core information technology system. There have been implementation problems since the ECRH was operating off of multiple systems before the decision
  • 19. to consolidate to one platform. The implementation of EPIC required considerable retraining for the staff and physicians. Data conversions have gone well. The difficulties have been more human-related relative to the effective use of the system. One of the major issues has been the lack of ECRH not meeting meaningful use requirements which has cost ECRH significant lost revenue from not meeting these goals. Legal Actions Pending for ECRHFederal Trade Commission Investigation With the merger and acquisition of NMHC, questions of antitrust have been raised. In the service lines of cardiology and oncology it has been found that ECRH controls 60% of the cardiology market and 52% of the oncology market. Chestnut Care in some markets has been strong in steering patient volumes to ERMC. Union leaders for the varying trades were instrumental in precipitating this investigation. At the time that this issue was raised, the President and Executive Branch of the federal government were very pro-labor, thus, their interest in pursuing this matter. As to the projected disposition of this case, it is anticipated that a negative determination will be made due to the market share control in oncology and cardiology. This could force ECRH to divest their ownership in the Chestnut Care insurance venture. Another option might be that certain hospitals of NMHC be divested. It is not anticipated that both determinations would occur. This case has cost ECRH considerable money to stave off investigation of this allegation. Predatory Collections and the Loss of Not-for-profit Tax Status for NMHC NMHC negotiated that they would continue to act independently. The consortium leadership set policies that included predatory collections for the patients that would be served in the NMHC hospitals. In a recent evening news report,
  • 20. an investigative reporter interviewed an elderly patient that had her home taken from her to pay for her medical bills. This home had been in her family for over 100 years. This story prompted the state’s Attorney General’s Office to investigate the predatory collection policies of ECRH and NMHC. The state has already taken an aggressive stance to investigate the status of not-for-profits not fulfilling requirements (e.g., charity care, research, and education). The state is in economic trouble and is seeking revenue from wherever they can find it. The outlook is dim regarding the anticipated final decision of the Attorney General’s Office. If NMHC is required to pay taxes, this would wipe out the bottom line for these hospitals and many of the needed services supplied to the indigent population by ECRH would be reduced or eliminated. Faith & Main Consultants Report Within the last year, ECRH contracted with Faith & Main to study the market perception of their women’s services. The following is a summation of the findings of Faith & Main. Interest in a Women’s Center Crosses County Lines · 36% of women in the service area would travel across county lines to receive excellent women’s health services · 72% of women in Chestnut County would consider using the women’s services of East Chestnut Regional Medical Center · Women in all counties were most interested in these services: · Breast care · General gynecology services · Female doctors
  • 21. · Services in one area · Physicals for women Interest in a Heart Care and a Health Information Line · A physician approved source of information · A nurse help line that could be a resource for women’s care in heart health as well be a source for health navigation. Clear Expectations Regarding Getting Appointments with Their Primary Care Physician · Women expect same-day appointments · In the collar counties to Chestnut County, women ranked this in the top 28.7% · Chestnut County women ranked this in the top 37.7% · Expectation of same-day appointments ranked highest for women of childbearing age · Percent expecting same-day appointments · 42.9 % of Chestnut County women of childbearing age · 31.3% of collar county women of childbearing age · Willingness to be Seen by a Nurse Practitioner Overwhelmingly “Yes” · 75.7% of Chestnut County women of childbearing age · 76.1% of collar county women of childbearing age Respondents Expressed How Health Care Could Be Improved · 24% of all Chestnut County women, and 26% of all collar county women named adding more primary care doctors and more children’s care with urgent care outranking any other
  • 22. single topic. Respondents of Childbearing Age Widely Represented in Study: · 86% of women respondents of childbearing age in Chestnut County had children under the age of 18 · 76% of women respondents of childbearing age in the collar counties had children under the age of 18 Willingness to be seen by nurse practitioner was viewed as favorable by those in this study. This data from Faith & Main will be used to ramp up improvements in the women’s services for ECRH. Strategic Plan Goals for the Upcoming Year · Women’s service line improvement · Increase obstetrical deliveries by 20% over 3 years · Establish nurse navigation system for the entire system · Facility improvement and development for women’s services · Improve access standards for women’s care · Assist in the marketing of the implementation of the consultant’s report regarding women’s services · Oncology Center grand opening · Mature the retail strategy with the primary care employed physician group · Assess the market impact of the lawsuits and develop marketing strategy to counteract the negative impact if decisions are made against ECRH · Aggressively recruit new physicians to reduce the average age
  • 23. of the medical staff and strategically enhance service line development · Use lean management processes to correct service issues found in the ED. Improve ED visits by 6%. · Review physician contracts to enhance physician service performance · Investigate the fast track ED concept · Implement the free standing ED strategy · Abandon the Accountable Care Organization (ACO) · Re-establish relationships with regional emergency medical services to raise the utilization of the medical air service. Growth goal is to get back to the previous level of utilization within 18 months · Decision to close the regional burn unit and let those cases go to the academic medical center · Implement the decision to close the behavioral health services of ECRH · Implement the decision to close AH CEO Instruction to Marketing Team The marketing department for East Chestnut Regional Health System will be asked to step up their game to develop a marketing plan for the regional health system. The CEO has had some concerns regarding the ability of the marketing department to keep up with the rapidly moving strategic environment that he has created. So he established a time line for the department to develop a system wide marketing plan over the next six
  • 24. weeks. The VP of marketing has been in all of the senior leadership cabinet meetings so she is aware of all of … IND301 Course Project – Final Project Grading Rubric Criteria A+ (100) A (95) B (85) C (75) D (65) F (55) F (0) Possible Points: 15 15 14.25 12.75 11.25 9.75 8.25 0 Thesis Statement: The work includes a concise, specific, one sentence thesis statement relevant to the student’s topic, located in the introduction and reiterated in the conclusion. The thesis statement is clear, concise, and specific to the topic, including a unique perspective that is broad enough to make a case, but narrow enough so that the case can be made feasibly. Located in the
  • 25. introduction paragraph and reiterated in the conclusion. The thesis statement is clear, concise, and specific to the topic, and is broad enough to make a case, but narrow enough so that the case can be made feasibly. Located in the introduction paragraph and reiterated in the conclusion. The thesis statement is specific and appropriate to the topic but may be either so narrow that there is little room to make a case, or so broad that the case cannot be feasibly made within the scope of the paper. Located in
  • 26. the introduction paragraph and somewhat reiterated in the conclusion. The thesis statement is provided, but the connection with the topic is unclear. The statement is too broad or too narrow to make a case. May not be clearly located in the introduction paragraph or reiterated in the conclusion. The thesis statement is too broad or too narrow and is irrelevant or inappropriate to the topic. Not located in the introduction paragraph or reiterated in the conclusion.
  • 27. The thesis statement is vague, unclear, and difficult to locate. No submission. Possible Points: 30 30 28.5 25.5 22.5 19.5 16.5 0 Analysis, Argument, and Discussion: The body paragraphs of the paper demonstrate original and effective argument analysis and The argument is analyzed and discussed critically in each body paragraph, using multiple perspectives, with significant evidence from The argument is analyzed and discussed critically in most body paragraphs,
  • 28. using evidence. Supporting details and evidence to The argument is analyzed and discussed critically in some body paragraphs using some evidence. Supporting details and evidence to justify claims are The argument is adequately analyzed and discussed in some body paragraphs, with some evidence that may be weak or The argument is rarely analyzed or discussed in the body paragraphs, and evidence is rarely present or relevant. Supporting No coherent
  • 29. argument, analysis, and discussion present in the body paragraphs. No submission. discussion using evidence and are related to the thesis statement. the different perspectives. Supporting details and evidence to justify claims are relevant, accurate, and specific to the thesis. justify claims are relevant, accurate, and specific to the thesis. mostly relevant, accurate, and
  • 30. specific to the thesis. unclear. Supporting details and evidence to justify claims are sometimes irrelevant to the thesis, inaccurate, or missing specificity. details and evidence are often missing, inaccurate, or tangential to the argument. Possible Points: 15 15 14.25 12.75 11.25 9.75 8.25 0 Writing Skills: Grammar, spelling, and syntax are appropriate for college writing. The work contains no errors in spelling
  • 31. or grammar; choice of words demonstrates a deep understanding of the topic, always using relevant key terms appropriately. The work contains no errors in spelling or grammar; choice of words demonstrates a good understanding of the topic, using relevant terms appropriately. The work contains a few spelling and/or grammatical errors; choice of words demonstrates proficiency on the topic using relevant terms for the most part. The work contains a few minor
  • 32. spelling and grammatical errors; choice of words demonstrates basic understanding of the topic, sometimes using relevant and appropriate terms. The work exhibits consistently poor spelling and grammar; choice of words demonstrates a lack of understanding of the topic, often using irrelevant or inappropriate terms. The work exhibits extremely poor writing skills; incorrect spelling and grammar limits the reader’s ability to follow ideas or thoughts. Choice of words
  • 33. demonstrates a lack of understanding of the topic, with many irrelevant or inappropriate terms. No submission. Possible points: 10 10 9.5 8.5 7.5 6.5 5.5 0 Structure and Organization: The work has a well- crafted structure The work is built around a clearly identifiable structure and The work follows an easily identifiable structure and The work is well structured and organized, with an adequate The work shows an acceptable structure and
  • 34. organization, The work shows a basic attempt to organize the material, The work shows no obvious organization, lacking a clear No submission. and organization, including introduction, body, and conclusion paragraphs that reinforce and build upon the thesis. Each paragraph contains effective transitions. Length of the submission is appropriate. organization, which brings a better understanding for the reader with a
  • 35. fully articulated introduction, body, and conclusion. Transitions are smooth and fully support the theme/thesis. Meets length requirements. organization, with a clearly articulated introduction, body, and conclusion. Transitions are appropriate and all link to the theme/thesis. Meets length requirements. introduction, body, and conclusion. Transitions often link to the theme/thesis. Meets length requirements. with an identifiable
  • 36. introduction, body, and conclusion. Transitions are somewhat related to the theme/thesis. Meets length requirements. struggling to differentiate the introduction, body, and conclusion. Transitions often show little or no relationship to the theme/thesis. May not meet length requirements. introduction, body, and conclusion. Does not meet length requirements. Possible points: 20 20 14.25 12.75 11.25 9.75 8.25 0 Use of Sources and APA Citations: The work demonstrates
  • 37. the selection and use of high-quality, relevant, and credible academic sources as evidence in support of the analysis and argument. In-text citations and reference list are formatted appropriately in APA style. The work uses high-quality, relevant, and credible academic sources effectively as evidence in all paragraphs. There are no errors in in-text citations or reference list formatting. The work uses relevant and credible academic sources effectively as evidence in all paragraphs.
  • 38. There are only a few, minor errors in the in- text citations or reference list formatting. The work uses relevant and credible academic sources mostly effectively as evidence in almost all paragraphs. There are minor errors in the in-text citations or reference list formatting. The work uses academic sources adequately as evidence in most paragraphs. Sources may not be the most credible, relevant, and high-quality options available. There
  • 39. are some significant errors in the in- The work uses sources, however these sources are too few, mostly not academic, high- quality, credible, or relevant. Sources are not used effectively as evidence in most paragraphs. There are many significant errors in in-text citations or The work does not use sources as evidence or contains entirely inappropriate sources. In-text citations and reference list are not attempted in APA format or not present. No submission.
  • 40. text citations or reference list formatting. reference list formatting. Possible Points: 10 10 9.5 8.5 7.5 6.5 5.5 0 Incorporation of Feedback: The student integrated feedback from the instructor on previous Milestones to revise their work for the final paper. Feedback was effectively integrated from previous Milestones. The revisions greatly enhanced the final paper and showed substantial growth over the
  • 41. term. Feedback was integrated from previous Milestones. The revisions enhanced the final paper. Feedback was somewhat integrated from a few of the previous Milestones. The revisions adequately enhanced the paper from previous work. Some additional detail and clarity needed. Attempt was made to integrate the feedback from previous Milestones but did not effectively enhance the paper overall from previous work. More
  • 42. details and clarity of concepts are needed to effectively enhance the paper. Minor changes made based on the feedback from previous Milestones without success, more extensive changes expected based on the feedback. Little to no attempt was made to improve upon the submission based on prior feedback. No submission.