Competitive Analysis Strategic Project Shyree Shepeard

HSAD 550-900: Planning in the Era of the Affordable Care Act Spring 2015-16
Competitive Analysis and Strategic Recommendations Project Shyree Lanee Shepeard
Drexel University, CNHP Faculty:Spencer R. Ward, Ph.D.
6e3c2dff-5a44-47b6-8c7a-B2298ed7f092-160705191626 Page 1
Introduction
Delaware’s healthcare system has made many strides within the last decade. However,
mental illness is tasked at being one of the critical drivers for healthcare inflation according to
data from Delaware State Medicaid (Community Health Needs Assessment, 2013. Major hospital
systems and behavioral health hospitals and practices are making strides to increase the quality
of mental health given and access to it for patients within the state. Bayhealth, the state of
Delaware’s second largest healthcare system has yet to answer the call to providing care for the
states mentally ill. The healthcare system would benefit from a strategic plan that would
increase their position within the state’s healthcare market as well as address the unmet need of
providing mental health services to the thousands of patients they see yearly. The first section of
this analysis will take a look at the strengths, weakness, opportunities and threats of the mental
health market and Bayhealth. This will drive strategic recommendations to maximize the
hospitals success within the community and help patients get well.
1.0 Bayhealth & Delaware Mental Health Market SWOT
Strengths Weaknesses
Internal
-Largest healthcare facility in Central and
Southern Delaware
-Multiple facilities
-Focus on improvement one life at a time
- Grow and develop quality clinical
programs
-Bayhealth is second to Christiana
Healthcare, the largest healthcare
system in the state of Delaware
- Lower than national average
patient/provider communication
survey results
-No employed mental health
professionals
-Weak alliance with community
mental health facilities
Opportunities Threats
External
-Over 50% of adults and adolescents with
any mental illness not receiving treatment
or counseling
-Adolescents in Delaware report higher
than national average improved
functioning from mental health treatment
-14 Mental health facilities in
central and southern Delaware
-Obesity initiative priority
-Sussex County new free standing
psychiatric hospital top open mid
2017

2.0 Delaware, Bayhealth and the Mentally Ill.
Current patient data within overall and mental health markets present a significant
opportunity for Bayhealth to invest in programs which support their vision and mission. Data
reported from the state of Delaware Community Health Status Assessment revealed that income
disparities are indicators of overall health status (State of Delaware Community Health Status
Assessment, 2013, p. 9) In figure 1, data from the US Censes Bureau shows that Kent and
Sussex Counties are lower than New Castle County in the percentage of students who graduate
high school as well as the percentage of people with bachelor’s degrees. Figure 2 shows the
median household and per capita income are lower in Kent and Sussex Counties compared to
New Castle. Figure 3 also demonstrates the poverty differences between the Counties, with New
Castle having the lowest poverty in the state (Quick Facts, New Castle, Kent & Sussex Counties,
Delaware, n.d.). The percentage of patients without insurance was the lowest in New Castle
County compared to Kent and Sussex Counties at 8.6%, 9.2% and 11.5% respectively (Quick
Facts, New Castle, Kent & Sussex Counties, Delaware, n.d.). Overall, the Kent and Sussex
county population is at an economic disadvantage compared to New Castle county. These
Counties make up the patient population which Bayhealth serves.
Figure 1
(Quick Facts, New Castle, Kent & Sussex Counties, Delaware, n.d.)
0.00% 20.00% 40.00% 60.00% 80.00% 100.00%
New Castle County
Sussex County
Kent County
DelawareEducation Statistics
Bachelor's degree or higher, percent of persons age 25 years+, 2010-2014
High school graduate or higher, percent of persons age 25 years+, 2010-2014

Figure 2
Figure 3
When analyzing the mental health population from the years 2009-2013, close to 73,000
(57%) people with any mental illness did not receive treatment per year for their illness
(Substance Abuse and Mental Health Services Administration Page 9). Of the 6000 adolescents
with a Major Depressive Episode, half did not receive treatment for their depression (Substance
Abuse and Mental Health Services Administration Page 7). This demonstrates a significant
unmet need and opportunity in the mentally ill population for the state. Especially in an
economic environment where people are not thriving from an educational and financial
perspective and have lower rates of access to health insurance.
Bayhealth’s position as the largest healthcare system in Kent and Sussex Counties puts it
in a strong position to address the mental health need. The healthcare system has two hospitals, a
free standing Emergency Department, satellite facilities, and employs over 3000 people and over
400 physicians to serve the Kent and Sussex communities (About Bayhealth Central Southern
Delaware Bayhealth, n.d.). In 2014, the hospital reported over 90,000 ED visits, over 18,000
patient admissions and almost $50 million in unreimbursed care to patients (About Bayhealth
Central Southern Delaware Bayhealth, n.d.). The organizational goal is healthcare improvement,
$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000
New Castle County
Sussex County
Kent County
DelawareIncomePer County
Per capita income in past 12 months (in 2014 dollars), 2010-2014
Median household income (in 2014 dollars), 2010-2014
11 11.5 12 12.5 13 13.5 14 14.5
New Castle County
Sussex County
Kent County
Persons in poverty, percent

one patient life at a time and the mission is to continuously grow, develop and implement clinical
programs of maximum quality (About Bayhealth Central Southern Delaware Bayhealth, n.d.).
This mission and vision strives for a focused patient-centric healthcare system which qualifies
success based on individual patient outcomes.
There are areas for concern, or weaknesses that could hinder Bayhealth taking on a
strategic position in the mental healthcare market. In a survey of patient experiences, Bayhealth
ranks below the state and nation when rated on how well doctors communicated with patients
(Hospital Compare: Data sources, n.d.,). Of the hospitals 63 services offered to patients, mental
or behavioral health isn’t among them. In addition, the hospital has a weak alignment to the
community mental health facilities.
The opportunity for Bayhealth lies within the statistics of the unmet need within the
mental health community. Although there are currently 15 mental health treatment facilities
within Kent and Sussex counties, over 50% of patients with any mental illness are not being seen
by a healthcare professional (National Directory of Mental Health Treatment Facilities 2015.)
The external threats within the marketplace focus primarily on Bayhealth’s number one
competitor and the largest healthcare system in the state. Christiana Care Health System’s
behavioral health program has seen more than 3,100 patients totaling over 8.500 sessions
(Christiana Care outlines expansion of behavioral health services | Delaware Business Now,"
n.d.). Because of its’ size, Christiana Care’s capability to penetrate into the Southern Markets
also present an threat to Bayhealths position within the market.
3.0 Strategic Goals
The Bayhealth strategic plan focuses on four key areas. The first, Access and Growth has
a goal to develop and grow clinical programs, facilities and physician practices of good quality.
Their strategic goal for operational excellence focuses on providing an “exceptional care
experience for patients, families, physicians and employees” (Strategic Plan, n.d.). The strategic
goal for clinical integration focuses on developing a system of integration aligned with physician
partners. The final strategic goal is brand promise. This focuses on presenting a set apart
healthcare system to the community (Strategic Plan, n.d.).
In addition, Bayhealth conducted a community health needs assessment in 2013. Based
on the assessment, the top priorities for the organization are; 1. Obesity, 2. Cancer, 3. Access to
Health Services, and 4. Mental and Substance Abuse (Community Health Needs Assessment.
(2013). One of the strategic initiatives for the access to health service priority is to “provide the
range of physician services needed in the community” (Community Health Needs Assessment.
(2013). One of the strategic initiatives for the mental and substance abuse priority is to “support
or immplement programs that assist mental health patients.” (Community Health Needs
Assessment. (2013).
4.0 Competition
1.0 Christiana Healthcare System

1.1 Christiana Healthcare System is headquartered in Wilmington, Delaware.
1.2 Overview/Profile
Christiana Care Health System is the state of Delaware’s and one of the nations
largest health care providers. It ranks 21st for hospital admissions in the nation. The
teaching institution comprises two campuses with more than 1,100 beds ("About
Christiana Care Health System," n.d). The health systems behavioral health serves
more than 3,100 patients.
1.3 Competitive Advantage
As one of the top hospitals in the country, Christiana Care Health System is poised
to lead the way for innovation. Leading the way in patient admissions and revenue,
the organization is in a better financial position to bring new products and services
to market. The healthcare system is fully integrated into the community with many
owned outpatient practices and clinics, making continuity of care easier to obtain.
1.4 Target Market
Christiana Care serves patients in all of Delaware, parts of Pennsylvania, Maryland
and New Jersey (Career opportunities at Christiana Care Health System, n.d.). This
market is the largest of the competitors.
1.5 Product/Services
Christiana Care Health System offers over 100 services to meet the needs of the
healthcare community. The behavioral health services they offer are unique to the
hospital.
2.0 Nanticoke Health Services
2.1 Naticoke Health Services is primarily located in Seaford, DE which is located in
Sussex County.
2.2 Overview/Profile
Nanticoke Health Services is made up of Nanticoke Memorial Hospital and
Nanticoke Physician Network. The hospital has a total of 94 staffed beds, making it
the smallest hospital and healthcare system of the competitors for this analysis. The
Nanticoke Physician Network comprises 35 employed physicians and healthcare
providers (Mission & Vision, Nanticoke Health Services, Seaford, Delaware, n.d.).
2.3 Competitive Advantage
When compared to Christiana Care and Bayhealth, Nanticoke scored the highest for
patient reported physician communication. It also was the highest rated hospital
between the three for overall patient rating of 9 or 10 (Hospital Compare, n.d.).
2.4 Target Market
The Nanticoke Hospital and Physician Network serve the communities of Laurel,
Bridgeville and Georgetown, Delaware as well as in Federalsburg and Hurlock,
Maryland. In addition, this group operates three Immediate Care locations in
Seaford, Laurel, and Georgetown
2.5 Product/Services
Nanticoke Offers over ten services throughout the hospital. They also offer
outpatient, and hyperbaric services. Within their physician network, psychology is
not a hired specialty.

5.0 Marketing Differentiators
Website: The website for Bayhealth is much more patient and user friendly. The ER wait
time on the home page make the website a key draw for any patient in need of urgent care. You
can find a doctor relative to your location and request an appointment from the home page. Also
you can email current patients at the hospital which appeals to the company’s mission of
improving care one patient at a time.
Because Christiana Care is a larger health system, the homepage on their website is more
reflective of a major health organization without the user friendly appeal. The website highlights
the prestige of the organization and it’s overall commitment to healthcare, highlighting four key
health areas at the bottom. Across the top you can search for a doctor however, the user
friendliness of Bayhealth is more suitable for a mental health patient in need of personal care.
Nanticoke’s website also highlights a user friendly homepage with the patient being able to see
the wait times and also schedule their place in line from the computer. Both Bayhealth and
Nanticoke are at an advantage over Christiana Care with the website capabilities. They both
serve smaller areas so theoretically one could assume they have the technological capabilities to
handle the traffic.
Location: Bayhealth is the largest healthcare system in Kent and Sussex counties. Given
the population statistics and overall mental health market in the State of Delaware, Bayhealth is
in position to create a service for patients who are mentally ill.

Local Market: This presents a disadvantage to Bayhealth. Without a foot in the mental
illness market, the majority of patients are in local state mental facilities, hospitals and private
practices. With over 15 private healthcare facilities in the lower part of the state, there is still a
disadvantage to the over 50% of mentally ill patients who are not being seen by a provider.
6.0. New Product/Service Recommendation
1.0 Because Bayhealth has a strong presence in both Kent and Sussex Counties in the state of
Delaware, I recommend an addition of a Tele-Behavioral Health Program to help meet the
needs of the patients who are not being seen by a mental health provider. The Bayhealth
mission of helping one patient at a time and their personal approach to care make a tele-
behavioral health division ideal to suit the unmet needs of mentally ill.
1.1 Mission
The mission of the Tele-Behavioral Health Program is to increase access to patients
in need of behavioral health services.
1.2 Services
The Tele-Behavioral Health Program will be a three-part program:
1. Use tele-psychiatric & tele-therapy services for patients to have access to care
2. Allow patients to schedule time privately with using the scheduling
capabilities of Bayhealth’s website.
3. Be on hand for in-patients in need of immediate behavioral health evaluations.
1.3 Staffing
The Tele-Behavioral Health Program will initially staff 3 Tele-Psychiatrists, 2
Advanced Nurse Practitioners, and 2 Tele-Psychologists/Therapists. One of the tele-
psychiatrists will need to live locally to be able to serve as the director for the
program and be on hand for strategic planning and program program evaluation.
Location
The Tele-Behavioral Health Program will be located virtually, which means it will
not need any additional space or building.
1.4 Customer Description
Patients who will benefit from this program are Delaware’s patients with any mental
illness who haven’t been seen by a mental health professional. These are also
patients who live in a lower socioeconomic part of the state and so the program will
eliminate the burden and cost of travel to either Dover or Milford. An internet
connection will allow them to have one on one care with a mental health
professional. The program will be for adolescents ages 14 and over. The rational is
that kids younger than 14 will not benefit from tele-behavioral health care and need
more focused personal care.
1.5 Ideal Customer Needs
Ideally the patients looking for this services are looking for care to help them with
their mental illness in a private way so they don’t have to deal with public stigma.
They are looking to get their life back on track but need to get over the hurdle that is

currently keeping over half of those dealing with mental illness from seeking care.
This program will meet the needs by literally meeting the patients where they are.
1.6 Payers
This program will be an addition of the Bayhealth Healthcare system. Patients will
need to have accounts with Bayhealth to access the system which would allow them
to schedule appointments. The program will accept commercial insurance,
Medicare and Medicaid. The program will also accept cash. What will be essential
is that patients will have to log in and create profiles in the system which their
medical information will be stored.
7.0 New Strategic Benefits
Data from the American Hospital Association shows that close to 30% of patients with
medical conditions also have mental health conditions (Bringing Behavioral Health into the Care
Continuum: Opportunities to Improve Quality, Costs and Outcomes, 2012). This presents an
opportunity for Bayhealth to capture patients during any point of care and provide behavioral
health services. In addition, a Tele-Behavioral Health Program would be the only all tele-
medicine mental health program available by a major Healthcare system in the state. Taking
advantage of Bayhealth’s goal of an an intimate patient experience, the Tele-Behavioral Health
Program would put the organization at a significant advantage.
Figure 4
1.0 Financial
The financial benefit the Tele-Behavioral Health Program can offer the hospital is
a significant reduction in total hospital costs. With the average length of stay for
all illnesses at 4.6, the number is increased for patients with mental illnesses at 7.2
length of stay days (Hospital Inpatient Care, FastStats - Mental Health, n.d.). In
total, the state of Delaware ranked mental disorders as the third highest increase
of hospital admissions at 30% from the year 2001-2004 (Delaware Hospital

Discharge Report, n.d.) Treating the illness and integrating a program targeting
patients downstate can reduce the number of urgent admissions which will reduce
overall hospital costs.
2.0 Operational
The new program will provide an opportunity for Bayhealth to incorporate a
integrated system of health that will cater to the individual patient. The Tele-
Behavioral Health provider will be on hand for patients within the community as
well as for staff who may be in need of urgent mental health evaluations for
current patients in the hospital. This on demand care will reduce the wait for the
hospital to reach outside of it’s network and reduce the possible disruption of care
risk for their patients.
3.0 Market
The Tele-Behavioral Health Program will be the first of it’s kind offered by a
major health system for the Kent and Sussex counties. This presents an
significant advantage over other hospital’s in the area and poises Bayhealth to
continue to lead the way for innovative care.
4.0 Customer
The reason behind this new initiative is the desire for Bayhealth to continue to
provide an excellent patient experience and care. The customer will benefit from
this program with personal behavioral health care and a system that will cater to
and track progress. Future possibilities for this system include links to resources,
personal reminders linked to their portable devices. All aimed at enhancing the
patient experience while increasing access to early behavioral health care.
5.0 Bridging the Gap
The final reason for bringing this Tele-Behavioral Health Program to Bayhealth is
to effort to bridge the gap. Data from the American Hospital Association
highlights many reasons why patients who suffer from mental illnesses do not
receive care. Not having the time, not knowing where to go for services, concerns
about confidentiality, the fear of negative perception including job perception
accounts for 57.8% of the reasons why patients are not receiving healthcare
(Bringing Behavioral Health into the Care Continuum: Opportunities to Improve
Quality, Costs and Outcomes, 2012). This presents a answer to a huge unmet
need for patients suffering with mental illnesses.
8.0 Closing
As stated by the American Hospital Association, “Behavioral healthcare is fragmented”
(Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs

and Outcomes, 2012). Patients seeking care have to pour through care in the inpatient and
outpatient setting. Provider linkage challenges, shortages of facilities and providers are all
challenges in the quest for optimal patient’s behavioral healthcare (Bringing Behavioral Health
into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, 2012).
Bayhealth, has significant advantages being the largest healthcare provider in Kent and Sussex
counties within the state of Delaware. Not having any investment into the behavioral health
market presents a challenge for the company to implement an new program. The Tele-
Behavioral Health Program meets this challenge with a program that will meet the needs of
patients, address their challenges to care without using physical resources to incorporate.

Citations
1. Community Health Needs Assessment. (2013). Retrieved from Bay health Kent General website:
http://www.bayhealth.org/media/file/CHNA%20Report%20Kent.pdf
2. Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer:
Delaware, 2014. HHS Publication No. SMA–15–4895DE. Rockville, MD: Substance Abuse and
Mental Health Services Administration, 2015.
3. “Substance Abuse and Mental Health Services Administration, Center for Behavioral Health
Statistics and Quality. Behavioral Health Services Information Series: National Directory of
Mental Health Treatment Facilities 2015, HHS Publication No. (SMA) 16-4939. Retrieved from:
http://www.samhsa.gov/data/mental-health-facilities-data-nmhss/reports?
4. About Bayhealth Central Southern Delaware Bayhealth. (n.d.). Retrieved from
http://www.bayhealth.org/about-us/about-us-home
5. Mission, Vision & Values. (n.d.). Retrieved from http://www.bayhealth.org/about-us/mission-
vision-values
6. State of Delaware Community Health Status Assessment. (2013). Retrieved from Delaware
Department of Health and Social Services, Division of Public Health website:
http://www.dhss.delaware.gov/dhss/dph/files/shachsa.pdf
7. Christiana Care outlines expansion of behavioral health services | Delaware Business Now.
(n.d.). Retrieved from http://delawarebusinessnow.com/2016/02/christiana-care-outlines-
expansion-of-behavioral-health-services/
8. Hospital Compare: Data sources. (n.d.). Retrieved from
https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=080004&stCd=
DE&stName=Delaware
9. National Directory of Mental Health Treatment Facilities 2015. (2015). Retrieved from
DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health
Services Administration website:
hhttp://www.samhsa.gov/data/sites/default/files/2015_National_Directory_of_Mental_Health_Tr
eatment_Facilities.pdf
10. Schmitt, B. (2016, February 29). Christiana Care Health System Boosts Access to Mental Health
Care by Integrating Mental Health Experts in Primary Care. Retrieved from
http://3f97c21cm2if3lrayt2ivf2v.wpengine.netdna-cdn.com/wp-
content/uploads/2016/02/Christiana-Care-Health-System-Boosts-Access-to-Mental-Health-Care-
by-Integrating-Mental-Health-Experts-in-Primary-Care.pdf
11. Christiana Care 2015 Year in Review by Christiana Care Health System - issuu. (n.d.). Retrieved
from https://issuu.com/christianacare/docs/christiana_care_2015_year_in_review
12. Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs
and Outcomes. (2012). Retrieved from American Hospital Association website:
http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf
13. Hospital Inpatient Care, FastStats - Mental Health. (n.d.). Retrieved from CDC website:
http://www.cdc.gov/nchs/fastats/mental-health.htm
14. Strategic Plan. (n.d.). Retrieved from http://www.bayhealth.org/about-us/strategic-plan
15. Figures 1, 2, 3
Quick Facts, New Castle, Kent & Sussex Counties, Delaware. (n.d.). Retrieved from United
States Census Bureau website: http://www.census.gov/quickfacts/table/PST045215/10001

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