Running Head: STRATEGIC PLAN 33

Strategic Plan

Team 1

Anita Altawan, Brian Chancellor,

Joseph Cleary, & Jessica Ehinger

A project submitted in partial fulfillment

of the requirement for the degree

Master of Arts in Leadership

Siena Heights University

Southfield, Michigan

3/27/2016


Background and Overview of the Organization

In 1993, three Central Iowa hospitals came together to form what was known as Iowa Health System. These organizations were: Blank Children’s Hospital, Iowa Methodist Medical Center and Iowa Lutheran Hospital. Later that same year Iowa Health Physicians group joined and the name was changed to Iowa Health – Des Moines. Between the years of 1995-1999 the health system saw the addition of St. Luke’s Methodist Hospital in Cedar Rapids, Allen Memorial Hospital in Waterloo, St. Luke’s Region Medical Center in Sioux City, Finley Hospital in Dubuque, Jones Regional Medical Center in Anamosa, Trinity Regional Medical Center in Fort Dodge, and Trinity Regional Health System in the Quad Cities. In 2009 the system saw the addition of Unity Health Care, which would later become Trinity Muscatine. That same year Iowa Health System launches Health Net Connect, a 3,200-mile fiber optic network from Denver to Chicago, and e-Prescribe Iowa, the nation’s first statewide electronic prescribing program. The following year Iowa Health System was rated one of the top health care systems in the U.S. by Thomson Reuters. In 2011 Methodist Medical Center of Illinois joins Iowa Health System and The Centers for Medicare and Medicaid Services select Trinity Regional Medical Center and Trimark Physicians as one of the nation’s original Pioneer Accountable Care Organizations. It was in 2013 that Iowa Health System would change its name to UnityPoint Health to “reflect the way its hospitals, physicians and home care entities are transforming health care delivery through patient-centered coordinated care” (Sinnard, 2013, p. 1).This change in name was in order to symbolize “the difference between the former hospital-centered health care process to one that more effectively addressed the total care of all patients, whether they were at a clinic, a hospital or home” (“History,” 2015, p. 1).

Today, Unity Point is the 5th largest nondenominational healthcare system in the nation with over 24,000 employees including 900 providers in over 28 clinics and 29 hospitals (“History,” 2015). Eric Crowell, President and CEO of Unity Point had the following to say about UnityPoint Health:

We are dedicated to our mission of improving the health of our community through healing, caring and teaching. Another vital part of our mission is teaching and training the health care workers of tomorrow. Through residency programs, clinical education programs, workshops and seminars, we provide the training necessary to assure continuing quality healthcare in our community. Working as caregivers, volunteers and teachers, the dedicated physicians and staff of our hospitals and clinics continue to reach out to improve the health of our communities and every patient we serve (“Message,” 2015.)

Directional Strategies

Mission

The role of a mission for an organization is to describe the organization’s purpose. The mission is a starting point in the development of the strategic vision of the organization (Logan, 2004). The mission of UnityPoint Health is to “improve the health of the people and communities we serve” (Mission and Values, 2015, p. 1).

Vision

The vision of the organization describes its ideal future. It incorporates the values and the mission of the organization. The vision unites the member’s for the organization toward a shared strategic direction (Logan, 2004). The vision of UnityPoint Health is to achieve the “best outcome for every patient every time” (Mission and Values, 2015, p. 1).

Values

An organization’s values acts as guidelines for behavior and conduct in an effort to achieve the vision. Values reflect how the organization carries out their mission (Logan, 2004). There are five core values that UnityPoint Health emphasizes and they include; integrity, pursuit of excellence, partnership, community stewardship and placing the patient first. UnityPoint Health’s focus on integrity is rooted in transparency of quality and service metrics to the public. In its pursuit of excellence, UnityPoint Health embraces innovation, creates a positive work environment for staff, and utilizes best-practices and evidence based care. This organization is an Accountable Care Organization (ACO) that integrates partnering to facilitate care coordination and access. Within community stewardship, UnityPoint Health promotes wellness and prevention as well as assesses for community needs. This organization places the patient first by the care that they provide as well as the coordination of care throughout the patient’s entire experience.

Goals

The primary goal of UnityPoint Health is to advance their “Triple Aim” (“The IHI,” 2016). The three aims include; better value and affordable care costs for all, better health for individual patients and better health for UnityPoint’s community. More specific goals are then derived from this “Triple Aim.” The progress toward these goals is measured yearly though survey data and the results of the progress are shared in the organization’s annual reports (“The Journey,” 2015).

One of these goals is that UnityPoint Health strives to increase transparency. Performance results are being made accessible to the general public and shared with employees. Transparency of performance results will hopefully drive performance. In 2016, they will begin to share quality, patient experience, and cost of care data so that patients can make a conscious decision as to which site of care they should choose (“The Journey,” 2015).

In an effort to remove uncertainty and fragmentation from the current healthcare journey, UnityPoint Health strives to improve coordination of care between members of its ACO. This fluid movement through the patient experience is further aided by clinical care pathways. These clinical care pathways sequence interventions and provide timeframes as well as expected outcomes for standardizing treatment of certain diagnoses (“The Journey,” 2015).

The organization is advancing itself in the use of telehealth as well to improve access. Along with being an ACO, it has an EpicCare program that sends notifications to the patient providers when they come to the hospital (“The Journey,” 2015). A recommended goal for UnityPoint Health would be to advance itself further in the use of telehealth. Since much the community in which is provided for is in rural settings, the use of telehealth can greatly improve access.

External Environmental Analysis

General

Social. Many large social changes in the general environment are readily apparent including that the population of the United States is becoming more diverse, pursuing more education (and student loans), and our aging population is expanding. The expansion of the ageing population is discussed further in the industry-specific section below.

The population of the United States is trending toward becoming more racially and culturally diverse. Projections predict that by 2043, the white population will fall below a majority and the US population will become a minority majority. While currently the minorities represent 37% of the population, it is projected that they will make up 57% in 2060 ("U.S. Census," 2012). This will have implications to healthcare in that there will be an increased need for cultural competency. Hopefully there will be a diversification of healthcare leadership to advocate for and represent the population to which it cares. Although the minority population comprises 35% of the population, it only comprises 17% of nurses and 12.3% of medical school graduates (Betancourt, Beiter, & Landry, 2013).

The trend of education over the past few generations has been to receive higher levels of education. Although this is definitely positive for the education of the average American, it has great implications on the financial status of families. As of 2012, thirty-seven million individuals and an astonishing 15.4% of households owe on student loans. The average 2010 college graduate from a four-year university owed over $25,250 in student loans. Studies show that approximately 21% of student loans are either delinquent or in default (Daniel, 2013). As our American population incurs more debt and increasing monthly payments for student loans, they will have less means by which to pay other bills, such as medical expenses.

Economic. The 2008 recession marked an increase in unemployment and for many a loss of healthcare coverage. The economic picture at the time of the ACA passage was very different than it is today. The following is a reflection of the past five years:

·  Since the passage of the ACA in 2010, 13.4 mission more Americans have found employment. In 2014 and 2015 an average of 200,000 jobs per month were added, which is the largest increase of jobs in a single year since the 1990s (Schoen, 2016).

·  Unemployment has decreased from 9.9 percent to a mere five percent over the last five years. However, these gains are in the private sector, and employment in the public sector is actually down since 2010. All of the job growth has been though full-time jobs, despite fears that the ACA would cause employers to transition those to part-time jobs to avoid paying benefits (Schoen, 2016).

·  There has also been a decline of 3 million in those who are working part-time but would rather be working full-time (Schoen, 2016).

·  Over the past five years, healthcare spending growth per person has slowed (Schoen, 2016).

The expansion of Medicaid by some states also has large economic implications. Many factors impact whether Medicaid expansion will be beneficial to the state and the impact that it will have on the healthcare economics of that state. Important variables that impact these effects include the number of Medicaid eligible candidates, the medical spending burden, and the state costs of Medicaid expansion (Caswell, Waidmann, & Blumberg, 2013). So far 30 states and the District of Columbia have chosen to expand their Medicaid programs (“Coverage,” 2015).

Industry-Specific

Social. There are social changes that have large implications in the healthcare industry. The “baby boomer” generation is aging as well as our life expectancy and our ability to extend life through multiple comorbidities. In 2012 the estimated population over the age of 65 was 43.1 million. By the year 2050 the expected population of this age is 83.7 million. In the year of 2050, those baby boomers who are still alive will be over the age of 85 (Ortman, Velkoff, & Hogan, 2014). The prevalence of comorbidities in those over the age of 85 is higher compared to other populations over 65 (Ahluwalia er al., 2011). This emphasizes the importance of coordination of care between the services that manage these comorbidities. Healthcare organizations will have to adjust to having a large population that is moving into an age category that increases healthcare demand. This increase of demand will be coinciding with a decrease in supply of healthcare workers. The aging population will also mean the retirement of a large portion of the healthcare workforce. As our society has a larger class of higher aged individuals and less of us to care for their needs, a problem emerges. On the side of supply, the population of nursing is aging. A 2010 study reveals that the average age for the working nurse is 46.8 years old more than half of those intended to retire by 2020 (Mullenbach, 2010). By 2020, it is estimated that there will be a shortage of 800,000 nurses (Ginter, Duncan, & Swayne, 2013). Another large strain for nursing demand that is often not talked about is the decrease in the lengths of stay and the increase of acuity over the course of the stay for patients (Upenieks, 2005). This means an increase in the number of FTEs per floor and more skilled nursing to care for these patients.

Economic. The economic environment has greatly changed since the institution of the Affordable Care Act. Healthcare coverage and cost is constantly growing and changing to adapt to the implications of the ACA. Some insurers have proposed increases exceeding 40 percent for 2016 because of the impact of not having the young (under 26) healthy population paying for their healthcare (Battersby, 2015). It is never really discussed that having individuals under the age of 26 stay on their parents healthcare may actually have a negative effect in driving up healthcare costs in the chance that they are deferring their own insurance and not paying in while their usage is minimal.

Along with the changes that happened on a large scale with the ACA, there were changes at the organizational level such as the establishment of accountable care organizations (ACO). As discussed at the ACO summit, the goals of these ACOs are to improve access, reform payment practices, provide better population health, and improve physician alignment (Koury et al., 2014). The reform to the current payment system has led many ACOs to large profits when the savings are spit with the Medicaid Shared Savings Program (MSSP). In a study of 32 ACOs that began the program in 2012, 12 of the ACOs received a total of $76 million in combined savings. This was part of the shared savings of $147 million from these organizations. There was only one organization that shared in losses through the program (Petersen & Muhlestein, 2014). As these organizations become accountable for their care and the financial incentive is present to reduce costs they will look for means to reduce waste. This would assuredly include tools like Six Sigma or activity-based costing (ABC). Much of the waste of previously divided entities will be reduced as these ACOs become responsible for the entire coordination of care and treatment of the patient. As we discussed above, there will be a flux in the older population who are living with comorbidities so coordination of this population’s care will become ever increasingly important.