Background and Overview of the Health Service Organization



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.

Service Area Competitor Analysis

The Service Area

The outreach of UnityPoint Health extends through the populations of Iowa, Illinois, and Wisconsin ranging through the geographical regions of nine large areas. The pertinent demographic communities include Anamosa (Iowa), Cedar Rapids (Iowa), Des Moines (Iowa), Dubuque (Iowa), Fort Dodge (Iowa), Meriter (Madison, WI), Peoria (Illinois), Quad Cities/Muscatine (Iowa, Illinois), Sioux City (Iowa), and Waterloo (Iowa). With the current location of our university we have decided to locally refer to the Meriter (Madison, WI) location in reference with our location in Michigan.

Meriter (Madison, WI) is home to the location of UnityPoint Health. The population of Madison is considered on the urban end, with a population of 245,691 (population estimates, 2014, para. 1). The Meriter UnityPoint health system has a discharge rate of 21,457 a year (Reports Detail, 2016, para. 1). Per the United States Census, Madison Wisconsin the health information provided included “with a disability, under age 65 years, percent, 2010-2014 = 6.5%” and “persons without health insurance, under age 65 years, percent = 8.3%” (“US Census,” 2010-2014). With the service area of Madison, WI the “total health care and social assistance receipts/revenue, 2012 ($1,000) = 4,054,428” (“US Census,” 2010-2014). The health system of UnityPoint directly serves the community providing “adult intensive care, alcohol/chemical dependency, cardiovascular, emergency, gynecology, hospice/palliative care, neonatal intensive care, neurology, obstetrics, oncology, orthopedics, pediatrics, psychiatry, pulmonary, rehabilitation/physical medicine, trauma, urology/nephrology” (Reports Detail, 2016, para. 1). The wide variety of healthcare possibilities is what allows for healthcare acceptance across the demographical board. Per the Kaiser Family Foundation:

Individuals who have newly gained coverage in the Marketplace are beginning to interact with their new health plans and seek care. By preserving its limited Medicaid expansion, Wisconsin continues to forgo significant federal funding available for coverage of adults. However, there is no gap in coverage for adults in Wisconsin unlike other states that have not implemented the Medicaid expansion and Wisconsin could elect to move forward with the full expansion in the future. Meanwhile, the health care system and providers in Wisconsin, as in all states, is evolving in response to new demands, changing health care markets, and emerging models of health care delivery and payment. It remains to be seen how these and other changes under the ACA will affect the health, health care access, and health care utilization of Wisconsinites in the long term (“The Wisconsin,” 2015, para. 33).

The demographics and logistics of the Madison, Wisconsin health area is wide and various in the demands it meeting and exceeding. The provisions of UnityPoint help to move these developments forward in the expansion of covering a vast demographic of individuals and their care needs. The Kaiser Family Foundation (“The Wisconsin,” 2015) provided a plethora of pertinent information specifically describing the logistics of the Wisconsin population stating “Wisconsin has long been a leader among states in expanding coverage to its low-income residents since even before the major coverage provisions of the Affordable Care Act (ACA) took effect on January 1, 2014. While Governor Scott Walker decided not to adopt the Medicaid expansion, thousands of previously uninsured Wisconsinites have enrolled in health coverage through the state’s broad BadgerCare Medicaid waiver, which increases coverage to low-income populations, and through the new Health Insurance Marketplace.” (“The Wisconsin,” 2015, para. 1). Sharing this information lays the environmental picture of UnityPoint’s Healthcare system as a whole and the demographics it reaches.

Competitor Analysis

Upon research of the UnityPoint Health demographical area and span throughout the communities the competitor analysis elaborated on several networks. For the logistics of this plan, the information provided will be from Mercy Health Network Inc., The University of Iowa, and Genesis Health System.

To begin the Genesis Health System, is an institute operating three acute care hospitals in the Iowa and Illinois areas. The Davenport, Iowa Genesis Health System allows for 502 beds and this hospital provides general, surgical, and specialist health services and employs over 450 physicians and staffs up to 3,100 employees with the added benefit of 1,000 volunteers at any one time. A strength of the Genesis Health System is in October of 2005, Genesis Medical Center Davenport became one of the three percent of roughly 6000 hospitals in the United States to achieve the highest honor in nursing; Magnet status (Genesis Health, n.d.). The benefit of a recognition such as this, it allows for the public to feel confident and aware of their own healthcare. The procurement of a safe atmosphere provides trust between patient and care provider.

The establishment of Genesis Health System was rated on a scale of five stars, receiving a point value of three stars. Patient’s surveys reported 49 percent “strongly agree” they understood their care when they left the hospital (Hospital Compare, n.d.). Additionally it was found that 74 percent of patients reported that their nurses “always” communicated well (Hospital Compare, n.d.). As a comparative section the definitive differences between the strengths and weaknesses of the Genesis Health System is evident. Being they were recognized for an excellence in nursing but patients report a lack of communication. Both accounts are taken into consideration when weighing the competitor analysis of these health establishments.

Secondly, The University of Iowa Hospital and Clinic employs 1,617 physicians, residents, and fellows. Currently employing 6,730 non-physician individuals and 1,904 educated nurses, and overall allowing 1,500 volunteers to influence the care and comfort of their patients. The main and strongest impact The Iowa University Health system has been able to implement is that of a recognition from Forbes magazine presenting “Forbes Magazine named University of Iowa Health Care as the Number 1 employer in the Health Care industry category and Number 7 employer overall (2016)” (Forbes, 2016, para. 1). Having the ability to be recognized for such a feat is a true testament to a healthcare work environment dedicated to the future of its employees. The Iowa University Health System is developing an organization that individuals can be proud to work for allowing for them to thrive and provide excellent, uninterrupted care.

Although the University of Iowa was recognized for the excellent employment opportunities and work environment: with every strength there comes some apparent weaknesses. Information provided via hospital compare, University of Iowa Hospital and Clinics received a three of five star rating. Patients who reported that staff “always” explained about medicines before giving it to them was reported at only 59% (Hospital Compare, n.d.). Aspects of communication were also evaluated where patients who “strongly agree” they understood their care when they left the hospital was only at 50% (Hospital Compare, n.d.). The variance between excellent work environment and the safety of their patients regarding patient education and medication reconciliation is alarming. Strengths and weaknesses were truly identified here and add to the definition of competitor analysis.

Lastly the third competitor analysis of UnityPoint Health comes from the Mercy Health Network Inc. A foundation combined of the two largest catholic, non for profit health organizations in the United States. Mercy Health Network Inc., developed and implemented a successful TeleHealth application. Stating “Established in 1993 as a joint development program of Mercy Medical Center - Des Moines and Mercy Medical Center - North Iowa, the membership of the Midwest Rural Telemedicine Consortium (MRTC) currently consists of 25 health care provider organizations” (TeleHealth, 2016, para. 1). This MRTC that was established is the largest telemedicine program in Iowa (TeleHealth, 2016). A true strength allowing for a wider patient reach using the implementation processes of the TeleHealth technology.

The affiliated health care center to Mercy Health Network Inc. is their Des Moines location. Mercy Medical Center-Des Moines, upon research the weaknesses began to appear. Per the website on hospital compartments Mercy Medical Center as a partner in Mercy Health Network Inc. was rated poorly on several aspects. When rated by a patient survey, Mercy Medical Center received a three out of a five star rating. Sharing several individual ratings will develop an idea of where exactly the weaknesses lay within the Mercy Health Network Inc. It was reported that patients who reported that they “always” received help as soon as they wanted was a mere 56 percent (Hospital Compare, n.d.). Another main objective to the healthcare industry is that of communication and an open line between care provider and patient. As stated by the hospital compare provided by , patients who “strongly agree” they understood their care when they left the hospital was rated for only 53% (Hospital Compare, n.d.). Relatively the differences between the innovations of TeleHealth and the discrepancies of communication lack, do paint a vivid idea of Mercy Health Network Inc.’s strengths and weaknesses.

Internal Environmental Analysis

Service Delivery

At UnityPoint and other health care organizations, the moment the patient arrives, the point-of-service activities begin to take place. When the point-of-service occurs there are many ways in which value is created for the patient. Some items patients may look at are wait times, if the nurse is courteous, and any important information a patient should be notified about with their health. Almost all hospital attempt to improve their point-of-service at one time or another. According to Ginter, Duncan, and Swayne (2013), “Numerous public and private organizations have attempted to improve point-of-service by ensuring the delivery of higher-quality services. However, there continues to be considerable controversy as to how effective service improvements alone can lead to sustainable competitive advantage” (p. 135).

|Point of Service |

|Strengths |Weaknesses |

|Communication |Health Promotion and Education |

|Timely Care | |

|Patient – Physician Rating | |

UnityPoint Health ranked above the 50th percentile of all Medical Shared Savings Program (MSSP) Accountable Care Organizations in eight of the ten areas surveyed. The feedback received from the patients is vital to help direct UnityPoint with improvements for patient care. Good communication is a key factor in helping patients decrease their anxiety levels and common concerns.

|Point of Service |

| |Resources |Competencies |Capabilities |

|Value (High or Low) |High |High |High |

|Rare (Yes or No) |Yes |Yes |Yes |

|Imitability (Difficult or Easy) |Difficult |Difficult |Difficult |

|Sustainability (Yes or No) |Yes |Yes |Yes |

Resources – are the stocks of human and nonhuman factors that are available for use in producing goods and services (i.e. tangible = land, labor, or capital; intangible = intellectual property, reputation, and goodwill).

Competency – the collective knowledge and skills possessed by individuals may be a source of sustained competitive advantage for the organization.

Capabilities – an organization’s ability to deploy resources and competencies, usually in combination, to produce desired services. Capabilities fall into one of the following two categories:

✓ The ability to make dynamic improvements to the organization’s activities through learning, renewal, and change over time; or

✓ The ability to develop strategic insights and recognize and arrange resources and competencies OR to develop novel strategies before or better than competitors.

According to Ginter et al., “Strengths must have value, be rare, be difficult to imitate, and sustainable in order to create a competitive edge” (p. 146). One competitive advantage Unity Point holds is in communication. In 2015, the theme for UnityPoint’s Leadership Symposium was “Unity begins with you”. It is when physicians, employees and leaders across UnityPoint embrace this phrase then at that moment individuals will do what is right for their patients, their families and everyone they serve. There were more than 400 leaders that gathered to the first annual “Own the Moment” patient experience conference in 2015. This meeting assisted leaders with understanding the feedback gathered from patients and help recognize the need for improvement. At UnityPoint, their key strength is communication and that is what they are working on to improve. They have a built infrastructure that allocates human and financial resources to improve the experience of the patients they serve. Communication is a key strength that UnityPoint Possesses, but they are always trying to improve.

The main weakness of UnityPoint is health promotion and education. UnityPoint’s limited health literacy is a developed program to help with health promotion and education. It is the ability for a patient to obtain, process, and understand basic health information and services. It affects a patient’s entire health experience at UnityPoint. Patients who have low health literacy are more likely to not take preventative measures and later on require hospitalization that could have been prevented.

Approximately 90 million individuals have difficulty understanding and using health information. You have to have the ability to read, understand, and effectively use basic health information. Low health literacy affects all types of individuals no matter their background or educational level. UnityPoint Health works with hospitals, outpatient clinics, and home health teams to develop communication tools and implement strategies that help increase an individual’s understanding and provide a better patients or family experience. Ginter et al. says, “The strategic relevancy of each weakness can be determined by asking questions similar to those used to evaluate strengths” (p. 150). UnityPoint has a goal to increase health promotion and education and has implemented a strategic plan to improve this weakness of theirs.

Organizational Structure

UnityPoint Health Partners have made several important changes to its governance structure. The health care organization has added more physicians to the board of managers, finance, and network development. UnityPoint Health has also created an advisory team which is comprised of executive leaders of independent physician groups across the network to help analyze and provide valuable input and guidance on key issues such as rick model development, data sharing and network evolution. UnityPoint has created structured governance in order to be successful.

|Organizational Structure |

|TYPE: Matrix |

|Strengths |Weaknesses |

|Patient-Centered Leadership |None Visible |

UnityPoint’s governance is focused on patient-centered leadership. The Board of Directors governs the organization caringly, responsibly, choosing to adopt many best practices so they can focus on patient care, patient concerns, and the patient’s health. According to UnityPoint Health, “When individuals choose a UnityPoint Health hospital, clinic, physician, or partner, they can be confident that the organization providing the care or service is organized and governed properly and consistent with the best practices in nonprofit governance” (“Good Governance,” 2015, para. 2). Their key strength is patient-centered governance and not many nonprofit organizations can provide governance such as this one. I did not see a weakness that UnityPoint Health possesses. This may be due to their large organization because they have all of the key areas covered.

|Organizational Structure |

| |Resources |Competencies |Capabilities |

|Value (High or Low) |High |High |High |

|Rare (Yes or No) |Yes |Yes |Yes |

|Imitability (Difficult or Easy) |Difficult |Difficult |Difficult |

|Sustainability (Yes or No) |Yes |Yes |Yes |

Resources – are the stocks of human and nonhuman factors that are available for use in producing goods and services (i.e. tangible = land, labor, or capital; intangible = intellectual property, reputation, and goodwill).

Competency – the collective knowledge and skills possessed by individuals may be a source of sustained competitive advantage for the organization.

Capabilities – an organization’s ability to deploy resources and competencies, usually in combination, to produce desired services. Capabilities fall into one of the following two categories:

✓ The ability to make dynamic improvements to the organization’s activities through learning, renewal, and change over time; or

✓ The ability to develop strategic insights and recognize and arrange resources and competencies OR to develop novel strategies before or better than competitors.

Based on the evaluation of UnityPoint Health, the point-of-service for your organization is a competitive strength. UnityPoint Health does a monthly, quartly, and annual review of its strengths and weaknesses. This organization has a competitive advantage because of its structure governance. The organization has all of its bases covered in order to keep the competitive advantage. You are looking at multiple areas when it comes to point-of-service. Not only do the big key items in an organization count, but the little items count too. UnityPoint Health is consistently improving the strengths and weaknesses in order to keep the competitive advantage. Ginter et al. says, “In Todays’ environment, strengths can quickly become weaknesses as successful strategies are challenged by competitors. A critical component of strategic momentum is continuous evaluation of the organization’s strengths and weaknesses relative to the environment (p. 136). This is why UnityPoint Health has been successful because they watching their competitors, while analyzing and trying to make adjustments to their own organization.

Strategy Formulation

Overview

The specific areas based upon the reaches of UnityPoint Health and the information provided throughout this plan has lead us to interpret the best interest of this health organization is to expand. By way of expanding UnityPoint has the ability to influence other health organizations and to reach more of the surrounding population. Increasing the quality of their patient care and the influence on the population. As discussed previously in this plan, the utilization of the general area of Madison, WI at the location of Meriter UnityPoint Health. Upon research it was discovered that a review of UnityPoint Health provided specific information pertaining to the expansion recently developed within the Wisconsin area. Akanksha Jayanthi discussed:

“UnityPoint Health expands its presence in the Midwest through a number of affiliations. Most recently, UnityPoint Health – Waterloo signed a letter of intent with Black Hawk – Grundy Mental Health Center. One of the health system's larger affiliations was finalized in January when UnityHealth Point announced a strategic partnership in its affiliation with Madison, Wis.-based Meriter Health Services. Overall, the health system has 30 affiliated clinic and home care locations” (Jayanthi, 2014, para. 12).

It is the best interest of UnityPoint Health as a healthcare organization to continue the expansion of their methods, culture, and technologies to provide exceptional care to the communities and populations of the Midwest regions.

Adaptive Strategy

The adaptive strategy most effective in the expansion and already in motion direction of UnityPoint Health we feel to be that of market development, pursing an expansion to utilize an influence of quality care in the marketplace. With the utilization of a geographical market in the horizontal integration UnityPoint Health as described by Akanksha Jayanthi is, “with 17 acute-care hospitals, 15 community network hospitals and more than 280 clinic locations, it is among the 15 largest nonprofit health systems in the country and is the fourth largest nondenominational health system” (Jayanthi, 2014, para. 3). The market development already in progression is providing the same exceptional care but to new market areas such as communities, cities, and surrounding states. The confirmation that UnityPoint Health is successfully expanding is demonstrated in that of the information provided, reaching the status of 15th largest nonprofit health system in the country. In the successfulness of UnityPoint Health it is also important to recognize the factors of a focused factory strategy that could also be applied to the strategic expansion of this healthcare organization. As stated by Ginter et al. (2013), “this strategy involves providing comprehensive services across multiple markets (horizontal integration) for one specific disease such as diabetes, renal disease, asthma, or cardiac disease” (p. 221-222). Provided UnityPoint Health expanded incorporating 280 clinic locations, ranging from dermatology, home health, and wound care just to name a few. The success of UnityPoint’s expansion is truly apparent (Jayanthi, 2014).

To evaluate the adaptive strategy to expand we will use the TOWS and SPACE analysis. A TOWS analysis looks at the threats, opportunities (environment) and weaknesses, strengths (organization). One of UnityPoint’s biggest threats is itself. As an organization begins to expand its portfolio and cover a larger geographical area, it becomes harder to maintain the same quality and service provided. Opportunities to expand horizontally have been plentiful and with more clinics, CAH’s, and providers looking to shift the risk away from themselves it is a great time to continue that expansion. UnityPoint’s biggest strength and asset is it’s 28,000 plus employees who have a vast knowledge base with many years of experience. UnityPoint has been expanding successfully and has continued to do so for over 20 years. An organizational weakness with expansion is creating new positions and expanding the chain of command. A SPACE analysis (Strategic Position and Action Evaluation) looks at the environmental stability, industry attractiveness (external) and competitive advantage, financial strength (internal). With the introduction of Obamacare and the expansion of Medicaid services the environment in which to expand has not only been sustainable but seen the need for growth and expansion. With the size of UnityPoint as an organization it has allowed all affiliates to keep up with technological change that may not otherwise be possible. This has also created industry attractiveness through financial stability, resource utilization and allocation, and value based purchasing. Through its already completed expansions UnityPoint has gained a competitive advantage through increased market share and product lifecycle, thus creating great financial stability.

Market-Entry Strategy

Based upon the decision to utilize the adaptive strategy of market development it is appropriate to implement the aspect of a market entry strategy pertaining to cooperation, specifically in the action of mergers. Per Ginter et al. (2013), “in mergers, however, the two organizations combine through mutual agreement to form a single new organization, often with a new name” (p. 232). As described in the development of this plan UnityPoint Health was established being the product of several mergers throughout the states of Iowa, Illinois, and Wisconsin. Combining in 2013 to become UnityPoint Health, within these mergers there are a definitive amount of positive strategies developed for the successfulness of this healthcare organization. A merger of healthcare providers allows for the improvement of efficiency and effectiveness and the enhancement of the populations access in the surroundings market areas (Ginter et al., 2013). The fit of mergers within the UnityPoint Health system is an effective strategy as they have already seen productive and established locations all working with the UnityPoint HealthCare’s reach. Jayanthi as discussed above provided exceptional information in the cooperation of UnityPoint and other healthcare establishments to elaborate quality care. Jayanthi (2014) states:

UnityPoint is a leader in connected health technologies. The health system created and launched HealthNet connect, a group of healthcare institutions connected on a private, secure fiber optic network that allows for instant provider-to-provider communication. The Federal Communications Commission provided the initial $7.8 million in funding for HNc as part of the Rural Healthcare Pilot Program, which provides funding for broadband networks to bring telehealth services to rural areas of the country. The fiber optic network runs a 3,200-mile stretch from Denver to Chicago (para. 7).

Presenting all the information it is established that UnityPoint has done a successful implementation of growth and strategic placement within the healthcare markets of Iowa, Illinois, and Wisconsin.

The evaluation of the market entry strategy of cooperation to achieve market development was evaluated by analyzing the appropriate external conditions, internal resources, competencies and capabilities, and organizational goals. The external conditions have culminated into the perfect storm to merge and or affiliate for those externally as well as UnityPoint. With the decrease in reimbursement, increase in cost and the focus on providers and organization to shift the risk elsewhere, UnityPoint has been successful in achieving the “best outcome for every patient every time”. UnityPoint has been successful in all of its mergers and affiliations and has competent people and the financial capabilities to continue to achieve market development.

Competitive Strategies

Strategic Posture. UnityPoint is the nation’s fifth largest non-denomination health system. The formally known Iowa Health System, reflects the way hospitals, physicians, and home care entities are transforming health care services through patient-centered coordinated care. Over the last several years UnityPoint has developed a team-based approach. They have expanded their services in order to become a point of unity for patient care. The UnityPoint Health brand is an expression of their promise to patients. The employees of UnityPoint Health work together as a team to create a full continuum of care. It is to meet the health needs of individuals before they become patients. UnityPoint also wants to serve their patients in a timely, convenient, and coordinated manner. UnityPoint Health stays up to date on the new products. According to Ginter et al. (2103), “Strategic posture concerns the organization’s fundamental behavior within a market – defending market position, prospecting for new products and markets, or balancing market defense with careful entry into selected new product areas and markets” (p. 239). UnityPoint Health has the internal and external conditions necessary to be successful in the future.

UnityPoint is “fit” based on its resources, competencies, and capabilities. UnityPoint uses a combination of strategic postures. UnityPoint Health is an analyzer in terms of strategic posture. An organization that is analyzer strategic posture uses a combination of defender and prospector strategic postures. The analyzer tries to balance all aspects of the organization. Ginter et al. (2013) quotes, “Characteristically they watch competitors and rapidly adopt those strategic ideas that appear to have the greatest potential” (p. 240-241). In any organization not just UnityPoint Health, you must watch every area in order to continue to be successful. You can’t just become successful and keep that current label without strategy. If you do not have the proper strategy aligned for the future, your organization will truly fail. UnityPoint Health is currently an analyzer, but if large scale shifts occur in the competitive market, legislator or direction of the organization, the strategic posture could be revisited.

Strategic Position. UnityPoint strives to provide the best outcome for every patient every time. In order to meet these goals, the leaders who govern UnityPoint Health provide the caring leadership to the community-based organization. When a patient chooses UnityPoint, they should be confident that the organization providing the care or service is organized and governed the successful way. With their governing body leaders they are able to have a successful future. Focus is the current strategic position for UnityPoint Health. It succeeds in creating this focus through its goal of achieving the best outcome for every patient everytime.

. Their future outlook looks positive. The governance board is very involved within the health system. The Board of Directors of UnityPoint Health meets at least five times per year and provides overall strategy and direction for the System. According to UnityPoint Health, the board-established directives relating to:

➢ Strategic planning

➢ Operating budgets

➢ Capital budgets

➢ Incurrence of indebtedness

➢ Managed care strategies of the System

➢ Transfers of assets between affiliates and other affiliates, other affiliates of UnityPoint Health, or UnityPoint Health (except to for-profit or other entities unrelated to UnityPoint Health)

➢ Business plans

[pic]

Figure 1 - UnityPoint Health’s Structure

UnityPoint is structure properly and with the strong foundation. These items are crucial to the future success of UnityPoint Health. UnityPoint Health’s strategy formulation is logical and fits together. The organization is structured to have a future and be successful, even with the weaknesses of the organization. This organization will definitely have a future with their strategic planning.

Summary and Conclusion

UnityPoint Health has chosen taken part in many initiatives that further cements its strategic posture of “focus” and separates itself from its competitors. Such initiatives as becoming an accountable care organization, its integration of telehealth, and its incorporation of transparency of performance, quality, patient experience, and cost data. UnityPoint Health separates itself through timely service, a theme of patient/family centered care, and programs such as EpicCare which improves communication. UnityPoint Health could further expand its focus posture through working toward becoming a Magnet Hospital and continuing to expand its programs in telehealth.

Through the analysis provided, the expansion of the UnityPoint Health provides its strength but also can be a threat, so an important element to future strategy must be to manage expansion as successfully as they have for 20 years.

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