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Develop a 4-7-page business case for the initiative you proposed in Assessment 1. Examine feasibility and cost-benefit considerations over a 5-year period, analyze ways to mitigate risks, and complete a cost-benefit analysis.

Introduction

Note: Each assessment in this course builds upon the work you have completed in previous assessments. Therefore, you must complete the assessments in the order in which they are presented.

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As a master’s-level health care practitioner, you are expected to consider a number of factors when analyzing the feasibility of a new initiative. For example, you must consider the various types of risk (such as patient safety, physical plant, financial, or reputation), as well as the present and future value of the service line or economic opportunity in which you are investing. You must also balance your ethical and moral responsibility to provide quality care to patients and populations with your responsibility to protect your organization’s assets and economic viability in the near and long terms.

Instructions

Develop a business case for the economic initiative you proposed in Assessment 1. Examine the feasibility and cost-benefit considerations of implementing your proposed initiative over the next five years. Analyze ways to mitigate risks and complete a cost-benefit analysis.

The requirements for your business case, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.

  • Analyze the potential economic opportunities and risks associated with your proposed initiative.
    • How do the potential opportunities benefit your organization or care setting?
    • How could potential risks pose a threat to the financial security of your organization or care setting?
    • How do the potential economic opportunities compare to the potential economic risks?
  • Propose ethical and culturally sensitive solutions that address the risks associated with your initiative to the future economic security of your organization or care setting.
    • Which risks are potentially the most significant for your organization or care setting?
      • How could you modify your proposed initiative to mitigate those risks?
      • How have other organizations and experts in the field dealt with similar risks?
    • How do ethics and equality factor into your proposed solutions?
      • Are your solutions unfairly burdening or disadvantaging any specific groups?
    • How will this proposal affect community health care delivery outcomes?
      • What makes this a great opportunity for economic growth?
      • What potential issues should be considered?
  • Analyze the economic costs and benefits of your proposed initiative over a five-year period.
    • Use the Cost-Benefit Analysis Template [XLSX] for your calculations. Add the worksheet to your business case as an appendix.
    • Does your analysis warn against specific aspects of your proposed initiative?
    • How would you recommend that your findings be incorporated into decisions about the feasibility of your proposed initiative?
  • Propose ethical and culturally equitable ways of keeping costs under control, while maximizing the benefits of your initiative.
    • What costs are you most likely to be able to control or reduce?
      • How would you go about ensuring this?
    • How could controlling or reducing these costs affect the benefits of your proposed initiative?
      • What strategies could you employ to maintain or maximize these benefits, while controlling or reducing costs?
  • How do you plan to ensure that any cost controls or benefit reductions are ethical and equitable?
  • Justify the relevance and significance of the quantitative and qualitative economic, financial, and scholarly evidence you used to support your business case.
    • This criterion applies to any evidence you cited throughout your business case. Your evidence should be persuasive and relevant to your findings, proposals, and recommendations. Consider one or more of the following questions when citing support evidence:
      • How is the evidence relevant to your organization or care setting?
      • How is the evidence relevant to your proposed economic initiative?
      • How does the evidence illustrate a solution that has been successful in the past?
      • How does the evidence illustrate that an initiative or solution is likely to be a net benefit to the organization or care setting?
  • Write concisely and directly, using active voice.
    • Proofread your document before you submit it to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your business case.
  • Apply current APA formatting to in-text citations and references.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

ADDITIONAL REQUIREMENTS

Your assessment should also meet the following requirements:

  • Format: Format your business case using APA current style. Use the APA Style Paper Tutorial [DOCX] to help you in writing and formatting your business case. Be sure to include:
    • A title page and references page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
  • Length: Your business case should be 4–7 pages in length, not including the title page and references page.
  • Supporting evidence: Cite 4–5 authoritative and scholarly resources to support your business case. Be sure that your sources include specific economic data.

Competencies Measured (GRADING RUBRIC)

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment scoring guide criteria:

  • Competency 1: Analyze the effects of financial and economic factors (such as cost-benefit, supply and demand, return on investment, and risks) in a health care system on patient care, services offered, and organizational structures and operation.
    • Analyze the potential economic opportunities and risks associated with a proposed initiative.
    • Analyze the economic costs and benefits of a proposed initiative over a five-year period.
  • Competency 2: Develop ethical and culturally equitable solutions to economic problems within a health care organization in an effort to improve the quality of care and services offered.
    • Propose ethical and culturally equitable ways of keeping costs under control, while maximizing the benefits of an initiative.
  • Competency 3: Justify the qualitative and quantitative information used to guide economic decision making to stakeholders and colleagues.
    • Justify the relevance and significance of the quantitative and qualitative economic, financial, and scholarly evidence used to support a business case.
  • Competency 4: Develop ethical and culturally equitable economic strategies to address dynamic environmental forces and ensure the future security of an organization’s resources and its ability to provide quality care.
    • Propose ethical and culturally sensitive solutions that address the risks associated with an initiative to the future economic security of the organization or care setting.
  • Competency 5: Produce clear, coherent, and professional written work, in accordance with Capella writing standards.
    • Write concisely and directly using active voice.
    • Apply APA formatting to in-text citations and references.

CBA Template

COST-BENEFIT ANALYSIS TEMPLATE
Step 1: Enter cost amounts as future value (FV) expectations. The future value will be automatically converted to present value (PV). Step 2: Enter benefit amounts as FV expectations. The FV will automatically be converted to PV. Step 3: Subtract the total PV benefits from the total PV costs to get the net benefit.
CostsCurrent Year (CY)CY +1CY +2CY +3CY +4CY +5Total Costs
Total Costs (Future Value)$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0
Total Costs (Present Value)$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0
blank row
BenefitsCurrent Year (CY)CY +1CY +2CY +3CY +4CY +5Total Benefits
Total Benefits (Future Value)$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0
Total Benefits (Present Value)$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0$ – 0
blank row
Present Value Discount Rate2%
PV Denominator1.001.021.041.061.081.10
Net Benefit$ – 0
End of Worksheet

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1

Business Case for a New Economic Opportunity

Learner’s Full Name

School of Nursing and Health Sciences, Capella University

NURS-FPX6008: Economics and Decision Making in Health Care

Instructor’s Name

Month, Year

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2

Business Case for a New Economic Opportunity

Whilborne Medical Center (WMC) is a multispecialty health care facility situated in

proximity to an industrial park. Its management is planning to start a new economic initiative in

the form of an urgent care center (UCC) within WMC’s premises. The UCC will not only help

provide quality health care to the community but also provide an additional revenue stream for

WMC. The objective of this business case is to present a detailed report on the feasibility and

cost–benefit considerations of implementing the proposed economic initiative over the next five

years. The business case includes an evaluation of various risks and opportunities associated with

the new initiative. It recommends ways to lessen the risks associated with setting up the UCC

and strategies for controlling costs and maximizing benefits.

Opportunities Associated With the Proposed Economic Initiative

An economic and environmental analysis was performed to determine the opportunities

and risks associated with the UCC. WMC is situated near Maxima Industrial Park. Most of the

patients treated at WMC are among the 30,000 workers from different companies in the

industrial park. Additionally, the area has around 3,000 locals. The UCC may cater to the non-

emergent needs of both the workers from the park and the locals in the area.

UCCs present an opportunity to reduce overcrowding in the ED at WMC. Often, EDs

have to tend to patients whose cases are urgent, but do not merit the emergent care that EDs

provide (Qin et al., 2015). Non-emergent cases can be diverted to the UCC, where health care

personnel will be able to treat workers of the industrial park who walk in with work-related

injuries or for preventive care. Additionally, any urgent health care needs of the local

community may be met by the UCC. The ED will be able to exclusively tend to the Comment [A1]: This is great that your initiative can help address a larger problem within the U.S. health care system as well as help your organization.

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

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more emergent cases, while the UCC will exclusively tend to the urgent care cases received by

WMC. Thus, an additional revenue stream for WMC will be created with the addition of the

UCC.

Additionally, UCCs must serve a high number of patients to break even (Yee et al., 2013).

Therefore, location near a target patient population is an important factor in the success of a UCC

(Gurganious & Greenfield, 2015). The required target population for the UCC is found in the

30,000 workers employed at Maxima Industrial Park. WMC has developed a relationship with

workers from the park through the annual health checkups it organizes. The UCC can benefit

from this relationship as there is a high likelihood that employees who are satisfied with the care

they received at WMC will return to the UCC for urgent care issues.

A competitor analysis conducted in the area shows that there are two primary health

clinics, but no UCCs in WMC’s vicinity. Most patients prefer primary health clinics over UCCs

and EDs (Qin et al., 2015). This issue is mitigated by the number of work hours that EDs and

UCCs have over primary health clinics. With the introduction of a UCC, patients will be able to

avail after-hours health care for minor illnesses on any day of the week at lower costs compared

to primary health clinics (Chang et al., 2015). Also, as patients can go to a UCC without an

appointment (unlike a primary health clinic), they will find the UCC more accessible for treating

minor illnesses (Yakobi, 2017). These advantages over its competitors will help WMC capture a

significant market share in the urgent care segment.

Risks Associated With the Economic Initiative and Ways to Address Them

The potential risks associated with the setting up of a UCC were identified. It was

observed during the competitor analysis that a retail health clinic inside a Walmart store situated

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near WMC could pose a threat to the UCC. Retail health clinics are walk-in clinics located inside

grocery stores or supermarkets. They mainly provide convenient care to retail store customers

suffering from minor illnesses. Like UCCs, many retail health clinics offer after-hours care and

easy accessibility without an appointment; at the same time, the health care cost at these clinics

is less than it is at UCCs (Chang et al., 2015). Therefore, the presence of the retail health clinic

puts the financial security of the UCC at risk as it might appear more attractive to patients in

need of urgent care.

A UCC is equipped to handle a wider number of ailments than a retail health clinic

(Chang et al., 2015). Being affiliated with WMC, the UCC can provide its patients access to

more facilities such as scans and tests that are not provided by retail health clinics and other

UCCs. These factors set the UCC at WMC apart from its competitors and can be used to promote

the clinic. Clients will consider the UCC a convenient and viable option for their healthcare,

where multiple tests can be done if needed. Additionally, the UCC must also ensure that the

focus of the clinic is on providing a convenient and satisfactory experience for the patient

(Gurganious & Greenfield, 2015). If patients receive quick and timely care from excellent

service providers, they will be encouraged to visit again and refer new patients to the UCC.

UCCs are known for providing immediate care to many patients in a relatively short time

(Yakobi, 2017). The staff and management of the UCC will have to be aware that the high-

volume, speedy health care delivery environment leaves room for errors such as misdiagnoses.

These errors can result in the UCC and its staff facing serious legal risks. Therefore, it is

important for the UCC to maintain meticulous documentation to insulate itself from the

consequences of misdiagnoses or medical malpractice. The symptoms, physical observations,

and lab results which are used to develop a plan to administer care should be identified to ensure

Comment [A2]: It is good that you have identified this threat…this is something that could undermined the economics of your initiative.

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that the plan has clarity and is logical (“Why good documentation matters“, 2016). It is also

binding on UCC physicians to set patients’ expectations by communicating with them effectively

about the nature of services provided (“Helping patients make informed decisions”, 2014). These

measures ensure that, despite the difficulties resulting from high demand, both patients and

health care practitioners are mindful of the treatment that is administered.

Cost–Benefit Analysis of the Proposed Economic Initiative

After considering the opportunities and risks involved, the costs and benefits of setting up

a UCC are analyzed. To assess the economic feasibility of setting up a UCC, the present value of

the estimated costs and benefits and the net benefit over a 5-year time horizon are calculated

using a present value discount rate of 11%. The present value discount rate has been determined

based on the standard cost of capital and the estimated target returns. The estimated capital cost

includes minor construction costs and the cost of purchasing furniture and equipment. These are

conservatively projected to be $350,000 in the current year (Golinkin & Danielle, 2013). The

estimated operating costs comprise expenditure on salaries paid to the staff; basic utilities such as

electricity, gas, and the Internet; insurance (including insurance for staff, business liability,

building, furniture, and equipment); and other operating expenses such as administrative and

marketing costs.

On an average, most UCCs have two full-time (or part-time) physicians, two nurse

practitioners, and three medical assistants or other clinical staff (Weinick et al., 2009). It is

assumed that two physicians, two nurse practitioners, three medical assistants, and a medical

receptionist will be recruited by the UCC. Based on the national average recruitment incentives,

staff salaries (per annum) in the first year of operation are assumed to be around

$232,000 for a full-time physician, $112,000 for a nurse practitioner, $35,000 for a medical

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assistant, and $32,000 for a receptionist (U.S. Bureau of Labor Statistics, 2017). The actual

growth rate of an employee’s salary in the U.S. is 2.7% per annum (Economic Policy Institute,

2018). For this analysis, salaries of the employees of the UCC are assumed to increase at a

conservative rate of 3% per annum. Additional costs will be incurred in years four and five to

hire a full-time nurse practitioner (year four) and a full-time physician (year five) to cater to the

increased number of patients.

The cost of basic utilities is assumed to increase by around 5% per annum, as utilization

of basic utilities will increase owing to an increase in patient volume. Considering that new staff

will be hired in the fourth and fifth years of operation, insurance costs are assumed to increase in

these 2 years owing to addition of staff. Other operating costs are assumed to be around 12% of

annual revenue based on WMC’s financial statements. As per the cost–benefit analysis, the

present value of the total costs over the 5-year period is estimated at $5,489,745.62, using a

present value discount rate of 11% (see Appendix for more information on cost–benefit analysis

over a 5-year period).

Benefit (revenue) was calculated based on the fee collected from each patient and the

number of patients expected to make use of the medical services at the UCC. Most clinics tend to

the needs of an average of around 357 patients every week and charge an average fee of

approximately $156 per patient visit (AMN Healthcare, 2015; Yakobi, 2017). Therefore, the

estimated revenue earned during the first year of operations will be $2,730,000. It is also

assumed that the revenue will increase by 5.3% per annum over the 5-year period based on the

national average (“Urgent Care Center Market”, 2018). Based on the estimated revenue over the 5-

year period and the 11% present value discount rate, the present value of total benefits is estimated

at $11,037,800.03 (see Appendix for more information on cost–benefit analysis over a

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

7

5-year period). The net benefit, calculated by subtracting the present value of total benefits from

the present value of total costs, is estimated at $5,548,054.41 over a 5-year period (see Appendix

for more information on cost–benefit analysis over a 5-year period). Based on the positive net

benefit, it can be concluded that this initiative will be an economically viable one.

It should be noted that, although the cost–benefit analysis suggests that setting up a UCC

is a viable option, some knowledge gaps and unknowns are bound to be present. The impact of

nonmonetary costs, such as the time and effort spent on marketing and ensuring a good patient

experience, has not been considered in the analysis. Nonmonetary costs can have an effect on the

patient volume and that, in turn, can affect the net benefit. An increase in capital and operating

costs due to some unexpected developments or unforeseen expenses can affect the net benefit

gained. The patient volume may also vary depending on unpredictable factors such as the health

care market environment. All these factors can have a significant impact on the result of the cost–

benefit analysis.

Ways to Control Costs and Maximize Benefits

It is essential for the senior management to regularly implement methods to control costs

and monitor the financial position of the UCC. Overhead costs that are not directly related to

providing health care services make up a large portion of the total costs of the UCC. Overhead

costs include expenditure on building maintenance, repairs, insurance, basic utilities, and

supplies. The UCC will keep a check on building maintenance costs by undertaking maintenance

checks on a regular basis. To avoid significant repair costs, the staff will ensure that equipment is

handled with care and maintained in good condition. By reviewing the usage of electricity, gas,

water, phone, and the Internet on an annual basis, the UCC will also control basic utility

expenses. Low-cost plans, based on the UCC’s requirements, will be chosen to control expenses

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8

on phone and Internet services. To avoid wastage of supplies, the staff will be encouraged to use

office supplies with discretion. Impractical cost control measures might adversely affect staff

morale and performance. Therefore, care will be taken to ensure that all the measures undertaken

are relevant, ethical, and culturally equitable.

Along with keeping a check on the costs, efforts will be made to maximize the benefits.

A potential means of increasing the benefits of the UCC is sending automated health reminders

to regular clients.

service to all patients will encourage them to come back to the UCC whenever they need

immediate medical attention. This will also help build strong patient trust and loyalty. Also,

understanding what motivates patients and their views about health care will help the UCC staff

to customize care and thus increase patient satisfaction and inflow (Qin et al., 2017). Therefore,

ensuring optimal utilization of resources and providing quality care will help the UCC maintain

its financial stability.

Conclusion

The UCC will cater to the urgent care needs of the community by providing quick,

affordable, and convenient health care services. The center’s proximity to the industrial area will

benefit workers who might require urgent care or want to get preventive health checkups done as

part of their employment requirements. Thus, the UCC will be able to generate an additional

revenue stream and contribute to the economic growth of WMC. Moreover, the cost–benefit

suggests that setting up the UCC will be an economically viable initiative. Ethical solutions such

as careful documentation of the treatment process and full communication of the plan of care

with the patient were recommended. These solutions, which reduce the risks associated with the

setting up of the UCC, will also help safeguard the future of WMC.

This will help ensure a regular inflow of clients. Providing consistently good Comment [A3]: Good strategy.

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

9

References

AMN Healthcare. (2015). Convenient care: Growth and staffing trends in urgent care and retail

medicine.

https://amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights

/Industry_Research/AMN%2015%20W001_Convenient%20Care%20Whitepaper(1).pdf

Chang, J. E., Brundage, S. C., & Chokshi, D. A. (2015). Convenient ambulatory care—Promise,

pitfalls, and policy. The New England Journal of Medicine, 373(4), 382–388.

Economic Policy Institute. (2018). Nominal wage tracker.

Golinkin, W. F., & Danielle, B. (2013). The dollars and cents of running a clinic. In J. Riff, S.

Ryan, & T. Hansen-Turton (Eds.), Convenient care clinics: The essential guide to retail

clinics for clinicians, managers, and educators (pp. 179–186).

Gurganious, V., & Greenfield, D. (2015). Starting an urgent care center: 5 essentials for

success. Medical Economics, 92(11), 47–48.

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Comment [A4]: The “www.” is retained as the link does not open without adding it to the URL.

BUSINESS CASE FOR A NEW ECONOMIC OPPORTUNITY 10

Helping patients make informed decisions. (2014, April). https://cmpa- acpm.ca/en/advice-

publications/browse-articles/2014/helping-patients-make-informed- decisions

Qin, H., Prybutok, G. L., Prybutok, V. R., & Wang, B. (2015). Quantitative comparisons of

urgent care service providers. International Journal of Health Care Quality

Assurance, 28(6), 574–594.

Urgent Care Center Market by Service (Acute Illness Treatment, Trauma/Injury Treatment,

Physical Examination, Immunization & Vaccination), Ownership (Corporate Owned,

Physician Owned, Hospital Owned), and Region – Global Forecast to 2023. (2018,

March). https://marketsandmarkets.com/Market-Reports/urgent-care- center-market-

197843477.html

U.S. Bureau of Labor Statistics. (2017). Occupational employment statistics [Data set]. https://www.bls.gov/oes/current/naics4_621400.htm

Weinick, R. M., Bristol, S. J., & DesRoches, C. M. (2009). Urgent care centers in the U.S.:

Findings from a national survey. BMC Health Services Research, 9(79).

http://dx.doi.org/10.1186/1472-6963-9-79

Why good documentation matters. (2016, October). https://cmpa- acpm.ca/en/advice-

publications/browse-articles/2011/why-good-documentation-matters

Yakobi, R. (2017). Impact of urgent care centers on emergency department visits. Health Care

Current Reviews, 5(3). http://dx.doi.org/10.4172/2375-4273.1000204http://www/http://www.bls.gov/oes/current/naics4_621400.htmhttp://dx.doi.org/10.1186/1472-6963-9-79http://dx.doi.org/10.1186/1472-6963-9-79http://dx.doi.org/10.4172/2375-4273.1000204

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

BUSINESS CASE FOR A NEW ECONOMIC OPPORTUNITY 11

Yee, T., Lechner, A. E., & Boukus, E. R. (2013). The surge in urgent care centers: Emergency

department alternative or costly convenience? Research Briefs.

https://researchgate.net/profile/Tracy_Yee/publication/257202014_The_surge_in_urgent

_care_centers_emergency_department_alternative_or_costly_convenience/links/5750682

008aed9fa2bd2d531

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BUSINESS CASE FOR A NEW ECONOMIC OPPORTUNITY 12

Appendix

Cost–Benefit Analysis Over a 5-Year Period

Costs Current Year

(CY) ($) CY +1 ($) CY +2 ($) CY +3 ($) CY +4 ($) CY +5 ($) Total Costs ($)

Capital Costs

Construction

350,000.00

Furniture & Equipment

Operating Costs Staff Salaries 825,000.00 849,750.00 875,242.50 1,023,885.20 1,315,719.80 Basic Utilities 55,000.00 57,750.00 60,637.50 63,669.38 66,852.84 Insurance 15,000.00 15,000.00 15,000.00 20,000.00 25,000.00

Other Operating Costs

327,600.00

343,980.00

361,179.00

379,237.95

398,199.85

Total Costs (Future Value)

350,000.00

1,222,600.00

1,266,480.00

1,312,059.00

1,486,792.52

1,805,772.49

Total Costs (Present Value)

350,000.00

1,101,441.44

1,027,903.58

959,366.23

979,396.29

1,071,638.08

5,489,745.62

Benefits Current Year

(CY) ($) CY +1 ($) CY +2 ($) CY +3 ($) CY +4 ($) CY +5 ($) Total Costs ($)

Increase in Revenue 2,730,000.00 2,866,500.00 3,009,825.00 3,160,316.25 3,318,332.06

Total Benefits (Future Value)

2,730,000.00

2,866,500.00

3,009,825.00

3,160,316.25

3,318,332.06

Total Benefits (Present Value)

2,459,459.46

2,326,515.70

2,200,758.10

2,081,798.20

1,969,268.57

11,037,800.03

Present Value Discount Rate

0.11

PV Denominator 1.00 1.11 1.23 1.37 1.52 1.69 Net Benefit 5,548,054.41

  • Opportunities Associated With the Proposed Economic Initiative
  • Risks Associated With the Economic Initiative and Ways to Address Them
  • Cost–Benefit Analysis of the Proposed Economic Initiative
  • Ways to Control Costs and Maximize Benefits
  • Conclusion

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