List of Figures
Chapter 1 - Introduction
Background
Importance of the Topic
Statement of the Purpose
Objective
Assumptions
Limitations
Delimitations
Definition of Terms
SummaryChapter 2 - Review of Competition and Other Influences
Social Influences
Economic Influences
Health Strategies
Higher Education
Managed Care
Sophisticated Stakeholders
SummaryChapter 3 - Procedures
Who Develops the Plan
Segmentation and Integration
Establishing Action Steps
Segmenting Information
Creating an Overall Schedule
Creating an Action Calendar
Doing the Work and Writing the Plan
SummaryChapter 4 - Results
Chapter 5 - Summary, Conclusions, and Recommendations
References
Appendix
Student Health Services - Business Plan Guide
Business plans provide a way of thinking about and planning the future health services for students by taking advantage of the environment and allocating resources. Meeting the expectations of stakeholders, particularly primary stakeholders - students, is a requirement for total quality management (TQM). Assuring the health of college students is the mission of a university health service. This chapter introduces the reader to planning for the assurance of college health.
Achievement of a university's mission with the assistance of health services depends on satisfying customer needs with planned actions based on the most current standards for college health. Business plans show the strategy for achieving the health services' goals (Fitko, 1997). These goals include assuring the health of college students, meeting all stakeholder needs, helping the university achieve its mission, and maintain or generate funding by effectively allocating resources. Trends in health care are toward 1) TQM (Shortell, 1995), 2) adding value (Saphire, 1995; Patrick, et al. 1997, Umiker, 1996) and 3) supporting community members so that they have greatest possible opportunity for well being (Jackson, 1997). Along with this third trend is the broadening the mission of the health services to encompass health promotion and disease prevention (Jackson, 1997; Lasker, 1997; Rohrer and Dominguez, 1998; Shortell, 1995).
Maintaining and generating funds to provide programs and services to assure the health of students and meet stakeholder expectations are the reasons for developing business plans.
The purpose of this project is to develop a business plan for a student health service that will guide the effective allocation of resources to assure the health of college students and provide services that meet the expectations of the service's stakeholders.
Using the principles recommended by Brindis and Reyes (1997), and Patrick, et al. (1997), develop a business plan that:
1. Provides activities designed to improve the health of college students based on a vision consistent with the broader health objectives for the nation in listed in Healthy People 2010.
1.1. Identifies the institution's "health status" goals to the national health objectives
1.2. Identifies outcomes beyond simply meeting the needs of students who use clinical services at the student health center building
1.3. Identifies the value of a healthy student body
1.4. Identifies the components of health that are individual responsibility and shared responsibility
1.5. Identify the ways that the health of faculty and staff relates to health of students
1.6. Identify the health service's stake in the health of the immediate non-campus community2. Provides user-driven programs and services
2.1. Supports formal, systematic methods of student self-reported behavioral and self-stated needs assessment
2.2. Educates and engages formally and informally in discussions and deliberations about the design and operation of college health services
2.3. Gives students the responsibility for shaping the services agenda, developing standards for the achievement of individual and community health status outcomes, and developing and refining strategies for measuring success
2.4. Uses student input and responsibility for keeping services sensitive and specific to the students needs3. Provides programs that address student community-wide health issues, are outcome oriented and accountable
3.1. Provides services to those who do not "walk in the door"
3.2. Provides programs that based on rigorous analyses of community health needs
3.3. Provides programs that are assessed by measures capable of determining whether the programs actually meet the needs of students
3.4. Provides programs that are wellness oriented rather than driven by a disease-oriented medical model
3.5. Develops impact data so that people underwriting the activities of college health services have a means of holding the services accountable for their efforts4. Provides for intra- and inter-sector collaboration for sharing of resources, stable financing, and access to healthcare for all college students
4.1. Assures students with affordable, appropriate, accessible, and consistent levels of health services
4.2. Provides portability of healthcare services from campus to campus with a broad-based, mandatory state or national health fee
4.2.1. Provides portable primary care, health education, psychological services, and other services within the scope of college health practice
4.2.2. Bridges family insurance to full-time employer-based insurance that student purchase during all of their college years, keeping it during summers or semesters away from school5. Provides internet and electronic communication
5.1. Provides for sharing of health promotion resources, on-line professional education, coalition building for advocacy, rapid aggregation and dissemination of information on program impact and assessment of consumer needs
5.2. Provides for collaboration among traditional stakeholders and augments communication links between college health and other campus programs (integrates college health into the broader educational mission of the host institution)6. Uses prevention and health promotion as the driving force for the agenda of college health
6.1. Advocates for the continued traditional leadership role of college health services in health promotion and disease prevention
6.2. Realizes that the results of these programs will not occur until far in the future and may have to plan for generating impact data from alumni
6.3. Supports interventions based on their potential to enhance the quality of student's lives in later years7. Provide plans to for first time or renewal accreditation as an ambulatory health services facility
Aligning the operation of health services with the health goals of the nation and the mission of the university is necessary for assuring the health of college students.
Providing value added services are necessary for assuring the health of college students.
Meeting all stakeholder expectations with total quality management is necessary for assuring health services for college health.
Students from a university form a community.
The project is limited to ambulatory medical health care, health promotion services and counseling, psychological and mental health.
Counseling, psychological and mental health services may not be addressed by this project if the student health service for which the business plan is being written does not have these services.
Business Plan. A written document that summarizes a business service (i.e., why the service exists and why the management team has what it takes to execute the plan). It defines and articulates how the management team expects to operate. A business plan is a tool used to develop ideas about how the health services should operate. A business plan is the place to refine strategies and "make mistakes on paper" rather than in the real world, by examining the service from all perspectives, such as marketing, finance and operations. Additionally, the business plan is a retroactive tool, against which a health services administrators can assess a services actual performance over time. (Seigel, Schultz, Ford, and Carney, 1987)
Clinical Health Care. See Medical Sector.
Community Health Care Management System. This system takes responsibility for maintaining and enhancing the health status of a population. These systems assesses the needs of the population served; develops resources necessary to meet those needs; installs the caregiver, management and governance systems in a coordinated fashion, and continuous cycle of outcomes measurement; develops guidelines and protocols; uses TQM processes, clinical re-engineering, corrective and preventive activity; and reassesses the outcomes of the efforts. (Shortell, 1995)
Integrated Health Systems. An integrated health system has the mission of improving health not providing services. This system screens and educates the population served about personal health risks, helps the populatio avoid disease, and treats the population effectively, economically, and with coordination and a customer service orientation. (Shortell, 1995)
Health Education and Promotion. See Public Health Sector.
Medical Sector. The medical sector focuses on individual patients,
emphasizing technologically sophisticated diagnosis and treatment
and biological mechanisms of diseases. Investigations are based
on biology, chemistry, and physics. Practitioners are usually
self-employed in the private sector, working autonomously in solo
or small group practices. Payment in the medical sector tends
to be on a fee-for-service or cost basis, which encourages professionals
to do everything possible for the patient at hand. (Lasker, 1997)
Offering. The offering section of the business plan tells the
amount of funding that is being sought. The offering section what
the management team will do to justify receiving the requested
financing. The section tells what principal use will be made of
the money received, and how the targeted investors, lenders, or
strategic partners will achieve their desired rate of return.
(Timmons, 1994)
Public Health Sector. The public health sector concentrates on populations, prevention, non-biological determinants of health, and safety-net primary care. Research is grounded in epidemiology and biostatistics, frequently making use of the social sciences as well. Virtually everyone in public health is employed by some type of organizations, many by government agencies, that are closely linked to the political world. Public health professionals typically work from fixed budgets, juggling limited dollars to achieve the greatest benefit for the entire population. (Lasker, 1997)
Quality Assurance. Quality assurance provides evaluations of how well health services do their jobs. Quality assurance is the assessment and reporting on the quality of health services. Quality assurance is studied in terms of explanations and documentation of how carefully health services select their doctors; how effectively services provide important preventive care services (like those listed in the Guide to Clinical Preventive Services); how responsive the staff is to patients' needs, whether for care or simply for information; actual outcomes of care; how healthy its customers are; and if the health service can demonstrate that it is doing a good job at keeping people healthy and improving people's health. Quality assurance shows how well a health service measures up in all dimensions (its systems, processes of care, and outcomes of care) in order to show how well students will be cared for. (National Committee on Quality Assurance, 1998)
Stakeholders. Stakeholders are all groups affected by, or that can affect, an organization's decisions policies and operations. There are primary and secondary stakeholders. Primary stakeholders are those who have a direct relationships necessary for the organization to do its major mission of producing goods and services for customers. Primary stakeholders are customers, stockholders, suppliers, employees, retailers, competitors and creditors. Secondary stakeholders are groups in society who are affected, directly or indirectly, the business' secondary impacts and involvement. Secondary stakeholders are local communities, general public, federal, state and local governments foreign governments, social activist groups, media, business support groups. (Post, Frederick, Lawrence and James, 1996)
Total Quality Management. Total quality management focuses on the customer. This approach, borrowing from Japanese management techniques, emphasizes achieving high quality and customer satisfaction through teamwork and continuous improvement of a business' products or services. It is a response to pressure from consumer activist and an attempt by business to address its customers' needs. With total qualtiy management businesses try to anticipate and respond to emerging stakeholder expectations. (Post, Frederick, Lawrence and James, 1996)
Value Added Services. Value added services are perceived as superior and inexpensive by its customers. Value added services exceed customers' expectations; delights them. Four areas of VAS are: 1) Environmental - physical setting sights, sounds odors that customers experience, 2) Interpersonal interactions with employees, policies and procedures including the willingness of employees to help customers cope with these policies and procedures, 3) speed of service, 4) cost of service. Examples range from simple ones such as sincere smiles, civility in face-to-face or telephonic contact, decreased turnaround time, or bending rules or policies to comprehensive new services or products. (Umiker, 1996)
This chapter introduced the reader to planning for the assurance of the health of college students. Business plans provide a way of planning the future health services for students by taking advantage of the environment and allocating resources. Meeting the expectations of stakeholders, particularly primary stakeholders (students), is a requirement for total quality management. Assuring the health of college students is the mission of a university health service. The remainder of the proposal describes the competition to and other influences on college health services and the procedures to be followed in developing and writing the business plan.
Trends in social and economic issues, and higher education give university health services many challenges. These include increasingly sophisticated stakeholders; reduced resources from campuses; a changing managed care environment; mandated performance of community-wide health education, promotion, and disease prevention and protection. These challenges require that health services ensure value added programs and services for their stakeholders.
The major social influences are issues of crime, safety, substance abuse, AIDS, educational reform, welfare reform and legal reform (Shortell, 1995). Brindis and Reyes (1997) notes that traditionally, health insurance coverage for students was though their parents' employment. Now, as many as 25% of 19 to 21 year old students and 43% of 25 to 34 year olds do not have any type of health coverage. Additionally, ethnically diverse students are enrolled at higher rates and higher proportions than the overall average are uninsured.
Health care costs approaching 15% of the gross national product are causing pressures for cost containment (Shortell, 1995). With the failure of federally mandated health care reform, the health care industry has had to address patient outcomes and accountability to customers and payers (Strong, 1997). The health care industry is consolidating through mergers, alliances and capital-intensive for-profit corporations and has taken over university health services (Patrick, 1997).
A major trend in health care affecting university health is toward community oriented care. Over the past 50 years, the orientation has gone from hospital as the center of care to categorical health programs (i.e., antismoking campaigns) to healthy communities (Lasker, 1997). A new conceptual model of health care is emerging the focuses on disease prevention, health promotion, and primary care (Shortell, 1995). Community oriented care is considered a cornerstone of health care reform (Wright, 1993).
Healthy communities has become the concept for providing health care since the early 1990s. This follows hospitals as the center of care, then a trend toward screening and treatment of illness and, finally, to managed care (Lasker, 1997). Managed care still has a large influence (Brindis and Reyes, 1997). Additional drivers for the trend to healthy communities are knowledge of behavior change techniques. There is an emphasis on preventing disease, health promotion and disease management rather than treating the conditions once the conditions occurred (Jackson, 1997; Shortell, 1995). An increased understanding that health behaviors cannot be considered without also looking at the social context. Modification of community attitudes and norms, and the consideration of environmental influences are moving health care to think in terms of healthy communities. (Jackson, 1997)
Leaders in higher education are finding support for the community approach from the Carnegie Foundation Report Campus Life: In Search of Community. This report examined the ecology of university campuses. Social concerns of lack of civility, crime, racial prejudice plus the lack of a "shared vision" or "common cause" also drive the trend to community oriented health services. (Jackson, 1997).
Competition for university health services comes from pressure to keep costs low, quality high, cash flow predictable and commitments flexible. Consequently, "outsourcing" of services is increasing as demonstrated by the recent outsourcing of the Brandies University Health Services. The result related to students is a reduction of health service operating hours and a decrease in the quality of clinical personnel (Faigel, 1998). Brindis and Reyes (1997) listed approaches for administration of healthcare that university's might consider. These include: 1) join managed card provider networks and share in the primary capitation systems, 2) establish a reimbursement relationship that covers only specified services delivered to the managed care provider's patients on the university site, 3) make fee-for-service reimbursement arrangements between managed care plans and college clinics, 4) develop protocols for referral and treatment between managed care providers and college health centers and 5) a managed care program could directly administer the student health services program.
All stakeholders are more sophisticated and have higher expectations than in the past. These stakeholders include customers, payers and providers. Student consumers are more sophisticated than in the past (Patrick, et al, 1997). According to Strong (1997) customers as patients do not have unquestioned trust of medical system. Current health care customers are better informed of advances in technology, changes in standards of practice, modes of treatment and levels of competence they expect from providers. The payers for university health services are, unlike health maintenance organizations and for the most part, students who pay 63% of health service funding (Brindis and Reyes, 1997). The remainder of funding comes from the university, 16%, and fee-for-service.
The payers are demanding higher quality and measurement of outcomes as can be seen by the number of groups doing research in this area. In the private sector, employers are forming groups to measure results of health services (Rodriguez and Schauffler, 1993; Washington Business Group on Health, 1998). The American College Health Association (ACHA) is encouraging its members to become accredited as a way of assuring quality health services (Brindis and Reyes, 1997).
Competition and other influences on university health services are broad. These are often related to trends in social and economic issues, and higher education give university health services many challenges. Additional influences include increasingly sophisticated stakeholders; reduced resources from campuses; a changing managed care environment; mandated performance of community-wide health education, promotion, and disease prevention and protection. These challenges require that health services ensure value added programs and services for their stakeholders.
The business plan will be developed and written from information collected from a planning guide. A student health service management team will be selected, responsibilities for sections and a timeline will be set. The SHS Business Plan Guide has been adapted for a university health service based on factors that influence health services. This guide will be followed to assess a health service in eleven areas.
The university health service management team will provide the information for development and writing of the plan. This will insure that the stakeholders get what they see - that is the team's analysis and understanding of the services and commitment to those services. This team will spend time gathering detailed data, interpret it and present it clearly with the assistance of the project coordinator.
The business plan will be written based on Timmons' Business Plan Guide (Appendix A) (Timmons, 1994). Information is segmented into the sections:
1. The industry and the health service and its services
2. Market research and analysis
3. The economics of the service
4. Marketing plan
5. Design and development plans
6. Programs and services plan
7. Management team
8. Overall schedule
9. Critical risks, problems and assumptions
10. The financial plan
11. Proposed health services offering
The sections are discrete and the information easy to utilize. As recommended by Timmons, the sections on analysis of the market opportunity, of the competition and of the selected competitive strategy will be developed first and the financial and operations aspects will be developed later.
Segmenting information. The director and management team of the university health service will be asked to complete all sections of the Business Plan Guide. An overall plan for the project, by section, will be devised and include priorities, who is responsible for each section, the due date of a first draft, and due date for a final draft. See Figure 2. Business Plan Timeline on pages 16-17.
Creating an overall schedule. A list of specific tasks, their priorities, who is responsible for them, when they will be started, and when they will be completed will be made. This list will be specific and detailed. Tasks will be broken down into the smallest possible component (e.g., a series of telephone calls may be necessary before a trip. The list will be examined for conflicts and lack of reality in time estimates. Peers and business associates will be asked to review the list for realism, timing, and priorities.
Creating an action calendar. Tasks on the do list will be placed
on a calendar (specifically a Gantt Chart). When the calendar
is complete, the calendar will be again examined for conflicts
or lack of realism.
Doing the work and writing the plan. The plan will be written
from the results of the completed sections in the guide. Adjustments
will be made to the do list and the calendar, as necessary. The
plan will be reviewed to make sure the plan has no misleading
statements and unnecessary information and caveats. The plan will
be reviewed by an objective outsider, such as an executive that
has the mindset of social entrepreneur who has significant not-for-profit
responsibility. The reviewer will act as a sounding board in the
process of developing alternative solutions to problems and answers
to questions stakeholders are likely to ask.
The Business Plan will be written based on information gathered from a planning guide. A student health service management team will be selected, responsibilities for gathering information by sections and a timeline will be set. The SHS Business Plan Guide has been adapted for a university health service based on factors that influence health services. This guide will be followed to assess a health service in eleven areas. Based on the information gathered for each section, the business plan will be written and presented to the student health service management team.
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This is the Table of Contents from the Business Plan Guide based on the one by Timmons. The Guide is approximately 70 pages long. However, each section has instructions, examples and work sheets for management team members or their designees to do the research for developing a business plan.
There are six steps to follow as before moving on to sections and completing the business plan.
I. EXECUTIVE SUMMARY
A. Description of the Business Concept and the Business.
B. The Opportunity and Strategy.
C. The Target Market and Protections.
D. The Competitive Advantages.
E. The Economics, Profitability, and Harvest Potential.
F. The Team.
G. The Offering.II.THE INDUSTRY AND THE COMPANY AND ITS PRODUCT(S) OR SERVICE(S)
A. The Industry.
B. The Company and the Concept.
C. The Product(s) or Service(s).
D. Entry and Growth Strategy.Ill. MARKET RESEARCH AND ANALYSIS
A. Customers.
B. Market Size and Trends.
C. Competition and Competitive Edges.
D. Estimated Market Share and Sales.
E. Ongoing Market Evaluation.
F. Samples of Research Instruments
Student Affairs Survey.
Student Self-Reported Needs.
ACHA College Health Assessment.IV. THE ECONOMICS OF THE BUSINESS
A. Gross and Operating Margins.
B. Profit Potential and Durability.
C. Fixed, Variable, and Semivariable Costs.
D. Months to Breakeven.
E. Months to Reach Positive Cash Flow.V. MARKETING PLAN
A. Overall Marketing Strategy.
B. Pricing.
C. Sales Tactics.
D. Service and Warranty Policies.
E. Advertising and Promotion.
F. Distribution.VI. DESIGN AND DEVELOPMENT PLANS
A. Development Status and Tasks.
B. Difficulties and Risks.
C. Product Improvement and New Products.
D. Costs.
E. Proprietary Issues.VII. OPERATIONS PLAN
A. Operating Cycle.
B. Geographical Location.
C. Facilities and Improvements.
D. Strategy and Plans.
E. Regulatory and Legal Issues.
F. Standards of Health Services.
Health Promotion Self Assessment.
Guidelines for Clinical Preventive Services: Tables for ages 19-39 and 40-64.VIII. MANAGEMENT TEAM
A. Organization.
B. Key Management Personnel.
C. Management Compensation and Ownership.
D. Other Investors.
E. Employment and Other Agreements and Stock Option and Bonus Plans.
F. Board of Directors.
G. Other Shareholders, Rights, and Restrictions.
H. Supporting Professional Advisors and Services.IX. OVERALL SCHEDULE
X. CRITICAL RISKS, PROBLEMS, AND ASSUMPTIONS
Xl. THE FINANCIAL PLAN
A. Actual Income Statements and Balance Sheets.
B. Pro Forma Income Statements.
C. Pro Forma Balance Sheets.
D. Pro Forma Cash Flow Analysis.
E. Breakeven Chart and Calculation.
F. Cost Control.
G. Highlights.XII . PROPOSED COMPANY OFFERING
A. Desired Financing.
B. Offering.
C. Capitalization.
D. Use of Funds.
E. Investors' Return.XIII. APPENDIXES
STEPS 5 and 6
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