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MHACB/506 v2
East Chestnut Regional Health System Case
Study: Pro-forma Income Statement
A Pro-forma Income Statement is an income statement that predicts income for your new or revised
product or service you are recommending to East Chestnut Regional Health System (ECRHS) after one
year. It shows the sales ECRHS expects to achieve during that period of time, along with the costs
associated with that level of sales. The organization must cover the costs of products or services it
delivers (Cost of Sales) and the marketing expenses we estimate to achieve those sales (We estimate
these using 7% of total revenues). This will leave us with a projected profit.
A good Pro Forma proves out a strategy by showing the expected revenue minus the expected costs and
the resulting profit. Conversely, it shows that you can’t have \$100,000 in forecast sales and \$3 million in
projected advertising, since that would result in a loss.
This is a very simplified exercise to help you understand the concept of a Pro Forma Income Statement.
In reality, you would provide a much more in-depth analysis of expenses. For instance, if you were hiring
two new sales reps, their salaries must be factored in.
Below is an example of a Pro-forma Income Statement:
Assume your projected sales revenue for one year for a new OB service to be \$200,000.
You calculate this by taking your projected revenue per visit from your Breakeven Analysis (we used \$200
per visit) x the number of visits you forecast from your projected market calculations in Part 1 of the
assessment (in this example, it might be 1,000 visits).
Next calculate the cost of sales. This is the Fixed Cost plus Total Variable Costs for 1,000 visits. Your
total costs would be 1,000 x \$100 variable cost per visit = \$100,00 + the one-time construction fixed cost
of \$50,000 = \$150,000 total costs (which is cost of sales).
Your Gross Profit would be \$200,000 – \$150,000 = \$50,000.
Subtract your Marketing Cost (which we estimate at 7% x \$200,000 = \$14,000).
This provides you with your Net Income (\$50,000 – \$14,000 = \$36,000). This represents the total amount
of profits you will generate in your first year.
Finally, calculate the Net Profit Margin. (\$36,000 / \$200,000 = .18 or 18%). You will need to analyze if
the total net income and total net profit margin fits within the objectives of your organization.
Use this form to create your Pro Forma Income Statement. Enter the projected numbers, following the
formulas beneath the line item.
Write projected year against each project detail:

Projected Sales Revenue:
Cost of Sales (Fixed + Variable Expenses):
Gross Profit (Projected Sales Revenue – Cost of Sales):
Marketing Expenses (7% of Sales Revenue):
Net Income (Projected Profit) (Gross Profit – Total Marketing Expenses):
Net Profit Margin % (Does this amount of profit make sense?) (Net Income/Sales Revenue):
MHACB/506 v2
East Chestnut Regional Health System Case
Study: Breakeven Analysis Worksheet
Breakeven Analysis in economics, marketing, and cost accounting refers to the point at which total cost
and total revenue are equal. A breakeven point analysis is used to determine the number of units of a
product or service that must be sold to cover total costs (fixed and variable costs).
This means you have covered all of your costs at the number of units sold the formula calculates.
The formula for breakeven analysis is as follows:
Breakeven quantity = Fixed costs / (Sales price per unit – Variable cost per unit)
Example of Breakeven Analysis:
Assume you know that a new suite of offices will need to be designed within your existing facility in which
to provide the service. The cost for build out for these offices will cost \$50,000. This is a one-time charge.
Assume your OB physician cost is \$70 per office visit of 15 minutes. The cost for your office staff per
patient visit is \$20 per office visit of 15 minutes. Supplies used per office visit is estimated at \$10. The
total variable cost associated with one office visit of 15 minutes is the sum of these charges (\$70 + \$20 +
\$10 = \$100) or \$100 per 15-minute office visit.
Assume your clinic charges a total revenue of \$200 per 15-minute office visit per patient.
To determine the breakeven point for offering OB service at your clinic, plug these numbers into the
formula:
Break even quantity = \$50,000 / (\$200 – \$100) = \$50,000 / \$100 = 500 patient visits.
Therefore, given the fixed costs, variable costs, and revenue gained for each patient visit, your
organization would need to provide 500 OB office visit to break even during the period of one year.
Use this form to create your ECRHS Breakeven Analysis. Enter the projected numbers, following the
formulas next to the line item.
Breakeven elements are listed below write breakeven costs and revenue against each element:

Costs:
Fixed costs (A set one-time cost that will be required to product or deliver a product or service, such
as construction of new office or lab space. This occurs once, and does not vary based on the number
of products or services delivered):
Variable costs (Costs that repeat each time the product or service is manufactured or delivered,
such as physician salary per procedure or visit, office staff salary per procedure or visit, supplies used
per procedure or visit, calculated per individual visit):
Revenue per Product or Service delivered (per visit):
Breakeven Quantity Required (Fixed Costs / [Revenue per Unit – Variable Cost per Unit]):
MHACB/506 v2
CASE STUDY: EAST CHESTNUT REGIONAL
HEALTH SYSTEM
History
Within the last 10 years, East Chestnut Regional Health System (ECRH) was formed from the merger of
three organizations: East River Medical Center, Northern Mountain Hospital Consortium, and Archway
Hospital.
East River Medical Center (ERMC)
ERMC is the anchor hospital for the system. The medical center resides along the east side of the
Chestnut River. Historically, ERMC was recognized as the location of choice for medical care. However,
this reputation has deteriorated over the last 3 to 5 years. As the city of Chestnut has grown, ERMC has
found itself on the edge of an urban blight. Safety has been a concern for patients, visitors, and
physicians who use and serve the medical center. The technology offered at the medical center has been
maintained at an excellent level of proficiency. At the same time, the medical staff is aging with the
average age of the physicians being 57. There are younger primary care physicians who serve the
specialists, but the specialists are aging as well. ERMC boasts a Level 1 Trauma Center with an air
service. The total number of licensed beds for ERMC is 550. On any given day, the occupancy rate is 300
Northern Mountain Hospital Consortium (NMHC)
NMHC was originally formed in response to the migration of patients to Chestnut. Due to the rather
aggressive strategies carried out by the hospitals in Chestnut, these rural hospitals decided to create a
consortium of rural hospitals so that they could gain economies of scale in a number of areas, which
worked together to stem any further deterioration of their market share. Patients were selecting to go to
the larger community for services and leaving the smaller communities that collared the Chestnut
metropolitan area. NMHC represented individual hospitals in four counties that circled Chestnut County:
Walnut, Butternut, Oak, and Maple. Walnut and Butternut Counties had good employment with Oak and
Maple Counties being mostly rural. In each county, the inpatient facilities averaged about 20 years of age.
The upkeep of these facilities has been sketchy. No facility needs any major upgrades, but modernization
is needed. The state does not have a Certificate of Need (CON) process. The medical staff makeup
varies each location. The hospitals in Oak and Maple Counties are critical access hospitals. Further
details will be provided regarding these organizations later in the case study.
Archway Hospital (AH)
AH is located directly in the community of Chestnut. It fully resides in the urban area of the community.
The hospital has 200 registered beds, but on any given day there are only 50 to 75 patients in this facility.
This hospital was a Doctor of Osteopathy (DO) hospital; therefore, most of the physicians that worked out
of this facility were DOs. The payer mix for this hospital was heavily burdened with Medicare and
Medicaid. This payer mix composed nearly 85% of the reimbursement. The facility is aging and needs
considerable repairs. It is questionable if it will be worth the investment in this facility.
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 2 of 10
The original merger that created the East Chestnut Regional Health System (ECRH) occurred 10 years
ago. This merger was between ERMC and AH. AH had a rather dynamic leader who was about 57 years
old at the time of the merger. The AH CEO became the new President and Chief Executive Officer of
ECRH after the merger. Since this CEO had only worked in a smaller organization, he had not
experienced the cultural changes and demands that occur after the merging of a large organization.
Additionally, he began to change the culture of the organization such that decisions were made on a
decentralized basis. He trusted the management team at AH to do the right things and make the right
decisions with low supervision. However, the Chief Operating Officer (COO) who was put in charge was
originally from AH but left 2 years after the merger with a new COO being put in place. This COO
developed a rather poor reputation and was known to want to build his own empire at AH and to be
dishonest at times. This reputation created a culture within the traditional AH that lacked a cohesive team
effort to create a system. This positioning of the COO was left unattended by the President and CEO of
ECRH since he was actively pursuing the acquisition of NMHC. The hospitals of NMHC were doing okay,
but those in the consortium realized that their ability to stand alone was becoming difficult in today’s
market. When the leadership of the consortium assessed the market as to a partnership, they decided
that ECRH would be the best choice. The other option was to develop a for-profit hospital that also
resided in Chestnut. The leadership was attracted to what they saw happen with AH. They liked that the
central leadership of the system allowed AH to continue as their own entity without a lot of centralized
control.
By the time all of this was put together, the President and CEO of ECRH was near retirement. He retired
about three years after the merger activity was complete. During those three years, he became lax in his
leadership role. ECRH deteriorated in market share and profitability during this time. Upon his retirement,
the Board of ECRH performed a national search for a replacement. They employed Hunter Brown as the
new President and CEO. Mr. Brown was the CEO of a smaller health system and had been in that
position for nearly 10 years. Therefore, he had limited experience from other markets in the art of
strategic implementation. However, he was also well trained, bright, and articulate in expressing his
knowledge. He has now been the President/CEO of ECRH for nine months.
As for the remainder of the leadership team for ECRH, there is a newly hired corporate counsel. She has
15 years of experience and is extremely competent in the work that she does.
The CEO also hired a new Chief Financial Officer. He has taken good strides in managing the accounts
receivable throughout the system as well as extracting exceptional dollars from high quality supply chain
management.
The Chief Operating Officer (COO) is new and has three years of previous experience from the same
organization where the CEO departed.
The Chief Medical Officer (CMO) has been retained from the old leadership team. His reputation is
excellent, and he works well with other physicians, including the medical staff and the employed
physicians.
The Chief Nursing Officer (CNO) is three years away from retirement. She is known for not getting along
with the medical staff and will always defend nursing when at times this is not appropriate.
The Senior Vice President for Human Resources is competent and respected by management and staff
throughout the organization.
The remainder of the leadership team was retained from the old regime. This included information
technology, employed physician group leadership, marketing, human resources, and other vice
presidents or directors responsible for varying service lines. It should be noted that the IT leadership is
just completing the implementation of the EPIC system. The future for this team depends on how well the
overall implementation of the system goes. Likewise, those in the marketing department will need to be
stellar in senior leadership advisement regarding the marketing of complex issues that will be
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 3 of 10
encountered ahead. They have been told if marketing misses the target, then replacements will occur
within this department.
The new CEO inherited the management team of AH and NMHC. For NMHC the organizational structure
was left intact with the COOs for each of the individual hospitals being retained. It was agreed that this
traditional structure would be left intact for at least five years. This agreement was near its end and the
new CEO had plans to change the existing structure as well as management. This change was being
considered for this year’s strategic plan development. Even if the structure of NMHC was going to be
changed to a more direct relationship with corporate leadership, the existing COO’s would be retained as
they have performed well since the merger. As for the COO of AH, he had been recently terminated. An
interim COO is now in place pending the board approved closure of this hospital.
Competitive Assessment
ECRH was not the only provider of care in the community. There was a for-profit hospital, Banford
10 years ago. The for-profit health system was the largest in the country. The CEO of this hospital was
good at optimizing performance because of the weaknesses of ECRH and its leadership. He was an
effective opportunist.
BMC has 400 registered beds with a current occupancy rate of 85%. They have been effective at taking
market share away from ECRH. For each loss of service line market share by ECRH, BMC has shown
proportional gains. After the acquisition of BMC, the for-profit immediately moved to build a new facility.
This new facility is located on the growing wealthy edge of the community. Additionally, at the time that
this new facility was developed, the for-profit syndicated ownership to the physicians. The highest level of
syndication occurred with the obstetrics and gynecology physicians in the community. Therefore,
women’s services deteriorated at ECRH. It should be noted that this physician syndication occurred
before the Affordable Care Act was passed, which precluded hospital ownership by physicians.
It is important that additional information is provided regarding ECRH. ECRH recently purchased 100
acres of land across the interstate from BMC. This land is located northwest of Chester. The intention is
to eventually build a new medical center on this location. The initial planning of this land has occurred,
and it has been approved to build a regional oncology center on this site. The construction of the project
is already underway with an anticipated completion in 6 months.
In addition, ECRH has an orthopedic hospital attached to the current ERMC site and a behavioral health
hospital at this same location. ECRH also has two ambulatory surgical centers that are conveniently
located on the growing northwest and southwest side in the community. The one surgical center is
located on the 100-acre development site. The orthopedic hospital has done well and has been listed in
the top 100 orthopedic hospitals. However, the behavioral health hospital is losing significant dollars, so
the Board of Directors for ECRH has decided to close this hospital. ECRH has also developed a joint
venture imaging center with the radiologists. This center resides across from a major shopping area in the
community. It is conveniently located near heavily populated neighborhoods and shopping. The only
downside is the location is not close to physician offices that would refer to this center. However, if a new
facility is built on the 100 acres, which would include physician offices, the imaging center will be in an
ideal location. Leadership is developing a free-standing emergency center on the 100-acre site, which is
on the northwest side of Chestnut.
The last competitive issue is the location of a medical school and hospital in the city of Chestnut. The
facility resides in a downtown location. This medical school had been established by the state nearly 45
years ago and is associated with Greenbranch University. It mostly serves the indigent community in
Chestnut and the surrounding area. This academic center has a rather negative reputation in the
surrounding area. There are four other medical academic centers in the state as well as a medical center
with a world-renowned reputation. There have been ongoing rumors that this world-renowned
organization was planning on assuming the responsibility of the Chestnut academic center. This change
would substantially alter the complexion of the local medical community if it were to occur. Speed in
ECRH dealing with some of its market issues is an imperative.
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 4 of 10
Chestnut County

With 433,689 people, Chestnut County is the 6th most populated county in the state.
The largest Chestnut County racial/ethnic groups are Caucasian (70.1%), African American (18.5%),
and Hispanic (6.5%).
In 2015, the median household income of Chestnut County residents was \$41,777. However, 21.1%
of Chestnut County residents live in poverty.
The median age for Chestnut County residents is 37.7 years old.
Employment is strong in Chestnut County. Unemployment resides at 4.5%. Employer diversity is
strong since the community is not dependent on singular large employers. Employment includes
some high-tech jobs, general manufacturing to support the automobile industry, and there is a large
university, Greenbranch University, located in the community. The university has 25,000 students and
offers most majors, which includes engineering and nursing.
Walnut County

With 42,537 people, Walnut County is the 57th most populated county in the state.
The largest Walnut County racial/ethnic groups are Caucasian (89.8%), followed by Hispanic (7.2%)
and African American (3%).
In 2015, the median household income of Walnut County residents was \$55,120. However, 10.8% of
Walnut County residents live in poverty.
The median age for Walnut County residents is 39.8 years old.
Butternut County

With 38,352 people, Butternut County is the 65th most populated county in the state.
The largest Butternut County racial/ethnic groups are White (87.0%), Hispanic (9.5%), and African
American (1.7%).
In 2015, the median household income of Butternut County residents was \$50,663. However, 13.4%
of Butternut County residents live in poverty.
The median age for Butternut County residents is 39.7 years old.
Oak County

With 37,120 people, Oak County is the 66th most populated county in the state.
The largest Oak County racial/ethnic groups are Caucasian (93.3%), Hispanic (4.0%), and African
American (1.1%).
In 2015, the median household income of Oak County residents was \$42,492. However, 14.9% of
Oak County residents live in poverty.
The median age for Oak County residents is 46.6 years old.
Maple County

With 27,816 people, Maple County is the 79th most populated county in the state.
The largest Maple County racial/ethnic groups are Caucasian (90.8%), Hispanic (7.1%), and African
American (1.0%).
In 2015, the median household income of Maple County residents was \$39,353. However, 15.4% of
Maple County residents live in poverty.
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 5 of 10

The median age for Maple County residents is 48.2 years old.
Both Oak and Maple Counties are rural with an older population. Many patients have Medicare and
Medicaid that come from these two counties. Likewise, the hospitals located in each of these counties
have been designated as critical access. Like many rural counties, Oak and Maple have been
blighted with younger people using drugs, including methamphetamine.
Employed Physicians
ECRH employs 400 physicians throughout its system. The breakdown for each location is as follows:
Chestnut County

135 primary care
100 specialists
Walnut County

40 primary care
10 specialists
Butternut County

30 primary care
12 specialists
Oak County

27 primary care
10 specialists
Maple County

25 primary care
11 specialists
There have been ongoing complaints from the newly recruited physicians that their practices have not
been marketed well; thus, their patient volumes have been slow to grow.
Service Line Performance Information
The following is a list of bullet points regarding service line performance by ECRH and issues of
operational concern.
1. Women’s health services deteriorated significantly since the syndication by Banford Medical Center.
Obstetrical deliveries are down 20% across the system. BMC has done an excellent job of creating
attractive facility and services for women. This includes nurse navigation, women’s breast center, and
a series of other amenities. BMC has also started a neonatal intensive care unit, which rivals the
services of ECRH.
2. The cardiologists at ECRH are aging. This has been a traditionally strong service for ECRH, but 50%
of the cardiologists will be retiring within the next 3 to 5 years. All cardiologists who serve ERCH are
employed by the health system. Cardiology is a service that is gaining strength within the
Greenbranch Medical Center, particularly since they brought in a renowned cardiologist to rebuild
their program.
3. The orthopedic volumes are down 7%. ECRH does jointly operate an orthopedic hospital with an
independent orthopedic group located in the community. There have been some internal problems
within the orthopedic group where the old guard of orthopedic surgeons has forced a low retention
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 6 of 10
with younger, and to some degree better trained, surgeons. Retention is becoming a growing concern
regarding the status of this group with consideration of ECRH hiring their own surgeons. The joint
venture hospital does not exclude other surgeons from working in this hospital.
4. Emergency department (ED) volumes are down 5%. The hospital uses an emergency physician
group to supply physicians to cover all of the EDs within ERCH. These physicians are known for poor
customer service and making rude comments to patients who are self-pay or Medicaid.
5. The ambulatory visits and services are up 3%. This volume increase is from the younger primary care
physicians who have been employed by ECRH. This young group of physicians has become great
support for ECRH and refer patients loyally to the organization.
6. General surgery cases are down 4%. The aging surgeons are starting to retire, and it is difficult to
recruit new surgeons to replace past demand. Some of this work is going to Greenbranch since they
have good general surgeons.
7. The oncology services for ECRH have increased in volume and revenue by 4%. ECRH’s
development of the new oncology center has created a magnet for referrals to the oncologists. The
oncologists are very enthusiastic about the development of this new center and have begun to shift
work to ECRH.
8. ECRH has the regional burn center. ECRH works with Greenbranch Medical Center for training
residence in the burn setting. This includes the plastic and general surgeons. The downside of this
service is that it is losing money. A decision has been made to close this service with Greenbranch
starting their burn center.
9. ECRH is a Level 1 Trauma Center, and this designation has been a historical positive for the system.
The helicopter service is well recognized by the community as well as first responder professionals
found in the region. They historically have been top for major trauma cases. The usage of this service
is down 5% since the for-profit has established a similar service. BMC however only has a Level 2
Trauma Center. They have worked diligently to acquire ambulance services in some of the outlying
communities. This has helped feed patients to BMC.
10. The ECRH Board of Directors decided to close the behavioral health hospital. It is uncertain where
patients will be able to receive inpatient care. An active out-patient service will still be provided by
ECRH.
Payer Mix
The payer mix for ECRH has deteriorated. The current inpatient payer mix for the entire system is as
follows:

55% Medicare
15% Medicaid
30% Commercial
There has been a long-standing joint venture relationship with a national insurance company for
commercial insurance. Administratively this venture has not developed as anticipated; however, in some
of the regional markets, the Chestnut Care insurance has a strong presence. Of the 30% commercial pay,
20% is Chestnut Care based. The national insurance company in the venture is Aetna. The next
strongest product is Anthem. It is the expectation of the CEO that Chestnut Care be leveraged and
positioned for growth.
The 15% Medicaid has helped the hospital gain additional disproportionate share dollars, which does help
the bottom line of the hospital.
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 7 of 10
Historical Strategic Initiatives
Accountable Care Organization
When the Affordable Care Act was passed in 2010, ECRH decided to get into the one-sided model of an
accountable care organization (ACO). This venture has not gone well, and ECRH has decided to leave
the ACO business. However, they are concerned about the public image of this decision. The details of
the termination are under discussion with a need to determine how to minimize the public perception of
termination, particularly since there was so much marketing of their getting in this venture. The regulatory
requirements of the government regarding the timing of terminating an ACO venture further complicate
this decision.
Primary Care Medical Home
The employed primary care group has been active in establishing accredited primary care medical homes
within all the primary care offices throughout the ECRH system. This initiative is a positive emerging
strategy for ECRH. It has also been an attractive draw for the family practitioners from Greenbranch
Medical Center residency program since Greenbranch has established an accredited medical home for
their family practice residency program.
American Nursing Credential Center Status (ANCC)
ECRH has been working on becoming a magnet status for ERMC. This work has stalled out as an
initiative. Some of this is due to the nursing leadership within ERMC. The CEO intends to move this
priority up in the organization’s goals.
Information Technology
ECRH has invested heavily in their information technology infrastructure. This investment became a
requirement just to be able to gather the data needed for the ACO development. This cost has become
significantly greater than anticipated. ECRH fully implemented EPIC as their core information technology
system. There have been implementation problems since the ECRH was operating off multiple systems
before the decision to consolidate to one platform. The implementation of EPIC required considerable
retraining for the staff and physicians. Data conversions have gone well. The difficulties have been more
human-related relative to the effective use of the system. One of the major issues has been the lack of
ECRH not meeting meaningful use requirements which has cost ECRH significant lost revenue from not
meeting these goals.
Legal Actions Pending for ECRH
With the merger and acquisition of NMHC, questions of antitrust have been raised. In the service lines of
cardiology and oncology it has been found that ECRH controls 60% of the cardiology market and 52% of
the oncology market. Chestnut Care in some markets has been strong in steering patient volumes to
ERMC. Union leaders for the varying trades were instrumental in precipitating this investigation. At the
time that this issue was raised, the President and Executive Branch of the federal government were very
pro-labor, thus, their interest in pursuing this matter.
As to the projected disposition of this case, it is anticipated that a negative determination will be made
due to the market share control in oncology and cardiology. This could force ECRH to divest their
ownership in the Chestnut Care insurance venture. Another option might be that certain hospitals of
NMHC be divested. It is not anticipated that both determinations would occur. This case has cost ECRH
considerable money to stave off investigation of this allegation.
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 8 of 10
Predatory Collections and the Loss of Not-for-profit Tax
Status for NMHC
NMHC negotiated that they would continue to act independently. The consortium leadership set policies
that included predatory collections for the patients that would be served in the NMHC hospitals. In a
recent evening news report, an investigative reporter interviewed an elderly patient that had her home
taken from her to pay for her medical bills. This home had been in her family for over 100 years. This
story prompted the state’s Attorney General’s Office to investigate the predatory collection policies of
ECRH and NMHC.
The state has already taken an aggressive stance to investigate the status of not-for-profits not fulfilling
requirements (e.g., charity care, research, and education). The state is in economic trouble and is
seeking revenue from wherever they can find it. The outlook is dim regarding the anticipated final decision
of the Attorney General’s Office. If NMHC is required to pay taxes, this would wipe out the bottom line for
these hospitals and many of the needed services supplied to the indigent population by ECRH would be
reduced or eliminated.
Faith & Main Consultants Report
Within the last year, ECRH contracted with Faith & Main to study the market perception of their women’s
services. The following is a summation of the findings of Faith & Main.
Interest in a Women’s Center Crosses County Lines

36% of women in the service area would travel across county lines to receive excellent women’s
health services
72% of women in Chestnut County would consider using the women’s services of East Chestnut
Regional Medical Center
Women in all counties were most interested in these services:
o Breast care
o General gynecology services
o Female doctors
o Services in one area
o Physicals for women
Interest in a Heart Care and a Health Information Line

A physician approved source of information.
A nurse help line that could be a resource for women’s care in heart health as well be a source for
Clear Expectations Regarding Getting Appointments with
Their Primary Care Physician

Women expect same-day appointments
o In the collar counties to Chestnut County, women ranked this in the top 28.7%
o Chestnut County women ranked this in the top 37.7%
o Expectation of same-day appointments ranked highest for women of childbearing age
Percent expecting same-day appointments
o 42.9 % of Chestnut County women of childbearing age
o 31.3% of collar county women of childbearing age
Case Study: East Chestnut Regional Health System
MHACB/506 v2
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Willingness to be Seen by a Nurse Practitioner Overwhelmingly “Yes”
o 75.7% of Chestnut County women of childbearing age
o 76.1% of collar county women of childbearing age
Respondents Expressed How Health Care Could Be
Improved

24% of all Chestnut County women, and 26% of all collar county women named adding more primary
care doctors and more children’s care with urgent care outranking any other single topic.
Respondents of Childbearing Age Widely Represented in
Study:

86% of women respondents of childbearing age in Chestnut County had children under the age of 18
76% of women respondents of childbearing age in the collar counties had children under the age of
18
Willingness to be seen by nurse practitioner was viewed as favorable by those in this study.
This data from Faith & Main will be used to ramp up improvements in the women’s services for ECRH.
Strategic Plan Goals for the Upcoming Year

Women’s service line improvement
o Increase obstetrical deliveries by 20% over 3 years
o Establish nurse navigation system for the entire system
o Facility improvement and development for women’s services
o Improve access standards for women’s care
• Assist in the marketing of the implementation of the consultant’s report regarding
women’s services
Oncology Center grand opening
Mature the retail strategy with the primary care employed physician group
Assess the market impact of the lawsuits and develop marketing strategy to counteract the negative
impact if decisions are made against ECRH
Aggressively recruit new physicians to reduce the average age of the medical staff and strategically
enhance service line development
Use lean management processes to correct service issues found in the ED. Improve ED visits by 6%.
o Review physician contracts to enhance physician service performance
o Investigate the fast-track ED concept
o Implement the free-standing ED strategy
Abandon the Accountable Care Organization (ACO)
Re-establish relationships with regional emergency medical services to raise the utilization of the
medical air service. Growth goal is to get back to the previous level of utilization within 18 months
Decision to close the regional burn unit and let those cases go to the academic medical center
Implement the decision to close the behavioral health services of ECRH
Implement the decision to close AH
CEO Instruction to Marketing Team
The marketing department for East Chestnut Regional Health System will be asked to step up their game
to develop a marketing plan for the regional health system. The CEO has had some concerns regarding
the ability of the marketing department to keep up with the rapidly moving strategic environment that he
has created. Therefore, he established a timeline for the department to develop a system wide marketing
Case Study: East Chestnut Regional Health System
MHACB/506 v2
Page 10 of 10
plan over the next six weeks. The VP of marketing has been in all the senior leadership cabinet meetings,
so she is aware of all the details. Therefore, the learning curve regarding the institutional strategic goals is
of no concern.
The following are elements that the CEO wants in the marketing plan.
1. A consultant, Faith & Main, was used to test the impression of the women in the key service markets
for East Chestnut Health System. The summary of the consultant’s report can be seen above. The
survey covered all aspects of women’s care. The marketing department will need to develop a
marketing campaign to match the recommendations of the consultant’s report.
a. It is recognized that the age span for communicating with women consumers will be quite
variable. On one end of the spectrum, you have the younger childbearing age women, next
are the women that are middle aged followed by women that are pre-elderly then those that
are elderly. Therefore, a communication plan using social media to conventional marketing
techniques will be required.
2. A communication plan will need to be developed for the closure of the regional burn center as well the
exiting the accountable care organization and the closure of the behavioral health hospital.
3. A communication plan will be needed to deal with the closure of AH.
4. A branding strategy will need to be developed to overcome the current weak brand identity that is in
place for the combined ECRH entities.
5. Develop marketing strategy for new physicians being recruited to the system. The ideal situation
would be to have a common identity for all marketing material. In the past the marketing material has
been local hospital based.
6. Develop marketing plan for the Primary Care Medical Home strategy as well the retail strategy for the
primary care network.
7. Proactively lay out a framework of communication to manage any negative outcomes of the legal
matters that the health system is now confronting.
a. The Federal Trade Commission investigation of the anti-trust issues for ECRH.
b. The predatory collections occurred as part of NMHC. It is felt that this case will force these
rural hospitals to move to a taxable entity with the loss of their not-for-profit status. The
development of this problem came about due to poor leadership within the consortium.
8. Develop advertising campaign for the opening of the new oncology center.
9. Develop advertising campaign for the ED/Trauma services of ECRH.
MHACB/506 Competency 3 Assessment and Rubric
Course Title: Ethical Marketing: The New Healthcare Economics
Competency Assessment Title: Market Demand and Pro-forma Income Statement
Assignment Directions
In this part of the course, you will prepare a pro forma income statement for a new or revised product or service you recommend for East Chestnut
Regional Health System.
Review Case Study: East Chestnut Regional Health System.
Pro Forma Income Statement for East Chestnut Regional Health:
Please complete the following prior to preparing the pro forma income statement and budget. You will need the following information in order to
prepare it.
Part I: Market Size Calculation:
Determine the size of the market for the ECRHS product or service you are recommending. Assume East Chestnut Regional Health is located in
the market in which you live or work.
Visit the University Library Consumer Demographics page.
From this page, visit the United States Census Bureau sites linked under the Demographic Data heading. A rough estimate of need for health care
products or services can be made based on the population demographics, using age, gender, and in some cases, race. On these sites, you can
gain information on the total U.S. market for health care, as well as the number of U.S. consumers who fit your target market segmentation.
Determine the local market for the product or service you recommend for East Chestnut Regional Health.
Next, multiply the percentage of people likely to purchase your recommended ECRHS product or service by the estimate of market share you
believe ECRHS can achieve for the product or service. For example, if there are 6,000 women who might be interested in ECRHS obstetrical
services, and ECRHS has a potential 40 percent market share, this results in 2,400 patients.
Prepare a 150- to 300-word summary of your market determination process.
MHACB/506 Competency 3 Rubric
Page 2 of 4
Part II: Breakeven Analysis:
A breakeven analysis determines the number of products or amount of service that must be sold to consumers for the organization to break even
or cover the costs of production or provision of the product or service.
You will prepare a breakeven analysis for the case study client, East Chestnut Regional Health.
Use the Breakeven Analysis Worksheet to prepare your analysis.
Prepare a 150- to 300-word summary of your breakeven analysis that includes the following:

The fixed and variable costs of product production or service provision
The price and number of units sold at that price
The number of units of product or service sold to cover the fixed and variable costs at the price level
Part III: Pro Forma Income Statement:
A pro forma is an income statement that predicts income for the new or revised product or service you are recommending to East Chestnut
Regional Health System (ECRHS) after one year. It shows the sales ECRHS expects to achieve during that period of time, along with the costs
associated with that level of sales. The organization must cover the costs of products or services it delivers (cost of goods sold) and the expenses
we estimate to achieve those sales (salaries for sales reps, advertising and promotion, office expenses, etc.). This will leave us with a projected
profit.
A good pro forma income statement proves out a strategy by showing the expected revenue minus the expected costs and the resulting profit.
Conversely, it shows, for example, that you can’t have \$100,000 in forecast sales and \$3 million in projected advertising, since that would result in
a loss.
Use the Pro Forma Income Statement Worksheet to create your pro forma income statement.
Create a pro forma income statement based on the above. Include the following for 1 year:

Projected sales volume in units and revenue
Projected cost of goods/services
Projected marketing expenses
Projected net income
Prepare a 500-word summary statement of your pro forma income statement for East Chestnut Regional Health System for the new or revised
existing product or service you have recommended. Include the following:

Summary of market size calculation (150 words)
Summary of breakeven analysis (150 words)
Summary of projected profit (200 words)
MHACB/506 Competency 3 Rubric
Page 3 of 4
Part IV: Marketing Plan Considerations:
Now that you have a better understanding of your market and the finances of the organization, you must consider how economics and finances
Write a 350- to 500-word analysis of how specific economic or financial issues will affect the marketing strategies for ECRHS.
MHACB/506 Competency 3 Rubric
Page 4 of 4
Competency Assessment Rubric
Assignment/Performance
Criteria
Mastery
100%
Meets Expectations
85%
Not Met
0%
Part I: Market Size
Calculation
(weight 24%)
The student comprehensively
described the marketdetermination process in the Part I
summary.
market-determination process in the
Part I summary.
The student did not describe the
market-determination process for the
product or service.
Part II: Breakeven Analysis
(weight 24%)
The student fully summarized the
fixed and variable costs of product
production or service provision, the
price and number of units sold at
that price, and the number of units
of product or service sold to cover
the fixed and variable costs at the
price level.
the fixed and variable costs of product
production or service provision, the
price and number of units sold at that
price, and the number of units of
product or service sold to cover the
fixed and variable costs at the price
level.
The student did not summarize the
fixed and variable costs of product
production or service provision, the
price and number of units sold at that
price, or the number of units of
product or service sold to cover the
fixed and variable costs at the price
level.
Part III: Pro Forma Income
Statement
(weight 24%)
The student thoroughly
summarized the properly created
pro forma income statement for
East Chestnut Regional Health
System for the new or revised
existing product or service
recommended, including a
summary of market size
calculation, a summary of
breakeven analysis, and a
summary of projected profit.
The student sufficiently summarized
the created pro forma income
statement for East Chestnut Regional
Health System for the new or revised
existing product or service
recommended, including a summary
of market size calculation, a summary
of breakeven analysis, and a
summary of projected profit.
The student did not summarize the
created pro forma income statement
for East Chestnut Regional Health
System for the new or revised existing
product or service recommended.
Part IV: Marketing Plan
Considerations
(weight 24%)
The student comprehensively
explained how specific economic
or financial issues can affect the
marketing strategies for ECRHS.
how specific economic or financial
issues can affect the marketing
strategies for ECRHS.
The student did not explain how
specific economic or financial issues
can affect the marketing strategies for
ECRHS.
Grammar and Writing
Mechanics
Accuracy in grammar, sentence
structures, sentence boundaries,
and word choice enhanced content
Rare inaccuracies/errors in grammar,
sentence structures, sentence
boundaries, and word choice did not
detract from the content
Frequent inaccuracies/errors in
grammar, sentence structures,
sentence boundaries, and word
choice detracted from the content
(weight 4%)

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