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| Situation Analysis| | Women and Infants’ Hospital of Rhode Island| Team C June 10, 2011 Table of Contents Executive Summary2 Understanding the Environment2 Understanding the Industry2 SWOT2 Marketing Strategy2 Introduction3 Understanding the Environment4 Policies & HealthcareError! Bookmark not defined. Impact of Healthcare Reform on ReimbursementError! Bookmark not defined. Economic & Financial Condition of NYS Hospitals4 Social Environment4 Understanding the IndustryError! Bookmark not defined. Market CompetitorsError! Bookmark not defined. Product SubstitutionError! Bookmark not defined.

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Supplier PowerError! Bookmark not defined. Bargaining Power of PayersError! Bookmark not defined. SWOT AnalysisError! Bookmark not defined. StrengthsError! Bookmark not defined. WeaknessesError! Bookmark not defined. OpportunitiesError! Bookmark not defined. ThreatsError! Bookmark not defined. Marketing StrategyError! Bookmark not defined. ChallengesError! Bookmark not defined. Capacity CrunchError! Bookmark not defined. Health ReformError! Bookmark not defined. Smart MarketingError! Bookmark not defined. Summary ConclusionError! Bookmark not defined. Works CitedError! Bookmark not defined.

Situation Analysis Women and Infants’ Hospital of Rhode Island Executive Summary This project seeks to produce a report and analysis of Maternal Fetal Medicine (MFM) services in Southeastern, MA. Understanding the Environment Understanding the Industry Add summary SWOT The overall strength of WIHRI is the outstanding reputation this group has among the area. The new office location was in a great location which was halfway between Boston and Providence, with the Providence area having less traffic flow in that direction. The new office is much larger and is very accessible from the highway.

The services offered have a strong array of tertiary services and referral network. The weakness would be the lack of awareness within the community. Another weakness was focused on insurance problems which would become an issue when crossing state lines. Also, having physicians accredited in both states is another area of concern. The opportunities determined that the payer mix with insurances was a great mix, with 40-50% Medicaid business. WIHRI had created a referral system with South Coast Hospital System which would guarantee patients. The main threats would be the current competition in the area that had a well established patient base.

Marketing Strategy The strategy is done by conducting an online communication research questionnaire. This questionnaire answers all the questions about demographics, patient types, amount of potential patients, and issues of concern in that area directly. There is paid advertising, developed marketing plans, planning of data and the analysis of the overall marketplace, which will determine the best plan for the new WIHRI practice. The primary focus on marketing at this point is to educate physicians and networks about the facility practices offered at WIHRI.

Business managers and clinicians directly visit local practices and talk with providers in the area on a person-to-person basis. There are also mailers to clinicians to gain referrals and to give some background information. In-services will be provided to local practices to inform them of the new offerings at WIHRI. Introduction Maternal Fetal Medicine (MFM) services in Rhode Island are based out of Women and Infants’ Hospital of Rhode Island (WIHRI), a subspecialty hospital focused on neonatal medicine and obstetrics and gynecology.

Women and Infants’ Hospital is part of the Care New England (CNE) Health System which is composed of four units: WIH, Butler Hospital (psychiatric subspecialty hospital), Kent Hospital (general care), and CNE Visiting Nurse Association (home health care). Women and Infants’ is the dominant provider of obstetric care in the state of Rhode Island servicing 82% of the market; it is also the primary teaching affiliate for Brown University in obstetrics and gynecology. It has the only Level 3 Neonatal Intensive Care Unit (NICU) in the state, which is a new state-of-the-art 80 bed individual room unit.

The NICU is the largest source of hospital revenue for WIH. Maternal Fetal Medicine, also known as high risk obstetrics, is also an important service that supports the NICU through admissions and referrals. The MFM group provides tertiary level outpatient care services throughout Rhode Island, Eastern Connecticut, and Southern Massachusetts. In Rhode Island, this group is a single competing practice consisting of one physician who primarily provides outpatient services (prenatal diagnosis and consults). In Connecticut, it competes with Yale New Haven Medical Center and the University of Connecticut.

In Massachusetts it competes with the University of Massachusetts and all of the practices in the Boston area including: Tufts Medical Center, Steward Health System, Brigham and Women’s, Massachusetts General Hospital, and Beth Israel Deaconess Medical Center. The WIH MFM group has had a presence in Southeastern Massachusetts for over 20 years, although the group recently closed an office in Foxboro, MA. As birthrates have declined, institution s have reached out from their primary service areas to develop, build and/or strengthen relationships with outlying birthing hospitals to build their referral base for neonatal and maternal transfers.

The WIH MFM group would like to maintain its regional dominance as competition for referrals increase. In order to solidify its presence in this market, they have signed a service agreement with South Coast Hospital System (including Charlton Memorial Hospital, St. Luke’s Hospital, and Tobey Hospital), and are also opening a larger outpatient office in Dartmouth, MA in June 2011. Understanding the Environment Political Factors The Massachusetts Mandated Health Reform law was established in 2006 and is an act to provide affordable, quality, and accountable health care.

Key provisions of the law include subsidized health insurance for residents earning less than 300% of the federal poverty level, and low-cost insurance for all other residents who are not eligible for insurance through their employers. The federal health reform act includes the Patient Protection and Affordability Act, signed on March 23, 2010 by President Obama; and the health Care and Education Reconciliation Act of 2010 that corrected some of the problems in the first law.

This means that Massachusetts gets extra funding to help pay for current health care program in addition to other benefits. How is this impacting WIHRI: Economic Factors Medicaid Massachusetts gets extra Medicaid funding from the federal government to help pay for health coverage for low income residents. Currently, these federal funds (mainly through Medicaid) pay for about 50% of all deliveries. However, Medicaid is a state program and there could be implications from referral practices that impact providing services in Rhode Island.

The Southeastern, MA area provides a significant portion of WIHRI revenue and loss of this market could have significant budgetary impacts. Private Health Insurance Medicare Other Delivery Reform that May Impact Hospitals Economic Factors The payer issues related to the WIH FPI relationships in Massachusetts are becoming more difficult as this entity of Group Insurance Commission (GIC) in MA becomes more powerful in its ability to include/exclude hospitals and provider groups from their “limited network” which are just recently being implemented. The Sr.

Vice President of Contracting at WIH met with the GIC leader in Boston in early June and was informed that WIH would not be included in this current year’s network, but could be “considered” for next year’s. This issue is important because the GIC is now controlling the provider network for all of MA state employees and soon will control all municipalities across MA. Social Factors Technological Factors Environmental Sustainability Legal Factors Cooperative/Competitive Environment Environmental Opportunities/Threats Implications for Strategy Development Understanding the Industry

Classification and Definition Obstetrics and Gynecology (Ob-Gyn) is a medical specialty that focuses on the health of women. The specialty in its entirety deals with the problems specific to women from birth to death. Specifically, the specialty deals with diseases and issues of the female genital tract and the health thereof. While it is considered a specialty service, Ob-Gyn is also considered a primary care service due to the large amount of preventative care that Ob-Gyn doctors provide. Oftentimes, women only go to an Ob-Gyn each year and while at that appointment, get other basic health screening done.

Ob-Gyn includes:  General ob-gyn, reproductive endocrinology/infertility, urogynecology, gynecologic oncology, and maternal-fetal medicine: Maternal Fetal Medicine (MFM) is the branch of Ob-Gyn that deals specifically with the physiology and pathology of the birth process. This includes prenatal diagnosis and diagnosis/treatment of complications arising during pregnancy and in the immediate time period after delivery of the infant. Prenatal diagnosis consists of ultrasounds, invasive testing, non-invasive testing, and genetic counseling. These services include follow up, support, and referral for fetal anomalies.

Ultrasound services can be divided into routine (Level 1), Nuchal Translucency, targeted (Level 2), fetal echocardiography, amniocentesis, chorionic villus sampling (CVS), Doppler imaging, USN Biophysical testing, and follow up examinations. Medical complications in pregnancy consists of managing or consulting on patients with chronic medical illnesses such as hypertension, diabetes, or any other disorder that may impact pregnancy. Need for support and consultation for these issues arises both before, during, and after the intrapartum (labor) period.

A significant amount of counseling due to medication exposure also falls under the purview of MFM. Changing Demographics Changing demographics also play a large role in the future of MFM. Assisted reproductive technologies like in vitro fertilization and fertility medicines are resulting in more complications involving multiple birth and complications from the medicines themselves. More women are also delaying childbirth to later years due to career or life planning which is leading to increasing risk in pregnancies.

The litigation threat over the industry also plays a role in demand for MFM consultative services. Existing Competitors Brigham and Women’s – This is a large, well-funded, and well-known group originating out of Boston, MA. They are affiliated with the Harvard Medical School and so gains leverage and notoriety from that relationship. Many of the physicians are also faculty members of the medical school. * Designation as a Center of Excellence for Women’s Health. Designation was created in 1996 to recognize those institutions that brought all of the facets of women’s health into one center.

Handed out by DHHS (www. hhs. gov) * Ranked as one of the Best Hospitals by US News and World Reports for the 18th consecutive year. Specifically, #3 in Gynecology, but not obstetrics. The moniker of “women’s health” though allows them to claim “we are one of the best for women’s health. ”  Women will interpret that as obstetrical care as well. (http://www. brighamandwomens. org) Branches in Milford, Foxborough both within easy driving distance from Rhode Island. * Is a rival of Tufts Medical School who WIHRI has a relationship with. (Strategy? )

Beth Israel Deaconess Medical Center – Similar to B&W in that it is also a teaching hospital of Harvard Medical School. (http://www. bidmc. org) * Does not carry the Center of Excellence in Women’s Health designation and does not have similar rankings in national magazines and such. Locations in and around Boston offer direct competition. : University of Massachusetts, Tufts Medical School * Both are medical schools with MFM faculty but are likely less of an impact in terms of marketing and market share. * The Harvard schools are more of the marketing bears in the neighborhood. In addition, WIHRI already has a women’s health relationship through the Reproductive Endocrinology/Infertility (REI) dept. with TUFTS that it is trying to expand to include MFM and the other women’s health specialties. Potential New Competitors Steward Health Care System (http://www. steward. org) – Large network of hospitals throughout  MA. They have several hospitals right along the RI border and are acquiring more. They have an affiliated medical group with its own MD’s. This is where the competition will mainly come from.

This system does not have the gravitas of the medical school affiliated programs, but they are a for-profit , private entity that provides competition more along the lines of the “patient experience. ” There are no doctors in training here. All are fully trained MD’s that will take care of you directly. “Servicescape” is geared entirely toward comfort, ease of access, etc. Summary 1. Competition and threats come from two sources – private systems offering patient experience and academic centers offering academic expertise 2. WIHRI can be competitive in both arenas, but will need to target different populations for each. . Will be extremely difficult to supplant the Harvard system in Boston, but may be able to contain. Will need to develop “something different” to distinguish WIHRI from those. 4. Will also need to build relationships for referral patterns. 5. Will need to consider affiliations (Steward? ) for possible synergy of effort instead of direct competition. This can be thought of as a potential opportunity instead of competition. WIHRI is an academic based entity with Center of Excellence designation. Strategically, adding a private, patient experience piece may add real value.

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