Competitive Analysis Strategic Project Shyree Shepeard

HSAD 550-900: Planning in the Era of the Affordable Care Act Spring 2015-16Competitive Analysis and Strategic Recommendations Project Shyree Lanee Shepeard

Introduction

Delaware’s healthcare system has made many strides within the last decade. However, mental illness is tasked at being one of the critical drivers for healthcare inflation according to data from Delaware State Medicaid (Community Health Needs Assessment, 2013. Major hospital systems and behavioral health hospitals and practices are making strides to increase the quality of mental health given and access to it for patients within the state. Bayhealth, the state of Delaware’s second largest healthcare system has yet to answer the call to providing care for the states mentally ill. The healthcare system would benefit from a strategic plan that would increase their position within the state’s healthcare market as well as address the unmet need of providing mental health services to the thousands of patients they see yearly. The first section of this analysis will take a look at the strengths, weakness, opportunities and threats of the mental health market and Bayhealth. This will drive strategic recommendations to maximize the hospitals success within the community and help patients get well.

1.0 Bayhealth & Delaware Mental Health Market SWOT

Strengths Weaknesses

Inte

rnal

-Largest healthcare facility in Central and Southern Delaware-Multiple facilities

-Focus on improvement one life at a time- Grow and develop quality clinical

programs

-Bayhealth is second to Christiana Healthcare, the largest healthcare system in the state of Delaware- Lower than national average

patient/provider communication survey results

-No employed mental health professionals

-Weak alliance with community mental health facilities

Opportunities Threats

Ext

erna

l

-Over 50% of adults and adolescents with any mental illness not receiving treatment

or counseling-Adolescents in Delaware report higher

than national average improved functioning from mental health treatment

-14 Mental health facilities in central and southern Delaware

-Obesity initiative priority-Sussex County new free standing psychiatric hospital top open mid

2017

Drexel University, CNHP Faculty: Spencer R. Ward, Ph.D.document.docx Page 1


2.0 Delaware, Bayhealth and the Mentally Ill.

Current patient data within overall and mental health markets present a significant opportunity for Bayhealth to invest in programs which support their vision and mission. Data reported from the state of Delaware Community Health Status Assessment revealed that income disparities are indicators of overall health status (State of Delaware Community Health Status Assessment, 2013, p. 9) In figure 1, data from the US Censes Bureau shows that Kent and Sussex Counties are lower than New Castle County in the percentage of students who graduate high school as well as the percentage of people with bachelor’s degrees. Figure 2 shows the median household and per capita income are lower in Kent and Sussex Counties compared to New Castle. Figure 3 also demonstrates the poverty differences between the Counties, with New Castle having the lowest poverty in the state (Quick Facts, New Castle, Kent & Sussex Counties, Delaware, n.d.). The percentage of patients without insurance was the lowest in New Castle County compared to Kent and Sussex Counties at 8.6%, 9.2% and 11.5% respectively (Quick Facts, New Castle, Kent & Sussex Counties, Delaware, n.d.). Overall, the Kent and Sussex county population is at an economic disadvantage compared to New Castle county. These Counties make up the patient population which Bayhealth serves.

Figure 1

New Castle County

Sussex County

Kent County

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

Delaware Education Statistics

Bachelor's degree or higher, percent of persons age 25 years+, 2010-2014High school graduate or higher, percent of persons age 25 years+, 2010-2014

(Quick Facts, New Castle, Kent & Sussex Counties, Delaware, n.d.)



Figure 2

New Castle County

Sussex County

Kent County

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000

Delaware Income Per County

Per capita income in past 12 months (in 2014 dollars), 2010-2014Median household income (in 2014 dollars), 2010-2014


Figure 3

New Castle County

Sussex County

Kent County

11 11.5 12 12.5 13 13.5 14 14.5

Persons in poverty, percent


When analyzing the mental health population from the years 2009-2013, close to 73,000 (57%) people with any mental illness did not receive treatment per year for their illness (Substance Abuse and Mental Health Services Administration Page 9). Of the 6000 adolescents with a Major Depressive Episode, half did not receive treatment for their depression (Substance Abuse and Mental Health Services Administration Page 7). This demonstrates a significant unmet need and opportunity in the mentally ill population for the state. Especially in an economic environment where people are not thriving from an educational and financial perspective and have lower rates of access to health insurance.

Bayhealth’s position as the largest healthcare system in Kent and Sussex Counties puts it in a strong position to address the mental health need. The healthcare system has two hospitals, a free standing Emergency Department, satellite facilities, and employs over 3000 people and over 400 physicians to serve the Kent and Sussex communities (About Bayhealth Central Southern Delaware Bayhealth, n.d.). In 2014, the hospital reported over 90,000 ED visits, over 18,000 patient admissions and almost $50 million in unreimbursed care to patients (About Bayhealth Central Southern Delaware Bayhealth, n.d.). The organizational goal is healthcare improvement, Drexel University, CNHP Faculty: Spencer R. Ward, Ph.D.document.docx Page 3


one patient life at a time and the mission is to continuously grow, develop and implement clinical programs of maximum quality (About Bayhealth Central Southern Delaware Bayhealth, n.d.). This mission and vision strives for a focused patient-centric healthcare system which qualifies success based on individual patient outcomes.

There are areas for concern, or weaknesses that could hinder Bayhealth taking on a strategic position in the mental healthcare market. In a survey of patient experiences, Bayhealth ranks below the state and nation when rated on how well doctors communicated with patients (Hospital Compare: Data sources, n.d.,). Of the hospitals 63 services offered to patients, mental or behavioral health isn’t among them. In addition, the hospital has a weak alignment to the community mental health facilities.

The opportunity for Bayhealth lies within the statistics of the unmet need within the mental health community. Although there are currently 15 mental health treatment facilities within Kent and Sussex counties, over 50% of patients with any mental illness are not being seen by a healthcare professional (National Directory of Mental Health Treatment Facilities 2015.)

The external threats within the marketplace focus primarily on Bayhealth’s number one competitor and the largest healthcare system in the state. Christiana Care Health System’s behavioral health program has seen more than 3,100 patients totaling over 8.500 sessions (Christiana Care outlines expansion of behavioral health services | Delaware Business Now," n.d.). Because of its’ size, Christiana Care’s capability to penetrate into the Southern Markets also present an threat to Bayhealths position within the market.

3.0 Strategic Goals

The Bayhealth strategic plan focuses on four key areas. The first, Access and Growth has a goal to develop and grow clinical programs, facilities and physician practices of good quality. Their strategic goal for operational excellence focuses on providing an “exceptional care experience for patients, families, physicians and employees” (Strategic Plan, n.d.). The strategic goal for clinical integration focuses on developing a system of integration aligned with physician partners. The final strategic goal is brand promise. This focuses on presenting a set apart healthcare system to the community (Strategic Plan, n.d.).

In addition, Bayhealth conducted a community health needs assessment in 2013. Based on the assessment, the top priorities for the organization are; 1. Obesity, 2. Cancer, 3. Access to Health Services, and 4. Mental and Substance Abuse (Community Health Needs Assessment. (2013). One of the strategic initiatives for the access to health service priority is to “provide the range of physician services needed in the community” (Community Health Needs Assessment. (2013). One of the strategic initiatives for the mental and substance abuse priority is to “support or immplement programs that assist mental health patients.” (Community Health Needs Assessment. (2013).

4.0 Competition

1.0 Christiana Healthcare SystemDrexel University, CNHP Faculty: Spencer R. Ward, Ph.D.document.docx Page 4


1.1 Christiana Healthcare System is headquartered in Wilmington, Delaware.1.2 Overview/Profile

Christiana Care Health System is the state of Delaware’s and one of the nations largest health care providers. It ranks 21st for hospital admissions in the nation. The teaching institution comprises two campuses with more than 1,100 beds ("About Christiana Care Health System," n.d). The health systems behavioral health serves more than 3,100 patients.

1.3 Competitive Advantage As one of the top hospitals in the country, Christiana Care Health System is poised to lead the way for innovation. Leading the way in patient admissions and revenue, the organization is in a better financial position to bring new products and services to market. The healthcare system is fully integrated into the community with many owned outpatient practices and clinics, making continuity of care easier to obtain.

1.4 Target MarketChristiana Care serves patients in all of Delaware, parts of Pennsylvania, Maryland and New Jersey (Career opportunities at Christiana Care Health System, n.d.). This market is the largest of the competitors.

1.5 Product/ServicesChristiana Care Health System offers over 100 services to meet the needs of the healthcare community. The behavioral health services they offer are unique to the hospital.

2.0 Nanticoke Health Services2.1 Naticoke Health Services is primarily located in Seaford, DE which is located in

Sussex County. 2.2 Overview/Profile

Nanticoke Health Services is made up of Nanticoke Memorial Hospital and Nanticoke Physician Network. The hospital has a total of 94 staffed beds, making it the smallest hospital and healthcare system of the competitors for this analysis. The Nanticoke Physician Network comprises 35 employed physicians and healthcare providers (Mission & Vision, Nanticoke Health Services, Seaford, Delaware, n.d.).

2.3 Competitive Advantage When compared to Christiana Care and Bayhealth, Nanticoke scored the highest for patient reported physician communication. It also was the highest rated hospital between the three for overall patient rating of 9 or 10 (Hospital Compare, n.d.).

2.4 Target MarketThe Nanticoke Hospital and Physician Network serve the communities of Laurel, Bridgeville and Georgetown, Delaware as well as in Federalsburg and Hurlock, Maryland. In addition, this group operates three Immediate Care locations in Seaford, Laurel, and Georgetown

2.5 Product/ServicesNanticoke Offers over ten services throughout the hospital. They also offer outpatient, and hyperbaric services. Within their physician network, psychology is not a hired specialty.



5.0 Marketing Differentiators

Website: The website for Bayhealth is much more patient and user friendly. The ER wait time on the home page make the website a key draw for any patient in need of urgent care. You can find a doctor relative to your location and request an appointment from the home page. Also you can email current patients at the hospital which appeals to the company’s mission of improving care one patient at a time.

Because Christiana Care is a larger health system, the homepage on their website is more reflective of a major health organization without the user friendly appeal. The website highlights the prestige of the organization and it’s overall commitment to healthcare, highlighting four key health areas at the bottom. Across the top you can search for a doctor however, the user friendliness of Bayhealth is more suitable for a mental health patient in need of personal care. Nanticoke’s website also highlights a user friendly homepage with the patient being able to see the wait times and also schedule their place in line from the computer. Both Bayhealth and Nanticoke are at an advantage over Christiana Care with the website capabilities. They both serve smaller areas so theoretically one could assume they have the technological capabilities to handle the traffic.

Location: Bayhealth is the largest healthcare system in Kent and Sussex counties. Given the population statistics and overall mental health market in the State of Delaware, Bayhealth is in position to create a service for patients who are mentally ill.



Local Market: This presents a disadvantage to Bayhealth. Without a foot in the mental illness market, the majority of patients are in local state mental facilities, hospitals and private practices. With over 15 private healthcare facilities in the lower part of the state, there is still a disadvantage to the over 50% of mentally ill patients who are not being seen by a provider.

6.0. New Product/Service Recommendation1.0 Because Bayhealth has a strong presence in both Kent and Sussex Counties in the state of

Delaware, I recommend an addition of a Tele-Behavioral Health Program to help meet the needs of the patients who are not being seen by a mental health provider. The Bayhealth mission of helping one patient at a time and their personal approach to care make a tele-behavioral health division ideal to suit the unmet needs of mentally ill.

1.1 Mission The mission of the Tele-Behavioral Health Program is to increase access to patients in need of behavioral health services.

1.2 ServicesThe Tele-Behavioral Health Program will be a three-part program:

1. Use tele-psychiatric & tele-therapy services for patients to have access to care 2. Allow patients to schedule time privately with using the scheduling

capabilities of Bayhealth’s website. 3. Be on hand for in-patients in need of immediate behavioral health evaluations.

1.3 Staffing The Tele-Behavioral Health Program will initially staff 3 Tele-Psychiatrists, 2 Advanced Nurse Practitioners, and 2 Tele-Psychologists/Therapists. One of the tele-psychiatrists will need to live locally to be able to serve as the director for the program and be on hand for strategic planning and program program evaluation.Location The Tele-Behavioral Health Program will be located virtually, which means it will not need any additional space or building.

1.4 Customer Description Patients who will benefit from this program are Delaware’s patients with any mental illness who haven’t been seen by a mental health professional. These are also patients who live in a lower socioeconomic part of the state and so the program will eliminate the burden and cost of travel to either Dover or Milford. An internet connection will allow them to have one on one care with a mental health professional. The program will be for adolescents ages 14 and over. The rational is that kids younger than 14 will not benefit from tele-behavioral health care and need more focused personal care.

1.5 Ideal Customer Needs Ideally the patients looking for this services are looking for care to help them with their mental illness in a private way so they don’t have to deal with public stigma. They are looking to get their life back on track but need to get over the hurdle that is



currently keeping over half of those dealing with mental illness from seeking care. This program will meet the needs by literally meeting the patients where they are.

1.6 Payers This program will be an addition of the Bayhealth Healthcare system. Patients will need to have accounts with Bayhealth to access the system which would allow them to schedule appointments. The program will accept commercial insurance, Medicare and Medicaid. The program will also accept cash. What will be essential is that patients will have to log in and create profiles in the system which their medical information will be stored.

7.0 New Strategic Benefits

Data from the American Hospital Association shows that close to 30% of patients with medical conditions also have mental health conditions (Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, 2012). This presents an opportunity for Bayhealth to capture patients during any point of care and provide behavioral health services. In addition, a Tele-Behavioral Health Program would be the only all tele-medicine mental health program available by a major Healthcare system in the state. Taking advantage of Bayhealth’s goal of an an intimate patient experience, the Tele-Behavioral Health Program would put the organization at a significant advantage.

Figure 4

1.0 FinancialThe financial benefit the Tele-Behavioral Health Program can offer the hospital is a significant reduction in total hospital costs. With the average length of stay for all illnesses at 4.6, the number is increased for patients with mental illnesses at 7.2 length of stay days (Hospital Inpatient Care, FastStats - Mental Health, n.d.). In total, the state of Delaware ranked mental disorders as the third highest increase of hospital admissions at 30% from the year 2001-2004 (Delaware Hospital



Discharge Report, n.d.) Treating the illness and integrating a program targeting patients downstate can reduce the number of urgent admissions which will reduce overall hospital costs.

2.0 Operational The new program will provide an opportunity for Bayhealth to incorporate a integrated system of health that will cater to the individual patient. The Tele-Behavioral Health provider will be on hand for patients within the community as well as for staff who may be in need of urgent mental health evaluations for current patients in the hospital. This on demand care will reduce the wait for the hospital to reach outside of it’s network and reduce the possible disruption of care risk for their patients.

3.0 Market The Tele-Behavioral Health Program will be the first of it’s kind offered by a major health system for the Kent and Sussex counties. This presents an significant advantage over other hospital’s in the area and poises Bayhealth to continue to lead the way for innovative care.

4.0 Customer The reason behind this new initiative is the desire for Bayhealth to continue to provide an excellent patient experience and care. The customer will benefit from this program with personal behavioral health care and a system that will cater to and track progress. Future possibilities for this system include links to resources, personal reminders linked to their portable devices. All aimed at enhancing the patient experience while increasing access to early behavioral health care.

5.0 Bridging the Gap

The final reason for bringing this Tele-Behavioral Health Program to Bayhealth is to effort to bridge the gap. Data from the American Hospital Association highlights many reasons why patients who suffer from mental illnesses do not receive care. Not having the time, not knowing where to go for services, concerns about confidentiality, the fear of negative perception including job perception accounts for 57.8% of the reasons why patients are not receiving healthcare (Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, 2012). This presents a answer to a huge unmet need for patients suffering with mental illnesses.

8.0 Closing

As stated by the American Hospital Association, “Behavioral healthcare is fragmented” (Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs



and Outcomes, 2012). Patients seeking care have to pour through care in the inpatient and outpatient setting. Provider linkage challenges, shortages of facilities and providers are all challenges in the quest for optimal patient’s behavioral healthcare (Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, 2012). Bayhealth, has significant advantages being the largest healthcare provider in Kent and Sussex counties within the state of Delaware. Not having any investment into the behavioral health market presents a challenge for the company to implement an new program. The Tele-Behavioral Health Program meets this challenge with a program that will meet the needs of patients, address their challenges to care without using physical resources to incorporate.



Citations

1. Community Health Needs Assessment. (2013). Retrieved from Bay health Kent General website: http://www.bayhealth.org/media/file/CHNA%20Report%20Kent.pdf

2. Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Delaware, 2014. HHS Publication No. SMA–15–4895DE. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

3. “Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Behavioral Health Services Information Series: National Directory of Mental Health Treatment Facilities 2015, HHS Publication No. (SMA) 16-4939. Retrieved from: http://www.samhsa.gov/data/mental-health-facilities-data-nmhss/reports?

4. About Bayhealth Central Southern Delaware Bayhealth. (n.d.). Retrieved from http://www.bayhealth.org/about-us/about-us-home

5. Mission, Vision & Values. (n.d.). Retrieved from http://www.bayhealth.org/about-us/mission-vision-values

6. State of Delaware Community Health Status Assessment. (2013). Retrieved from Delaware Department of Health and Social Services, Division of Public Health website: http://www.dhss.delaware.gov/dhss/dph/files/shachsa.pdf

7. Christiana Care outlines expansion of behavioral health services | Delaware Business Now. (n.d.). Retrieved from http://delawarebusinessnow.com/2016/02/christiana-care-outlines-expansion-of-behavioral-health-services/

8. Hospital Compare: Data sources. (n.d.). Retrieved from https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=080004&stCd=DE&stName=Delaware

9. National Directory of Mental Health Treatment Facilities 2015. (2015). Retrieved from DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration website: hhttp://www.samhsa.gov/data/sites/default/files/2015_National_Directory_of_Mental_Health_Treatment_Facilities.pdf

10. Schmitt, B. (2016, February 29). Christiana Care Health System Boosts Access to Mental Health Care by Integrating Mental Health Experts in Primary Care. Retrieved from http://3f97c21cm2if3lrayt2ivf2v.wpengine.netdna-cdn.com/wp-content/uploads/2016/02/Christiana-Care-Health-System-Boosts-Access-to-Mental-Health-Care-by-Integrating-Mental-Health-Experts-in-Primary-Care.pdf

11. Christiana Care 2015 Year in Review by Christiana Care Health System - issuu. (n.d.). Retrieved from https://issuu.com/christianacare/docs/christiana_care_2015_year_in_review

12. Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes. (2012). Retrieved from American Hospital Association website: http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf

13. Hospital Inpatient Care, FastStats - Mental Health. (n.d.). Retrieved from CDC website: http://www.cdc.gov/nchs/fastats/mental-health.htm

14. Strategic Plan. (n.d.). Retrieved from http://www.bayhealth.org/about-us/strategic-plan15. Figures 1, 2, 3


http://www.cdc.gov/nchs/fastats/mental-health.htm

http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf

https://issuu.com/christianacare/docs/christiana_care_2015_year_in_review

http://3f97c21cm2if3lrayt2ivf2v.wpengine.netdna-cdn.com/wp-content/uploads/2016/02/Christiana-Care-Health-System-Boosts-Access-to-Mental-Health-Care-by-Integrating-Mental-Health-Experts-in-Primary-Care.pdf



https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=080004&stCd=DE&stName=Delaware

https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=080004&stCd=DE&stName=Delaware

http://delawarebusinessnow.com/2016/02/christiana-care-outlines-expansion-of-behavioral-health-services/

http://delawarebusinessnow.com/2016/02/christiana-care-outlines-expansion-of-behavioral-health-services/

http://www.dhss.delaware.gov/dhss/dph/files/shachsa.pdf

http://www.bayhealth.org/about-us/mission-vision-values

http://www.bayhealth.org/about-us/mission-vision-values

http://www.bayhealth.org/about-us/about-us-home

http://www.samhsa.gov/data/mental-health-facilities-data-nmhss/reports

http://www.bayhealth.org/media/file/CHNA%20Report%20Kent.pdf


Quick Facts, New Castle, Kent & Sussex Counties, Delaware. (n.d.). Retrieved from United States Census Bureau website: http://www.census.gov/quickfacts/table/PST045215/10001


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Competitive Analysis Strategic Project Shyree Shepeard

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