Running head: STRATEGIC PLANNING PROCESS MAP 1

Strategic Planning Process Map

Tawny Nichols

University of San Diego

ENLC557
STRATEGIC PLANNING PROCESS MAP 2

Step 1 - Set the Stage

ABC Company started in the early 90s by providing home health services in multiple

locations throughout southern California. By 1997, ABC Company had created an outsourcing

business of billing and coding and had sold their chain of home health agencies. Using ABC

Company’s custom EMR, ABC Company targeted home health agencies with a high percentage

of Medicare patients. As former providers, ABC Company sought to radically change the fraud

and abuse that existed before the creation of the Prospective Payment System (PPS).

Unfortunately, ABC Company has had a difficult time convincing home health agencies that

compliance, clinically, financially, and within data collection tools, is of the utmost importance.

ABC Company led the outsourcing market with innovative ideas and processes but has

continued to see competitor imitation diminish their competitive advantages. The intense

competition has left ABC Company asking “now what?”

ABC Company’s executive team consists of their Chief Executive Officer, Chief

Operations Officer, and Executive Vice President of Business Development. Reporting to the

COO is the VP of Operations, VP of IT, and VP of Data Science. Many functions were

centralized like compliance, ICD coding, and billing under a Director of Quality and Standards

who reports to the VP of Operations. The VP of IT oversees the network required to support and

maintain centralized functions, and the Director of Data Science oversees the data labs including

neural networks, classification, and principal component analysis.

ABC Company’s mission is to provide the best specialized service that radically transoms

the way their partners manage post-acute care. ABC Company values stewardship, radical

collaboration, and innovation. ABC Company’s vision is to challenge the status quo of post-

acute care and lead the industry towards incorporating technology that champions caregivers,
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family members, and patients. The strategic planning process will include the executive team,

vice presidents, directors and four supervisors. They will all participate in interviews, helping to

identify strategic areas, and articulating mission and core values. Only the vice presidents will be

responsible for developing strategies and writing out the action steps for their own areas.

However, all will responsible for carrying out the implementation and evaluation (Ebener &

Smith, 2015).

The key decision maker is the CEO who also controls the lion’s share of the board. His

vision is to empower younger team members to explore the benefits of implementing new

technology. However, the CEO is very limited in his understanding of technology and is

continually reverting to traditional ways of solving problems. Although he firmly believes in

allowing others to make critical decisions, he has shown a tendency to fight against it. This

tendency is especially true when strategies do not produce results within a few weeks. The CEO

tends to abandon the plan in favor of implementing newer ideas that he has recently developed.

The most significant external assumption is that since Medicare has announced a new

payment reform, ABC Company will most likely see a decrease in reimbursements or will need

to change their current practices to accommodate this reform. Also, the creation of lower quality

imitations has resulted in assumptions that most of the market will not pay for high-quality

review services. Internally, older thinking around services has to produce assumptions that

automation or technology will not be able to make a significant impact on effectiveness. Some of

ABC Company’s leaders would prefer to see technology replace labor and not assist services.

Their crucial assumption is that technology products have a higher profit margin and this would

be better suited for ABC Company’s profitability desires. Other ABC Company leaders disagree
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and have made assumptions that shifting from services to technology is not as direct as it may

appear.

However, it is the opinion of all ABC Company’s leadership that the Home Health

industry has fallen behind the times and must change its traditional practices by accommodating

as much technology in their practices within a patient’s home and within their centralized

operations. The most significant mandate is that technology must be implemented to solve these

problems by either building the solutions internally or purchasing technical solutions. The

strategic planning process will help determine the specific question that ABC Company is

hoping to address. Implementing technology may appear like a straightforward request, but not

understanding why or how to measure the success of the implementation can cost companies

wasted time and resources. By establishing a solid planning team, the facilitator can help

maintain a positive environment, keep the group focused, and encourage everyone to think

strategically.

Step 2 – Do Your Homework

On the surface, ABC Company appears to be similar to most services companies within

home health. They have a strong loyalty to patient care and believe that home health can be a

viable option for reducing cost. Unlike the vast majority of their competitors, ABC Company

refuses to use taxpayer dollars by offshoring their services and continues to hire coders as

employees. Unfortunately, their objectives often change depending on external demands from

clients while the long-term planning sessions remain a work-in-progress. The leadership is eager

to perform, but there is little direction within the contradictory visions provided. A strategic plan

will help drive change at the core of ABC Company’s leadership (Ebener & Smith, 2015).
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By far, the most substantial strength of the company is its management experience within

home health services. Also, technology leadership has a strong business knowledge of home

health services and tracks current healthcare technology trends. ABC Company’s 25-years in the

home health market drives a level of insight and understanding of the problems facing the post-

acute industry that creates a competitive advantage. ABC Company has chosen to invest in

research and development which has produced the structure to support clinical decision

technology. ABC Company is committed to maintaining healthy and productive relationships

between lead members of the clinical department and lead members within the technical

development and data science teams.

Communication is the most significant weakness of the organization. While much effort

has been made to bridge the gap between clinical and IT, significant communication gaps still

exist within the executive team. Formal decisions between key team players are often replaced

or overruled by informal decisions between a few players without any tracking, notification, or

accountability. Also, due to budget constraints, key resources are required to perform multiple

roles which prevent initiatives from moving forward to completion promptly. Technically, it is

imperative that ABC Company address its fragmented applications. By optimizing its technology

platform and consolidating its technology stack, ABC Company can reduce operating costs.

The opportunity is clear – Home Health growth will outpace the rest of healthcare growth

over the next decade. The primary driver for this growth, the size of the population approach

70+, cannot be impacted by any policies and market factors. More people will need home health

services. When you combine this fact with price pressure and an industry-wide effort to shift

more care to the home setting, it becomes clear that solutions that improve the management of

home health patients or streamline home health processes will have a growing market with
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significant demand for results. The affordable care act has opened the door for additional

information about payment reform, value-based purchasing, and risk adjustment which supports

informed decision making through healthcare analysis. Compared to the majority of providers,

ABC Company is well positioned for the PPS final rules for Conditions of Participation which

have put more pressure on new quality reporting and efficiency measures for appropriateness in

home health. This transparency has created a wealth of data for ABC Company to make better

business decisions.

The most dangerous threat comes from changes in either policy supporting home health

efforts or funding for home health. Value-based purchasing will most likely lead to direct

competition between multiple post-acute providers which will mean that home health agencies,

skilled nursing facilities, and other long-term care providers will be competing for the same book

of business. This market competition, combined with increased pressure to reduce healthcare

costs and with the high cost of skilled workers, will require multiple innovative models and

diversification of services. The most significant short-term threat is a potential drop in revenue

from Medicare payment reform. Craving out a competitive edge among the ambiguity is

imperative.

ABC Company is in a strong position to meet the demands of pending environmental

change within the niche market of home health. Its staff is knowledgeable of its industry and

service offerings but struggles to manage changing priorities. Although the team is highly

motivated to deliver on commitments, lack of clear vision and resource constraints make the

work environment challenging. Fortunately, ABC Company’s opportunities for growth far

outweigh its threats of political insecurity. ABC Company’s investment in technology and

clinical expertise has allowed the company to remain focused. With the right strategic plan,
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ABC Company is in a stable position to lead its industry through these uncertain yet exciting

times.

Internal External

Positive Strengths Opportunities

 Strong leadership team  Unprecedented Home Health market
 High investment in R & D growth
 Reputation for compliance  PPS final rule for conditions of
 Over 25 years of experience participation
 Clinical analytic solutions  Affordable Care Act
 Strong reputation and name  Post-Acute Care Measures require
recognition in marketplace risk adjustment
 Home Health lagging in response to
shared risk models
Negative Weaknesses Threats
 Poor communication, cross-  Political insecurity
functionality and within departments  ACO model will cause more direct
 Fragmentations within IT platform competition to provide a VBP
 Key resources covering too many solution
roles  Increased pressure of reduction in
 Inability to hire new staff timely healthcare costs
 Over-reliance on a push strategy in  Cost of highly skilled workforce
marketing  Potential loss of revenue from
payment reform

Step 3 – Describe Your Culture

ABC Company values integrity, teamwork, and solving problems. ABC Company’s

mission is to provide the highest quality of medical coding and home health documentation

review to assist providers in giving the highest quality of medical care that allows patients to

remain in the home. There are four mission critical elements:

 Commit to the success of our clients by applying integrity-based ingenuity to create

specialized health care solutions

 Provide dynamic learning environment for our people that rewards team behavior

 Be recognized within the health care community as the business processing standard
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 Provide a meaningful and positive return to our stakeholders.

According to Ebener and Smith 2015, the institutional business portion of the mission

statement should state what is being provided by the business. ABC Company’s mission

statement might be limiting if it is only to provide quality coding and documentation review. The

institutional purpose should identify social drive and the benefit to society (Ebener & Smith,

2015). Instead, a better mission statement would be to provide the best specialized service that

radically transforms the way our partners manage post-acute care. With this statement, ABC

Company’s social purpose is to assist the provider in removing functions that distract from the

delivery care. When coding is identified accurately, a clinician is more likely to develop a

holistic treatment plan that accounts for patient’s complexity. The implied social value is that

patients prefer to remain in their home for delivery of care instead of in the hospital or a long-

term facility. The institutional values ought to add some color to the “what” of the business plan

and the “why” of the social purpose (Ebener & Smith, 2015). The values implied by the mission

parts are ingenuity, teamwork, excellence, and profitability. Perhaps the four elements could be

reduced to just four words as Ebener and Smith suggest.

Step 4 – Frame the Question

The top three strategic areas of concern for ABC Company is that their overall costs are

higher relative to key competitors, there are fragmentations within the IT platform, and that

critical resources are covering too many roles. Total costs are comprehensive, essential, and

changeable. The issue for ABC Company is not whether it is possible to change in a positive

direction but whether the company has control over this change. ABC Company may not have

control over labor wages that are dependent on a market with supply and demand contingencies,

but they do have control over the value of services provided at the price they are charging
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(Ginter, Duncan, & Swayne, 2013). Perhaps the action for ABC Company is not only to lower

costs but add additional services that have a perceived higher value.

If ABC Company can address the fragmentations with the IT platform, the cost of

development will drop significantly, and the speed of getting new functionally with value will

increase. This strategy is comprehensive because the entre services model rests on the platform.

If the platform broke, it would have a critical impact on ABC Company’s ability to deliver its

services. ABC Company can integrate its platform with new technologies and has a talented

development team who can control this strategic area.

The last strategic area focuses on the lack of resources. In the past ABC Company has

tried to lower cost by removing management positions to eliminate overhead. However, this has

limited their ability to finish strategic projects. Competencies and capabilities can be a dominant

source of sustained competitive advantage (Ginter, Duncan, & Swayne, 2013). Adding more

management positions will significantly change the organization for the better by providing more

people for maintaining strategic momentum. ABC Company does have the ability to control this

by hiring more people to manage the goals needed for other strategic areas.

Step 5 and 6 – Answer the Question and Get Specific

ABC Company’s top three strategic areas are 1) their overall costs are higher relative to

key competitors, 2) there are fragmentations within the IT platform, and 3) critical resources are

covering too many roles. In hopes of reducing costs, ABC Company’s strategic goal is to

automate the data entry processes. Action step 1 is the Web Developer will access the EMR’s

toolkit (Allscripts, Cerner, and EPIC) and familiarize themselves with the syntax for retrieving

patient records, inserting diagnosis codes, and updating workflows within two weeks. Action

step 2 is the Web Developer and Nurse Informaticist will collaborate to provide the Web
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Developer with specific functionality and requirements within two weeks. Action step 3 is the

Web Developer will build the new feature to reflect each EMR’s different syntax for finding a

patient record, inserting diagnosis, and updating the workflow within two weeks.

The strategic goal that addresses fragmentations is to assign 50% of the next three sprints

to reduce technical dependencies on retired applications. Action step 1 is the System Architect

will identify all old relationships and create a new environment while each Developer works on

their applications to build their functions in the new system in the first sprint cycle (4-6 weeks).

Action step 2 is each Developer will work on their code to remove all dependencies and ensure

that the functionality will still work without these dependencies in the second sprint cycle (4-6

weeks). Action step 3 is Developers will fix all bugs caused by gaps between the old and new

system and ensure that all previous functionality is intact in the third sprint cycle (4-6 weeks).

Since critical resources are covering too many roles, the strategic goal will be to expand

the quality department. Action step 1 is the VP of Operations (VP) will hire a person to fill the

Director of Quality (Director) within four weeks. Action step 2 is the new Director will hire two

QA reviewers within four weeks of being hired. Action step 3 the VP will work with the

Director to transition all quality responsibilities within the first 90 days of the Director’s hiring.

Step 7 – Discover the Vision

ABC Company’s vision is to challenge the status quo of post-acute care and lead the

industry towards incorporating technology that addresses the growing crisis of chronic disease in

the United States. ABC Company’s leaders value patient engagement, especially with chronic

illnesses, and believe that family members and personal caregivers matter in this endeavor. We

believe that post-acute care in a non-institutional setting is the best long-term solution. We think

that doing what is best for the patient requires assisting providers in navigating regulatory
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change, payment reform, and advanced data technology. We forecast that the consolidation of

post-acute providers is inevitable and desire intentionality in solving significant problems within

the continuum of care. If post-acute care expenditures remain a fracture of hospital and physician

expenditures, it is easy to understand why a venture capitalist or large data labs have not invested

in this sector. If there are organizations that have been profitable under these systems, why have

they not invested their profits in data? Healthcare is just beginning to see some of the challenges

with the clinician shortage and elderly population growth so if the status quo providers are

having issues now, what will ten years bring?

We challenge shortsightedness, outdated strategy, and wishful thinking that technology

alone will solve our problems. Since data is the new currency, we will respect data collected for

CMS by providing services and education regarding data compliance. Since patient life revolves

around the home, we will recognize patients and family members as managing partners by

building tools that lead clinicians in designing treatment plans for non-clinical caregivers. Since

multiple post-acute care options are available, we will encourage the freedom of choice based on

objective, quantifiable data by developing a provider standard. Most importantly, we will do all

of this through evidence-based practices, the hard work of data science, and investment in

research and development. This endeavor will not be comfortable, but it will be good.

Step 8 – Hold Yourself Accountable

ABC Company needs to establish revenue growth strategy objective, to increase service

revenues by aggressively growing their market share in the post-acute segment, and a

productivity strategy objective, to improve operating effectiveness though staff competency and

technology (Ginter, Duncan, & Swayne, 2013). First, business development will be responsible

for expanding coding services to incorporate all of the post-acute care opportunities such as long-
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term skilled nursing facilitates. Second, the quality team will focus on creating education to fill

gaps between experienced coders and coders without any work experience. Third, ABC

Company’s data lab team will implement Natural Language Processing (NLP) scripting for

physician documentation to expedite the capturing of clinical data required for coding to cause

cost reduction. Lastly, ABC Company’s development team will progress in data integration and

record abstraction to assist with services and optical character recognition OCR to also help with

cost reduction.

The plan will immediately focus on the VP of Data Science who will narrow the data labs

scope and finalize project plan within two weeks. Data Scientist A will utilize NLP libraries and

provide proof of concept within one month. If successful, Data Scientist B will incorporate

libraries into Computer Assisted Coding (CAC) models within one month. The data lab team

will be successful when the CAC utilizes physician documentation for coding predictions with

an accuracy threshold higher than 90% and applicable relativity of at least 70% within three

months.

During the first three months, the EVP of Business Development will complete a market

research analysis complete with a service package offering for post-acute coding services. The

EVP will collaborate with Director of Quality will develop requirements of services analysis

within one month. The CEO will review the report to determine when the expansion will be

profitable and capital required for cash flow within two weeks. The new services description will

be added to the offerings for the sales and marketing team. The marketing campaign will start by

month four. ABC Company will know they are successful when the first non-home health only

contract is signed within six months.

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By month six, the Director of Quality will produce a comprehensive education package to

assist less experienced coders. Quality Analyst A will write new education material for OASIS

& Home Health Coding basics and submit to the quality team for review within three months.

Quality Analyst B will write education material for Pathophysiology & Pharmacology and

submit to the quality team for review within the same three months as above. The Director of

Quality will finalize and provide final content to the development team within one month.

Developer A will display content within education portal within one month. The Quality team

will be successful when the first inexperienced coder passes the coding exam with a minimum

score of 95% within two weeks of launching the program.

After the completion of the data labs’ predictions, the VP of IT will narrow data

collection scope and finalize project plan. Developer A will build document collection tool for

computer generated documents within one month. Developer B will create document collection

tool for non-computer generated (handwritten) records within three months. The Project

Coordinator will facilitate collaboration between development and the Nursing Informatics to

determine capture requirements within one week of any request for clarification. The collection

tool for computer generated documents will have a recognition rate higher than 90% within six

months. The collection tool for non-computer generated records should read a minimum of 40%

of documentation elements within nine months.

Within three months, all project scopes and requirements should be finalized. At this

time, the first accountably session will take place with executive teams. These accountability

sessions will occur every three months in evaluate, reconsider, and update the strategic plan

(Ebener & Smith, 2015). Also, since the data labs project has significant risks, a strategic

thinking session will take place after three months to focus on technical change and determine if
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contingency planning is needed (Ginter, Duncan, & Swayne, 2013). After six months, another

strategic thinking session will occur with executive team discuss any adaptive change that is

required, especially as it relates to updated in government regulations implemented at the

beginning of next year (Ebener & Smith, 2015). These sessions will help ABC Company identify

priorities and create a sense of urgency for what will help make a significant difference in the

organization.
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References

Ebener, D.R. & Smith, F.L. (2015). Strategic Planning: An Interactive Process for Leaders. Mahawal,
N.J.: Paullist Press.
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2013). Strategic Management of Health Care
Organizations. San Francisco, CA: Jossey-Bass Imprint.