HCM 415 Module 4 Project One Example

Project One: Where Ashford Valley VNA Stands, a Situational Analysis

[Student Name]

Southern New Hampshire University

HCM 415: Healthcare Strategic Management and Policy

Project One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project One: Where Ashford Valley VNA Stands, a Situational Analysis

Module Two scanned the forces that affect every home health agency. This project narrows the lens to Ashford Valley Visiting Nurse Association's own market and its internal condition. It defines the service area, estimates who holds which share, describes competitors and the forces that shape their behavior and then builds a SWOT analysis whose entries each rest on an internal figure or a published study. The analysis ends with paired strategic options and three issues the strategic plan must resolve.

The Service Area

Ashford Valley serves four counties with about 410,000 residents, of whom roughly 19% are 65 or older. The area includes a small city with the region's three hospitals and large rural stretches where a single visit can mean a 45-minute drive each way. Using Medicare public files and agency intake data, the planning office estimates about 9,800 home health admissions a year in the area across traditional Medicare, Medicare Advantage and Medicaid. Referrals come mainly from hospital discharge planners, primary care practices and specialist clinics.

Market Share

Ashford Valley's roughly 3,040 admissions give it about 31% of the market. Three for-profit agencies and a cluster of small local providers share the rest. The largest newcomer, a regional chain acquired by a private equity firm four years ago, has grown to about 18% in that time, largely by hiring nurses away with signing bonuses and by courting two large primary care groups. No hospital in the area owns a home health agency, which is unusual and explains why the health system's plans matter so much.

Table 1. Estimated Home Health Admissions and Share, Four-County Area

Note. Estimates by the planning office from Medicare public files and intake data; figures rounded.

Competitor Profiles

National chain A is efficient and well capitalized, with a four-star quality rating and strong ties to the city's orthopedic surgeons, and it focuses on short post-surgical episodes. National chain B has a two-star rating and has been losing share. The private equity backed regional chain is the most aggressive. Zhu et al. (2025) documented private equity acquisitions of home health agencies across the country, organized by year, fund size and location, which confirms that such owners are an established part of the industry, not a passing experiment. Their incentive to grow quickly and sell within several years shapes how this competitor recruits and prices.

The Health System as Partner or Rival

Kestrel Health, the three-hospital system that sends Ashford Valley 41% of its referrals, is not yet a competitor but could become the most important one. It has announced plans for a hospital at home program and has asked several agencies about partnerships. Levine et al. (2020) found that hospital-level care at home cost less than hospital care and reduced readmissions, so the system has strong reasons to proceed. It could build its own home health capacity, buy an agency or contract with one. Each path would change Ashford Valley's market overnight.

Forces Shaping the Market

Five forces shape how much value any agency can keep. Referral sources hold real power because patients rarely choose an agency without advice. Medicare Advantage plans hold growing power over price. Nurses, the key input, hold strong bargaining power in a tight labor market. Substitutes include skilled nursing facilities and, soon, hospital at home. New entry is relatively easy because home health needs little capital, as the regional chain showed. Together these forces explain the market's low margins and why scale, quality and referral ties matter more than price.

Using SWOT Carefully

SWOT is familiar, but it is often misused. Van Wijngaarden et al. (2012) examined SWOT in health care organizations and found that it tends to produce long lists based on the opinions of whoever is in the room, with little prioritization and weak links to the strategies that follow. They argued it works better when combined with data and when participants are clear about which factors are truly internal. To follow that advice, each entry below cites internal data or research, and the list is kept short enough to act on.

Strengths

Four strengths are supported by evidence. Of all agencies in the four counties, Ashford Valley alone is nonprofit and offers hospice alongside home health, which gives it a continuum from recovery to end of life that no competitor offers. Its patient experience survey scores rank at four stars, above all three for-profit rivals. Its heart failure remote monitoring program, covering 90 patients, recorded 30-day readmissions of 11% last year compared with 19% for similar agency patients not enrolled. And its 41% share of Kestrel referrals reflects decades of trust with discharge planners.

Weaknesses

The weaknesses are equally concrete. The registered nurse vacancy rate is 17%, and about 1,100 referrals were declined last year. The overall quality star rating is three, driven mostly by hospitalization and timely initiation of care. An audit found about 9% of admission assessments understated function, lowering payment. The operating margin is near 0.6% and days cash on hand stand at 34, leaving little room for investment. The scheduling system is twelve years old and cannot optimize routes, so nurses in rural areas spend up to a third of their day driving.

Opportunities

The opportunities flow from the scan. The older population will grow for at least a decade. Value-based purchasing can raise Medicare payment by up to 5% for agencies that improve, and Li (2024) showed that care from the highest-rated agencies reduces hospitalization, which gives hospitals and plans reason to prefer them. Kestrel's hospital at home program could use Ashford Valley nurses for the recovery phase that follows the acute stay. And Medicare Advantage plans building quality networks may reward agencies that can prove results.

Threats

Four threats stand out. Medicare Advantage rates are below traditional Medicare, and the share of these patients keeps rising. Nurse wages have increased about 6% a year while Medicare updates lag. The private equity backed chain continues to offer signing bonuses and has hired eleven of Ashford Valley's nurses in two years. Workers themselves are strained; Sterling et al. (2020) interviewed home health aides during the pandemic who described feeling invisible, afraid of infection and unsupported, conditions that drive people from the field. Finally, Kestrel could decide to build or buy its own agency.

SWOT Summary

Table 2 condenses the analysis. Each item is short, measurable and linked to a source in the text above, which makes the table a reference for the options that follow rather than a list of impressions.

Table 2. Evidence-Based SWOT for Ashford Valley VNA

Note. Each entry is supported by internal data or a cited source in the text.

Pairing the Factors

Pairing the quadrants produces options. Strengths with opportunities: offer Kestrel a hospital at home partnership built on the remote monitoring results and the agency's hospice continuum. Weaknesses with opportunities: fix assessment accuracy and hospitalization measures to earn value-based gains and a higher rating. Strengths with threats: use the nonprofit mission and hospice role to recruit nurses who want meaningful work rather than bonuses. Weaknesses with threats: without more nurses, Kestrel may choose another partner, so staffing must come first.

Three Priority Issues

The analysis points to three issues the plan must resolve. First, capacity: the agency cannot grow, partner or improve quality while it turns away a third of the patients it could otherwise take in some months. Second, the Kestrel relationship: whether to pursue a formal partnership before the system chooses another route. Third, quality: moving from three to four stars to protect payment and referrals. Every other issue, including technology and contracts, connects to these three.

Limitations

Market shares are estimates, because Medicare Advantage and Medicaid volumes are not fully public. Competitor strategies are inferred from public information and conversations with referral sources. The remote monitoring comparison is internal and not risk adjusted. These limits do not change the priorities, but the plan should revisit them as better data arrive.

Conclusion

Ashford Valley holds the largest share of a low-margin market, with a unique nonprofit continuum, strong patient experience and deep referral ties. Its position is also fragile: too few nurses, middling quality ratings and a dominant referral source weighing its options. The strategic alternatives in Module Five must address capacity, the Kestrel relationship and quality, in that order.

References

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

Li, J. (2024). Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home. Medical Care, 62(1), 11-20. https://doi.org/10.1097/MLR.0000000000001930

Sterling, M. R., Tseng, E., Poon, A., Cho, J., Avgar, A. C., Kern, L. M., Ankuda, C. K., & Dell, N. (2020). Experiences of home health care workers in New York City during the coronavirus disease 2019 pandemic: A qualitative analysis. JAMA Internal Medicine, 180(11), 1453-1459. https://doi.org/10.1001/jamainternmed.2020.3930

van Wijngaarden, J. D. H., Scholten, G. R. M., & van Wijk, K. P. (2012). Strategic analysis for health care organizations: The suitability of the SWOT-analysis. The International Journal of Health Planning and Management, 27(1), 34-49. https://doi.org/10.1002/hpm.1032

Zhu, D. T., Reddy, A., Bejarano, G., & Braun, R. T. (2025). Private equity acquisitions of home health agencies. JAMA Health Forum, 6(11), Article e254922. https://doi.org/10.1001/jamahealthforum.2025.4922