HCM 415 Module 7 Project Two Example

Project Two: Ashford Valley VNA Strategic Plan, Fiscal Years 2027 to 2029

[Student Name]

Southern New Hampshire University

HCM 415: Healthcare Strategic Management and Policy

Project Two

[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 Two: Ashford Valley VNA Strategic Plan, Fiscal Years 2027 to 2029

Executive Summary

Ashford Valley Visiting Nurse Association has served four counties since 1921 and remains their only nonprofit provider of both home health and hospice. It enters this plan with strengths, including four-star patient experience and deep ties to Kestrel Health, and with serious constraints: a 17% nurse vacancy rate, a three-star quality rating, a 0.6% operating margin and 34 days of cash. Over fiscal years 2027 to 2029, the agency will pursue three goals: rebuild its nursing workforce, create a joint venture with Kestrel that follows patients once their acute stay at home ends, and earn a four-star quality rating. If the plan succeeds, declined referrals will fall from 1,100 to 150, the margin will reach 2.5% and cash will grow to 60 days.

Purpose and Process

This plan replaces an annual budget-and-projects cycle with a three-year strategy the board will review each quarter. It draws on a mission review, an environmental scan, a situational analysis, a weighted comparison of four alternatives and a balanced scorecard, completed over six months with input from the board, managers, front-line nurses and Kestrel's post-acute leaders. Where the plan relies on estimates, it says so.

Mission, Vision and Values

The board adopted a revised mission during the Module Two review. In short, it promises safe care at home, and a peaceful death at home when that time comes, to residents of all ages and incomes, delivered by the region's one nonprofit agency that combines nursing, therapy and hospice. The vision looks to 2030, when the agency wants to be the first organization local hospitals and doctors think of for any patient going home. The three values stay the same, compassion, integrity and excellence, but each now comes with a visible habit: families hear back the day they call, records show what patients truly need and care begins within 48 hours.

The Situation in Brief

The agency holds about 31% of roughly 9,800 annual admissions in its market. Medicare Advantage accounted for 22% of admissions five years ago and 38% now, and it pays less than traditional Medicare, a gap consistent with Skopec et al. (2020), who found that Advantage enrollees receive less home health care. Value-based purchasing now moves up to 5% of Medicare payment, about $1.3 million for this agency, based on quality. A private equity backed chain has reached 18% share in four years and has hired eleven Ashford Valley nurses. Kestrel, which sends 41% of referrals, is launching hospital at home and weighing partners.

Strategic Goals

The analysis identified capacity, the Kestrel relationship and quality as the issues on which everything else depends. The plan therefore sets three goals, each with measurable objectives, lead owners and actions, supported by strategies for payer contracts, technology and the agency's hospice and palliative programs.

Goal 1: Rebuild the Nursing Workforce

Objective: reduce registered nurse vacancies from 17% to 10% by the end of fiscal 2027 and to 6% by fiscal 2029, and cut first-year turnover from 32% to 20%. Actions: launch a twelve-month residency for newly licensed nurses, with twelve graduates a year from fiscal 2028 and half the cost funded by Kestrel; add retention pay for rural routes; install route-optimizing scheduling to cut driving time from a third to a quarter of the rural day; and begin a safety program with injury reporting and paired visits in higher-risk homes.

The safety focus reflects McCaughey et al. (2012), who found that home health aides injured at work were more likely to intend to leave, and it recognizes that nurses who work alone in homes face similar risks. Recognition and a reachable supervisor on every shift complete the support. Lead owner: vice president of human resources.

Goal 2: Partner for Integrated Care at Home

Objective: sign a joint venture agreement with Kestrel by the end of fiscal 2027 and reach 420 venture admissions a year by fiscal 2029. Levine et al. (2020) randomized acutely ill adults and found acute care delivered at home cheaper, with fewer readmissions, than a ward stay, and Werner et al. (2019) reported that discharge to home care, rather than to a nursing facility, was the cheaper route for Medicare. Both findings make a strong home health partner valuable to Kestrel.

Terms to seek include equal board seats, shared capital for technology, a written commitment that the venture will serve rural ZIP codes, preferred post-acute status for Kestrel discharges and an exit clause after three years. Landers et al. (2016) argued that home health creates the most value when coordinated with hospitals and physicians, so the venture will share care plans and a nurse liaison on Kestrel's discharge units. Lead owner: vice president of business development.

Goal 3: Earn a Four-Star Quality Rating

Objective: raise the quality star rating from three to four by fiscal 2028 and keep patient experience at four stars. Actions: certify all clinicians who open cases in scoring function, with a monthly chart audit, to cut understated assessments from 9% to 3%; raise timely initiation of care from 88% to 95% through same-day intake scheduling; and reduce 60-day hospitalization from 16.1% to 14.5% using fall risk screening, medication review at the first visit and remote monitoring for heart failure and lung disease.

Two studies justify the priority. Pozniak et al. (2022) found that value-based purchasing was associated with fewer hospitalizations and skilled nursing stays and better function, so agencies that improve are rewarded. Li (2024) found that patients treated by the best-rated local agency had fewer hospitalizations and emergency visits and more days at home, which is why hospitals and plans watch ratings. Lead owner: chief nursing officer.

Supporting Strategies

Payer contracting: renegotiate Medicare Advantage contracts at renewal, using quality data to seek rates that meet a board minimum, and decline contracts that remain below cost after two negotiation rounds. Technology: after scheduling, add secure data exchange with Kestrel's record so referrals and discharge summaries arrive electronically. Hospice and palliative care: expand the palliative consult service by two nurse practitioners to strengthen the agency's differentiation and give Kestrel's venture a path for seriously ill patients who choose comfort care.

Timeline

Table 1 shows major milestones. The first year concentrates on workforce and assessment accuracy because every other goal depends on them. The venture agreement is signed in year one but ramps up in years two and three as staffing allows.

Table 1. Major Milestones, Fiscal Years 2027 to 2029

Note. Milestones are planning targets subject to quarterly board review.

Financial Projection

Table 2 projects revenue, expenses and margin. Revenue grows mainly from accepting referrals now declined and from venture admissions, partly offset by an assumed 1% annual Medicare rate reduction and continued Medicare Advantage growth. Expenses rise with added nurses, residency costs and scheduling technology. One-time investments total about $900,000 over three years, with Kestrel funding roughly $400,000 of it through the residency and data exchange.

Table 2. Three-Year Financial Projection (millions of dollars)

Note. Projection by the planning office; assumes 1% yearly Medicare rate cuts and venture volumes in Table 1.

Risks and Contingencies

Four risks could derail the plan. If Kestrel chooses another partner or talks stall past twelve months, the agency will pursue independent growth at a slower pace and reopen merger discussions only if cash falls below 25 days. If recruitment lags, the agency will temporarily limit new short post-surgical admissions to protect capacity for complex patients. If Medicare cuts exceed 1% a year, capital projects after scheduling will be delayed. If the private equity chain raises bonuses, the agency will emphasize mission, schedule flexibility and the residency rather than match cash offers. Zhu et al. (2025) documented steady private equity activity in home health nationwide, so this competitor should be treated as permanent.

Measuring Progress

Progress will be tracked on the balanced scorecard developed in Module Six, which places mission and community measures above customer, internal process, learning and growth and financial measures. Each measure has one owner. Managers review their measures monthly, the executive team monthly, the board's strategy committee quarterly and the full board twice a year. Any measure off target for two consecutive reports receives a written corrective plan.

Communication

Staff will hear about the plan from the chief executive at open meetings in every office before it appears in writing. Each meeting will explain what the Kestrel venture is and is not, stressing equal governance and the rural commitment, because rumors of a takeover could speed departures. Referral sources get a single-page overview, while a short annual community report will show declined referrals, rural visits and charity care against targets.

Conclusion

This plan asks a century-old agency to change how it recruits, how it partners and how it measures quality, while keeping its promise to serve people of every income across four counties. Its three goals depend on each other: nurses make quality and partnership possible, quality makes Ashford Valley the right partner and the partnership brings the patients and capital that sustain the workforce. With quarterly review and clear fallbacks, the board can adopt the plan knowing both what success looks like and what it will do if conditions change.

References

Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., MacMillan, R., Jones, K., Bowles, K., Dowding, D., Lee, T., Moorhead, T., Rodriguez, S., & Breese, E. (2016). The future of home health care: A strategic framework for optimizing value. Home Health Care Management & Practice, 28(4), 262-278. https://doi.org/10.1177/1084822316666368

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

McCaughey, D., McGhan, G., Kim, J., Brannon, D., Leroy, H., & Jablonski, R. (2012). Workforce implications of injury among home health workers: Evidence from the National Home Health Aide Survey. The Gerontologist, 52(4), 493-505. https://doi.org/10.1093/geront/gnr133

Pozniak, A., Lammers, E., Mukhopadhyay, P., Cogan, C., Ding, Z., Goyat, R., Hanslits, K., Ji, N., Jin, Y., Repeck, K., Schrager, J., Young, E., & Turenne, M. (2022). Association of the Home Health Value-Based Purchasing Model with quality, utilization, and Medicare payments after the first 5 years. JAMA Health Forum, 3(9), Article e222723. https://doi.org/10.1001/jamahealthforum.2022.2723

Skopec, L., Zuckerman, S., Aarons, J., Wissoker, D., Huckfeldt, P. J., Feder, J., Berenson, R. A., Dey, J., & Oliveira, I. (2020). Home health use in Medicare Advantage compared to use in traditional Medicare. Health Affairs, 39(6), 1072-1079. https://doi.org/10.1377/hlthaff.2019.01091

Werner, R. M., Coe, N. B., Qi, M., & Konetzka, R. T. (2019). Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Internal Medicine, 179(5), 617-623. https://doi.org/10.1001/jamainternmed.2018.7998

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