C. W. Williams Community Center: Phase 3

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Phase Two: External and Internal Analysis

Lakenya Campbell, Betty Cherelus, Weslyne Coicou

Tamera Green, Chadric Russell, Yury Viarenich

Palm Beach State College

HSA4938

Dr. Michele Tiggle-Stephenson

February 17, 2021

External Analysis

Issue Map

Issue Map

Categories of Issue

General Environment

Health Care System

Service Area

Economic

In 2020, the unemployment rate increased to 14.7% or 23.1 million unemployed US residents. This is the highest increase ever recorded in the history of the data or since 1948 (U.S. Bureau of Labor Statistics, 2020).

Personal income dramatically decreased in all states on average of 10%. North Carolina’s growth rate was -12.5% in the second quarter of 2020 (U.S. Bureau of Economic Analysis, 2020).

Part-time workers experienced a higher peak unemployment rate than full-time workers. Unemployment was significantly higher in industries that provide in-person services

Global pandemic and nationwide lockdown negatively impacted the economy (Congressional Research Service, 2021).

Due to globalization, the spread of COVID-19 was virtually unstoppable and impacted people on every continent in every country leaving millions of people dead and injured. COVID-19 directly or indirectly impacted every human on the planet causing damage to the wealth and growth of the countries. The United States possibly has been economically negatively impacted more than any other country in the world.

Health insurance premiums are getting higher annually.

Affordable Care Act (ACA) provides premium tax credits for 8.3 million people with household incomes between 100% and 400% of the federal poverty level (HealthCare.gov, 2021).

In 2020, most of the states expanded Medicaid coverage to more low-income eligible adults to 138% of the federal poverty level. North Carolina did not do the Medicaid expansion (HealthCare.gov, 2021).

The average unemployment rate for 2020 was 6.3%, which is about 2% higher than in 2019. The historical unemployment record of 13.2% or 173,000 people was in May 2020 (US Bureau of Labor Statistics, 2021).

In 2019, Median household income was

$62,817.

Persons in poverty 12.8% of the total population of Charlotte city. (United States Census Bureau, 2020).

Social/Demographic

Adults age 65 and older projected to outnumber children under 18 by 2034 (U.S. Census Bureau, 2021).

Increase of adults over the age of 65 from 16.5% in 2019 to 16.9% in 2020 (Statista, 2021).

Since 2010, the American Indian population increased by 13.1%, Asian by 29.3%, African American by 11.6%, Native Hawaiian up by 21%, White by 4.3%, and Hispanic population increased by 20% (U.S. Census Bureau, 2020).

Racial minorities had a higher unemployment rate. (16.7% unemployed black workers compared to 14.2% White workers, and 18.9% for Hispanic workers compared to 13.6% for non-Hispanic workers (Congressional Research Service, 2021).

According to Social Security Administration, 65-years old today will live to age 83; one out of every four will live past age 90 and one in ten will live to age 95. The aging population creates additional pressure on the US healthcare system (SSA, 2020).

In 2018, among minorities, amount of uninsured adults below age 65 has increased for the following categories: American Indian 21,8%, Asian 6.8%, African American 11.5%, White 7.5%, Hispanic 19.0% (Kaiser Family Foundation, 2020).

Charlotte is the largest city in North Carolina and the 15th largest in the United States with an estimated population of 885,000 people for 2019. (United States Census Bureau, 2020).

Percent of persons with high school diploma 89.1%. Bachelor's degree holders 44.3% (United States Census Bureau, 2020).

The population consists of white 48.8%, African American 35.2%, American Indian 0.4% Asian 6.5%, Native Hawaiian 0.1%, Hispanic 14.3% (United States Census Bureau, 2020).

Legislative/Political

Federal Government tax credits available to individuals to help lower the premium of healthcare services. For a single individual in 2020 annual income limits were between $12,490 to $49,960. Household income limits were between $21,330 to $85,320 (American Council on Aging, 2021).

In 2020, North Carolina’s Medicaid program income limit for individuals was $1,064 a month, and the married couples’ income limit was $1,437 a month (American Council on Aging, 2021).

The United States has an unstable political situation and the country about equally divided in political vision and beliefs.

Amount of legal immigrants significantly decreased in recent years. During 2020, amount of legal immigrants and tourists dropped to its record numbers in history. 15,000 refugees were admitted to the United States in 2020 — the lowest level since the passage of the Refugee Act in 1980. The New White House administration plans to increase the annual refugee admissions cap to 125,000 in the 12-month period starting Oct. 1, 2020 (U.S. House Committee on the Judiciary, 2021).

The Affordable Care Act helped millions of low-income Americans during the hardships of the COVID-19 pandemic.

Medicaid coverage expansion is not in effect in all of the states, leaving struggling low-income Americans at the age of life and death.

Due to COVID-19 Pandemic, ACA opened a special enrollment period to allow more Americans in need to receive proper medical coverage (PhysiciansWeekly, 2020).

Since 2017, North Carolina Governor Roy Cooper was pushing the expansion of Medicaid that could allow 624,000 residents to become newly eligible for coverage. Republican lawmakers rejected the expansion in 2017 and 2019 (HealthInsurance.org)

Republican lawmakers have no longer supermajority and next voting mnay change situation with

Technological

Increased government funding and stimulus support for medical facilities to help during the COVID-19 pandemic.

Highest in history raise of telehealth associated with the emergence of the COVID-19 pandemic (U.S. centers for Disease Control and Prevention, 2020).

Most of the patients instead of doing actual physical visits to the healthcare facilities turned to Telehealth which is faster, often cheaper, and is risk-free.

Always evolving technologies got additional funding for researches and implementation during the COVID-19 Pandemic.

New procedures and technological advancements have been implemented to minimize the risk of COVID-19 infection between patients and healthcare workers.

Charlotte has medical giants such as Charlotte Memorial Hospital, Novant Health Presbyterian Medical Center, and Atrium Health’s Carolinas HealthCare offering the latest healthcare technologies including organ transplantation and cancer treatment.

Competitive

Global pandemic overwhelmed healthcare systems worldwide. Extreme pressure and the risk of being infected have driven medical professionals away from the industry.

COVID-19 patients are received prioritized medical care living behind patients with other health-related problems.

Decrease of patient’s in-person visits to all medical facilities due to risk of being infected.

More providers offer a larger variety of healthcare plans for every budget. Most of the healthcare providers implemented bonus programs that allow earning rewards and use them towards payment of the premiums or healthcare expenses.

Mergers and acquisitions by healthcare giants placing unrealistic pressure on small private healthcare organizations.

Hospitals in towns surrounding Charlotte such as Novant Health Huntersville Medical Center located in Huntersville and Novant Health Matthews Medical Center located in Matthews strive to achieve the same level of healthcare quality.

Validation of the Strategic Assumptions

Performance and general environment trend/issues

The main source of the general environment trends and issues that have impacted C.W Williams Community Health Center is Covid-19 and its impact on employment. The unemployment rise in North Carolina has affected coverage as “An estimated 257,000 people in North Carolina lost their health insurance due to job loss during the first six months of the COVID-19 pandemic” (Kasakove, 2020). Along with COVID impacting C.W’s patient visits, the hospital will have to provide extra coverage for the increase in uninsured patients that need hospitalization.

Performance and health care system trends/issues

Healthcare insurance has been on the rise during the previous year and it impacts work-based coverage. According to a KFF survey from North Carolina Health news, it “found workers on average are paying nearly $5,600 this year toward family coverage, up from about $4,000 in 2010 and $1,600 in 2000” (Galewitz, 2020). Coverage from employers exceed the coverage rates from Medicare and Medicaid, so they feel more pressure to provide enough support for workers to help pay off insurance premiums. This impacts the hospital’s employees and their wages as health costs increase. Another trend is the increase in the search for Medicaid coverage. However, Medicaid is limited in eligibility because of the state’s policy as it’s “ one of 12 states that has not adopted Medicaid expansion, a major piece of the Affordable Care Act, which expands eligibility for Medicaid to people with incomes below 138% of the federal poverty level.(Kasakove, 2020).

Performance and service area trends/issues

C.W. Williams Community Health Center is located at Wilkinson Blvd, which is also near Charlotte Community Health Clinic and FastMed Urgent Care. Wilkinson Blvd has a lower-middle class label, and its traffic issues has served as barriers to healthcare for the company. A news report from WBTV stated “The traffic outside of C.W. Williams health clinic on Wilkinson Blvd matches the patient traffic inside, it's busy.” (“County withholds CW Williams”, 2014), which shows that there is an issue with accessibility for company.

Effect of new technology developments

The shift in Telemedicine and virtual appointments has been increasingly noticeable throughout the past year. UNC Health recently installed an Rx Savings Assistant Solution that is designed to “instantly increase prescription fills by making them more affordable for more patients. This technology supplements other patient assistance programs and leverages their electronic medical record (EMR) investment.” (Huth, 2021).

Legislative/Political environment changes

North Carolina (NC) is one of the states to not expand Medicaid coverage. However, with the new Covid-19 Relief Bill, there is a potential for progress to be made for people who are unemployed or receive unemployment benefits to receive further aid from Obamacare. The purpose of the relief bill for states such as NC is to “expand their Medicaid programs to cover people making up to 138% of the poverty level.” (Ervin, 2021). The expansion is predicted to increase federal share of Medicaid, thus resulting in a net increase for the state.

Effect of new local, state, or federal regulations/laws

The Senate 704 Bill and House Bill 1043 are two bills that were passed in response to the pandemic. One of the highlights of the Senate Bill is it “Seeks to increase supplies of personal protective equipment (PPE), provides certain legal immunity for health care entities and providers, authorizes increased use of telehealth, creates a pandemic health care work force study, and modifies certain regulatory requirements” (Trathen, Turlington, 2020). The House Bill lent appropriations for NC healthcare, specifically funding local hospital departments, clinics, and health programs that assist family and minority groups.

New economic issues

North Carolina is suffering economic decline from job losses that occurred during the covid-19 pandemic. The difference in community employment between pre-covid-19 and post-covid-19 is significant enough to raise alarm for the state. Market figures came to an analysis that “Nearly 60 of North Carolina’s 100 counties had fewer jobs in October of this year than before the Great Recession. Many parts of the state had never recovered all of the jobs that disappeared in the Great Recession, so the losses during COVID-19 are further compounding a long-term problem.” (McHugh, Umbarger, 2020). Charlotte had the most impact since it’s the most commercially based city of the state. It did not receive the highest percentage loss of jobs but in pure numbers, the city did experience a loss of 77,374 jobs between February 2020 and October 2020.

Service Area Structural Analysis

Service Area Structural Analysis
Five Forces	Forces Driving Service Area Competition	Conclusion
Threat of New Entrants	There are a couple of medical facilities, such as Carolina Medical Center and Presbyterian Hospital Foundation that are within a 5-mile radius outside of C.W. A competitive advantage is that Carolina Center offers hospitalization stays with more than 3,000 patient bed days. Also, it has a major trauma unit that handles these cases 24/7 out of the week. Presbyterian Medical Center offers unique services such as Cancer, Neurology, Heart & Vascular that C.W. services do not have.	Medium. The threat of new entrants is likely to stay medium because C.W. Williams is affiliated with the two hospitals and has their own physicians that come into the medical centers to assist them. This is more of a recruitment process for more extensive medical care provision. The barrier to entry is high because of the highly specialized cost of medical services.
Intensity of Rivalry	Services provide clinical research to find new ways to prevent detect or treat diseases that sets them apart from the rest.	High. The competition will remain at an all-time high as more patients explore possible solutions to high-risk diseases through technological devices which increases patient in-flow. The barrier to exit is high because new patients are being lured in through high satisfactory customer service and all types of health services it has to offer.
Threat of substitutes	The threat of substitutes is high because of classified medical devices and unlimited hours of services that have a high retention of patient satisfaction.	High. Patients are only allowed to be given services to what the community health center provides, so therefore other types of services have to be rendered somewhere else.
Bargaining Power of Buyers (Customers)	The bargaining power of suppliers is low because services rendered are costly through managed care programs, prices can be lower in other medical facilities.	Low. Medical devices are up to date in advancement in regards to technology to detect medical issues and the utilization for basic check-ups.
Bargaining Power of Suppliers	The Bargaining power of suppliers is high, health care providers are willing to have the most cost-effective technological device due to the innovation in the market, prescriptions, and the longevity of the treatment.	High. Drugs are more expensive, doctors get paid more, administrative costs are high and health insurance are costly.

Internal Analysis

The Value Chain

Service Delivery

Pre-service. C.W Williams has been operating since 1981, providing outstanding care to the underserved areas of North Carolina (C.W. Williams- Rich History of High-Quality Health Care in Charlotte, NC 2019). This company offers specific services to assist their customers during their visit to the facility but also before and after. One of the services provided before-hand is the option for transportation to care facilities for customers (Trusted Community Health Center and Urgent Care Charlotte NC, 2019). All customers may go online, fill out a form or call to request transportation from their home to the specific facility. This company also provides online registration for new patients through a portal and scheduling plus billing for existing patients (Trusted Community Health Center and Urgent Care Charlotte NC, 2019). By offering these services, patients can fill out tedious forms, pay outstanding bills, cancel and reschedule all in the comfort of their homes. Not only does it reduce physical paperwork it also allows patients to fill out forms at their leisure that would have been wasted time in the office.

Point of service. Simultaneously, C.W Community Health Center offers a multitude of services, providing Preventive care, Medical, Dental, Behavioral management, Pharmaceutical assistance, Community Outreach, Translation services, Pediatric care, Homelessness services, testing and screenings, and most recently, Covid testing (Clinical Services, 2019). This well-diverse facility assists their underserved community in every way possible. Going above and beyond to ensure all customers can be taken care of, this company has 26 areas of care (Trusted Community Health Center and Urgent Care Charlotte NC, 2019). Strategically thinking, pre-service elevates the point of service by accommodating patients, but also supporting the company with time management.

After service. In addition to the pre-service and point of services, this well-rounded business contributes to the community by offering diabetic counseling and health education to anyone. Due to the community and population, they care for teaching and recommending management plans to help the African American community tremendously. According to Illinois Science Council, this disease is more prevalent among the poor, less educated, and ethnic minorities(Thomas Bilo, 2019).

Support activities

Organizational culture. C.W Williams takes pride in the values and diversity of their company. They ensure each employee is in a safe, comfortable environment to operate efficiently and successfully. In a similar fashion of valuing their patients, they expect each employee to respect one another and strongly encourage teamwork. Guaranteeing the highest quality of care with pride and compassion is one of their main goals along with improving the spiritual, physical, and psychosocial status of the community. (C. W. Williams Health Center: A Community Asset, 2008).

Organizational structure.- C.W has a matrix organization structure. According to Strategic Management of Health Care organizations, this is defined by the organization being structured around projects or programs where centralized functional specialists interact with and provide services to program teams (Ginter et al., 2018). This type of structure allows the company to run multiple services and programs within a facility proficiently and professionally.

Strategic resources. CWWCHC is partnered with several health care organizations to provide support to their Federally Qualified Health Center(FQHC). Health Resources and Services Administration, Affordable Cares Act, Federal Torts Claims Act are a few of the programs C.W Williams are partnered with to uphold the high standard of care (Trusted Community Health Center and Urgent Care Charlotte NC, 2020).

Organizational Strengths and Weaknesses

Value Chain Component	Value-Creating Strength	Value-Reducing Weakness
Service Delivery
Pre-Service	· The strategic location of the health center · Provision of superior quality services compared to competitors · Prioritizing satellite clinics · Provision of accessible and quality care to the patients.	1. Lack of enough transport
Point-of Service	1. Acceptance of medical coverage, programs, and enrollments that facilitate payment of medical bills. · Embracing more fully a system of outpatients to avoid high costs and admissions of less serious conditions. · Fast and discounted pharmacy Clean facility in a good location	1. Limited services 2. Staff and staffing pattern
After-Service	· Availability of transport for patients · Health education · Feedback platform.
Support Activities
Culture	· A large base of patients. · Construction of satellite clinics. · Provision of quality care and excellent services. · Dedicated board and staff	NONE
Structure	1. C.W. Williams is managed by state-of-the-art technology.
Strategic Resources	· Use of innovation and high-end technology. · Community involvement and participation. · Proper and coordinated information systems. · Staff learning and development, and community education.	1. Difficulty in keeping up with advanced strategy components due to high costs of maintenance.

Competitive Relevant Advantages and Disadvantages

Strengths

Is the Value of the Strength High or Low? (H/L)

Is the strength Rare? (Y/N)

Is the Strength Easy or Difficult to Imitate? (E/D)

Can the strength be Sustained? (Y/N)

Implications

Service Delivery

-Pre-Service

· The strategic location of the health center

· Provision of superior quality services compared to competitors.

· Prioritizing satellite clinics.

· Provision of accessible and quality care to the patients.

Long-term competitive advantage.

Threshold condition.

Service Delivery

-Point-of-Service

· Provision of superior quality services compared to competitors.

· Fast and discounted pharmacy

· Clean facility in a good location.

Long-term competitive advantage.

No competitive advantage

Threshold condition

Service Delivery

-After-Service

· Availability of transport for patients.

· Health education.

· Feedback platform

Improves patient satisfaction and ensures loyalty

Ensures patients understand well health information.

No competitive advantage.

Support Activities

-Culture

· A large base of patients.

· Construction of satellite clinics.

· Provision of quality care and excellent services.

· Dedicated board and staff

Long-term competitive advantage.

Support Activities

-Structure

· C.W. Williams is managed by the state of the art technology.

Elevating the center as the leading comprehensive community-based service provider in the community.

Support Activities

-Strategic Resources

· Use of innovation and high-end technology.

· Community involvement and participation.

· Proper and coordinated information systems.

Long-term competitive advantage.

Weaknesses	Is the Value of the Weakness High or Low? (H/L)	Is the Weakness Common (Not Rare) Among Competitors? (Y/N)	Is the weakness Easy or Difficult to Imitate? (E/D)	Can competitors Sustain their Advantage? (Y/N)	Implications
Service Delivery -Pre-Service Lack of enough transport	H	Y	D	N	No competitive disadvantage.
Service Delivery -Point-of-Service · Limited services · Staff and staffing pattern	H H	Y Y	D D	Y N	No competitive disadvantage. Threshold position
Service Delivery -After-Service NONE
Support Activities -Culture NONE
Support Activities -Structure 1.Complexity in understanding the hierarchy.	L	Y	D	Y	Threshold condition.
Support Activities -Strategic Resources 1. Difficulty in keeping up with advanced strategy components due to high costs of maintenance.	H	N	E	Y	Short term competitive disadvantage.

Implications of the Competitive Advantages and Disadvantages

Competitive Relevant Strengths	Strategic Implications
· Strategic location of the health center.	1. Easily accessible by the patients.
· Provision of superior quality services compared to competitors	2. Superior quality services enhance support and preference for the health center, which increases loyalty and patient satisfaction.
3. Growth, proper budgeting, provision of quality, and excellent services.	3. Long sustenance, growth, and development.
4. Dedicated staff and board members.	4. Improved performance and provision of quality services.
5. Use of state of the art technology in maintenance and operation of the health center.	5. Enhance the delivery and efficiency of health care services.
Competitive Relevant Weaknesses	Strategic Implications
· Difficulty in maintaining quality given the non-profit aspect along with the increasing population of patients.	1. May ruin the hospital’s reputation.
· Lack of enough transport.	Stagnating service delivery which may damaging patient loyalty.
· Limited services.	Inability to provide services fully for the patients which will lead to damage of the health center’s reputation.

Directional Strategies

The directional strategies allow organizational leaders to give directions on what the organization needs to be doing and the organizational plans in achieving the results. It is regarded as an option strategy that C.W. Williams Community Center seeks to take advantage of the targeted market direction to gain profit.

Organization’s Mission Statement. The organization's mission is to promote a much healthy future for communities around by constantly offering affordable and accessible excellent health care by containing pride, respect, and compassion. The mission puts the organization on a competitive edge following its commitment to serving the community.

Organization’s Vision Statement. The organization's vision is to offer high-quality personal, affordable and comprehensive health care to improve people's lives through their care. C.W. Williams Community Center focuses on partnering with other healthcare organizations where it aims to expand its high-quality services offer into areas that are in shortage of health care services. The organization tends to target remote areas where patients need to travel for long distances to be able to access health facilities. Among the strategies that the C.W. Williams Community Center tends to deploy is by offering subsidized healthcare through insurance-based health care to the patients. The states majorly initiate it to help cater to the affordable cost of medication and quality treatment care (Schwartz & Woloshin 2019).

Organization’s Values. C.W. Williams Community Center embraces values such as respecting each individual whether staff or patient or community, as it is a valued commitment that fosters healthy relationships among the stakeholders. It aims in providing affordable quality care to patients with much compassion and pride that satisfy their objectivity in improving health among individuals. The organization encourages partnership with other entities focusing on the health to help in responding to the social health and overall economic development of community needs. It operates in a sober and autonomous environment that is of a financially sound and well-equipped organization that is efficient, comfortable, and well-trained staff that works in teams and committed to taking care of the patients and improving people's health through their quality services care. The organization’s RESPECT strategy describes offering reliable healthcare, efficient operations, supportive staff, personal care, effective systems, and timely services.

Organization’s Strategic Goals. The C.W. Williams Community Center is endowed with various strengths and opportunities that place it in a competitive advantage in the market. Its goal is to provide high-quality healthcare services that are affordable by partnering with the state by offering subsidized healthcare options through insurance covers that are meant to be cheap and reliable, enabling it to maneuver through remote locations. The organizational goal is to enhance its growth through partnership with other organizations, partnering with the state, and increasing the staff number majorly increasing the physician capacity to help cover a wide base of customers.

The organization aims to capture and encroach remote areas with no healthcare facilities care by providing satellite clinics that make it easier for patients to access the C.W. Williams clinic hence they do not have to travel long distances to be treated. Its goal is to be able to be on a competitive edge in the market through offering quality services. Introducing other services such as primary care and preventive and controls services, substance and abuse counseling, diagnostic laboratory as well as X-Ray and health education that promotes healthy living among the communities.

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