Cap 1 M6

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Assignment Guidelines:

In response to your peers, critique other students’ evaluation of their business implementation plan and recommend changes to strengthen it. Ask probing questions to challenge your peers to deepen their analysis and justification of their own ideas.

Student An:

Tivity Health SpringyFeet Implementation Plan

As the population ages, there is a trend in lifestyle for seniors towards more active living and improvement of health to increase longevity. Tivity Health Inc. is integrating an innovative idea that seeks to fill the needs of the 65 plus population by creating opportunities to enable better health and wellness through a new service product called SpringyFeet. Tivity Health is marketing a new product called “Springy Feet” as an enhancement to the SilverSneakers program to improve access to podiatry care for SilverSneakers members enrolled through Medicare and MedicareAdvantage insurance. Customers will have access to affordable and accessible podiatry services, custom footwear, and massage therapy to avoid injury during exercise. For a small fee of 48$ per year members can prevent complications of exercise and provide a pleasant and cost-effective experience.

Rationale

The strengths and rationale for our product service line is a strategy Tivity Health embraces to promote health and wellness through preventative care. As part of Tivity Health’s business implementation plan, these programs were developed internally to meet a service void in the industry of healthcare to expand into the health and nutrition wellness market for the workplace and other healthcare providers. By aligning services our new product service SpringyFeet would allow members to get significant discounts which would include podiatry services, shoe fittings, and ancillary services like foot massage and reflexology which is an unmet niche in the industry.

Opportunity

For Medicare recipients there is a problem with foot services which are covered as “routine foot care is excluded from coverage in the absence of localized injury or symptoms involving the foot” (Center for Medicare Services, 2019). By creating the program SpringyFeet Tivity Health's solution addresses the problem of accessibility and affordability to podiatry services by providing an alternative resource. This solution is unique because it provides a combination of podiatry, shoe fitting, and foot massage therapy for an affordable price to members of the SilverSneakers program.

Market

Tivity uses market research and analysis tools such as SWOT and PEST as part of its strategic mitigation plan. They then match these analyzed factors for the product line into an action plan to enable success over the competition. Tivity engages in regular comprehensive reviews of the Company’s organization, business structure, costs, product offerings, and delivery as part of this plan. Tivity Health is known for outsourcing areas of the business that need to be offloaded and either selling them or partnering with others. For SpringyFeet the market analysis reveals that there is a need for this product service. The market size is that “more than 135 million Americans are eligible for programs through SilverSneakers” (Tivity Health, 2019). Each of these members can also enroll in SpringyFeet.

Competition

To critique an area of opportunity to assess the business plan, Tivity continues to make a mark in the industry and maintain a competitive edge with its three main products SilverSneakers, PrimeFitness, and WholeHealth Living. The company is acutely aware of key competitors such as “Stay Well Management”, and “Health Solutions” and has analysts who follow healthcare trends, and also the competition to maintain an advantage in the industry. A potential obstacle for SpringyFeet is that what often seems like a great idea can easily go flat if frequent feed-back from consumers is not obtained. For Tivity Health and the new service product line SpringyFeet it is important to continually readjust and recalculate a company’s strategy based on surveys and sales data.

Innovation

As a leading provider of fitness and health improvement programs, Tivity has strong capabilities in developing and managing networks of fitness centers and complementary and alternative practitioners. It manages its specialty health benefit programs through its three main networks: SilverSneakers, Prime Fitness, and WholeHealth Living. The approach that Tivity Health uses with its ABCD strategy is to share resources among the various programs which are already developed which includes technology. Through their A-B-C-D strategy, the goals of which are to “(A) add new members in our three existing networks - SilverSneakers®, Prime® Fitness, and WholeHealth LivingTM; (B) build engagement and participation among our current eligible members; (C) collaborate with partners to add new products and services that will leverage the value of our brand, and (D) deepen relationships with our partners and their instructors within our national network, we believe we are well-positioned to strengthen our market leadership position in serving the age 50-plus market” (Tivity Health, 2019). The project management plan for SprngyFeet will be innovative and follow the same strategies to prepare and introduct this new product to the healthcare marketplace.

Physical and Technological Resources

Physical business platforms for SpringyFeet will develop through relationships and partnerships with podiatry groups, supply vendors, and insurance opportunities which will strengthen the core of the business. This is an essential component of their business plan as they seek to strengthen both financial and human assets. What needs to be done is meeting and collaboration between vendors of the programs that Tivity Health already has as existing partners through SilverSneakers, Prime Fitness, and WholeHealth Living. The opportunity exists for SpringyFeet to expand as they “collaborate with partners to add new products and services that will leverage the value of the brand” (Tivity Health, 2019). Innovation needs to be done and defined at the beginning of the project and throughout various timelines, as the goal is to maintain high member retention and acquisition of additional partners which include podiatrists insurers, and vendors as the business grows.

Implementation Schedule

To roll out the program Tivity Health realizes that in addition to physical and technological resources, effective planning requires appropriate scheduling of the implementation plan. This is an area where I am challenged and may need to make some adjustments in my critique, it also may be too long. Two areas they will address is to think through the entire plan with the project team and anticipate how much each of the major elements will take to complete. SpringyFeet’s project leaders will use their skills to recognize that change often involves building consensus and bringing key stakeholders along such as insurers, podiatry groups, and footcare vendors.

Tivity Health will identify three major elements of the SpringyFeet project and use optimization to map out processes. These three elements are Marketing and Web Design, Insurance and Podiatry Support, Member services Coordination, and Distribution of benefits. SpringyFeet will have an effective “hierarchical listing of what must be done during the project” (Stevenson, 2018). Tivity Health will use the optimization of processes to map out processes for SilverSneakers/SpringyFeet. (See Appendix A) for SpringyFeet’s Work Breakdown Planning Chart). This plan will outline what needs to be done by month 1, month 3, and month 6 incremental timeline. Insurance and Podiatry Support is the second element of the implementation schedule and will involve developing new partnerships with health insurers, and other government healthcare-related businesses.

Project Review Processes

The project review process for SpringyFeet will also include a specific plan to understand and to resolve the project conflict difficulty and indicators of success to ensure that the project stays on target. The Key milestones will be reviewed as part of the review process of the three major elements of the project at 1 month, 3 months, and 6 months. By the third month 3 of the project, the plan is to have member enrollment figures at 250,000 over 6 geographic regions.

Market analysis will be reviewed concerning affordability and the economy. For our members, Tivity Health will evaluate if the additional $48/member fee is unaffordable in the current environment. This may not be a factor given the fact that podiatry services are not a covered service under most plans. The company will carefully analyze this through market analysis and make adjustments in pricing or service options needed as part of the review process. All 16,000 locations that are available to SilverSneakers have the SpringyFeet Program available to their members. This will be a deliverable with a timeline of the 18th month of the project. By month 7 a 50% increase in capacity and enrollment should be attainable. Resources that are shared among Tivity Health’s programs and will require several project management teams as outlined to keep an eye on deadlines.

Intrapreneurship and Entrepreneurship Factors

The product SpringyFeet is entrepreneurial as it is now in unchartered territory in providing choices for podiatry services toward positive outcomes for Medicare and Medicare Advantage consumers.

It is also intrapreneurial as this service will situate itself among the other service lines and connect through the same website capabilities and marketing platform as Tivity Health’s other successful programs in their service portfolio. Both the intrapreneurial and entrepreneurial factors SpringyFeet will enhance the intellectual brand of TivityHealth’s programs by maintaining the philosophy of a health-centered environment. Tivity Health Inc. states that “Work-Based Wellness Trends, New Market opportunities, Niche target Markets forming new partnerships, Industry or lifestyle trends lead to a healthy environment culture for an aging population” (Tivity Health, 2019).

Key Roles, Responsibilities, Qualifications

Planning and strategy are key to the implementation plan. Planning resources include "physical assets, financial assets, and human assets" that leaders then combine with the knowledge to implement concepts or ideas (Nystrom, 2012). We will need to define the roles and responsibilities of the team members of the cross-functional implementation team. The role I will play is as the Project manager. I will plan to lead the overall project and create a schedule with key persons assigned to teams to identify the critical path to success. Laufer, Hoffman, Russell, and Cameron (2015) indicate that some of the best project managers concentrate on four main activities: creating a collaborative environment, instituting a formal review and improvement processes, averting significant problems, and keeping the project moving. My plan will involve collaboration on project objectives, regular review through team meetings, problem-solving, and a timeline that will keep the project moving and on target. The qualifications for this role are my experience in team leadership and my MBA education which will enable me to motivate team members toward accomplishing the organizational objectives of SpringyFeet.

The marketing and strategy team will be a shared resource that Tivity Health Inc. has in place in its program structure. Shared resources will be an important part because the key people who already work with SilverSneakers will know the company and experience to promote this new product. Tommy Lewis who is the acting Chief Operating Officer and President of the nutrition division at Tivity Health Inc. will oversee the marketing and strategy team for SpringyFeet. Tommy is a great fit for this role because of his education and experience with the customer experience and growth initiatives. Additionally, "in 2018, Lewis was named the HIMSS National Chapter Leader of the Year, and in 2017 he earned the Investor Relations Charter (IRC) credential award" (Tivity Health, 2020). His working knowledge of Tivity Healths other existing programs Nutrisystem, SilverSneakers, South Beach Diet, and Wisely Well give him an edge on company familiarity and the success of other product initiatives and working with these teams.

The product/service design will be led by our project team coordinator Chief Financial officer Adam Holland and his team. “Adam is responsible for all corporate financial functions including planning and analysis, forecasting and budgeting, external reporting and strategic initiatives” which will include SpringyFeet (Tivity Health, 2019). Adam has decades of experience and clinical expertise in the improvement of healthcare clinical and financial outcomes and will be a great leader for this team. His cross-functional role in the strategic initiatives of product/service design will be a great fit for the organization. Insurance and Podiatry Support will be a team led by Bonnie Shirato who is the chief people and culture officer for Tivity Health Inc. Her education and experience of over 20 years in healthcare organizations as well as her human resource background, make her a great fit for this position. She will also lead the Member services Coordination and Distribution of benefits sub-team. This team will work directly to ensure the millions of SilverSneakers members who are eligible for SpringyFeet get the maximum amount of their benefit dollars once enrolling in the program. These teams will work in conjunction with the other major teams but with different subtasks. Examples of some of the subtasks of this team will involve getting a query of eligible members and review existing participating vendor contracts to make revisions as needed.

They will also work with legislators and lobbyists on Medicare contracts. Another subteam will check eligibility coordination and assist members who are eligible to enroll through the enrollment process. These cross-functional teams will work in tandem to roll out the new product-service line SpringyFeet in a coordinated and timely fashion based on a schedule timeline.

Contingency Plans

Tivity Health Inc. realizes that for the plan for SpringyFeet to be successful it should capture all the resources needed and also have a contingency plan in place to succeed. Bryson and Bromiley (1993) propose that implementation scheduling, when done effectively, speeds projects along and enhances the overall probability of project success. Effective management for Tivity Health to consider is supply chain management. “Variations create uncertainty which can cause inefficiencies in the supply chain” (Stevenson, 2018). This plan is outlined so that if there are modifications that need to be made as to the product planning and implementation plan is underway there will then be fewer disruptions in the implementation plan for SpringyFeet.

The team contingency leadership plan consists of four key leaders. Myself, Ansje Gershkoff Project Manager, Tommy Lewis Marketing and Strategy, Adam Holland Product Service Design, and Bonnie Shirato Insurance and Podiatry Support. For Leadership cross-over, I will cover Tommy's team as needed and Adam will cover Bonnie's team and vice-versa. That way if there is an unexpected shift in personnel for any given reason, the team leaders can cover each other's roles and have access to the project timelines, documentation, meeting schedules, and leaders for each project team. (See Appendix A for SpringyFeet Contingency Plan)

Financial Analysis: Projected Costs

Projected costs of running SpringyFeet are total Fixed costs of 525,000. Since SpringyFeet is a service product and there are millions of eligible members for the program, Tivity Health Inc. expects a short period of under six months before break-even of launching the program especially in light of the shared resources of the sales and marketing department and general administrative costs it will share with Tivity Health’s other successful programs. The operations will be housed in a separate office area in Franklin, Tennessee so there will be a portion of the rent, salaries, insurance, utilities, computer equipment, property, and buildings that are included in the costs. (See Appendix A for fixed and variable costs).

When considering the cost analysis Tivity Health Inc took into account that some costs are avoidable such as duplicating web design teams. SilverSneakers has a great web design team in place which will also create the marketing and design for the SpringyFeet website to enable cost savings for this expense. Based on projected sales and revenue Tivity realizes that resources will be well spent in the service area sector where member enrollment is the essential component to the success of the program. Other costs are related to fundraising and lobbying for additional revenue support from stakeholders and Medicare legislative changes in government. These components should be considered as associated costs in obtaining capital. Based on market forecasts the parent program SilverSneakers “has gained revenues increased by 9.8% t $153.0 million compared to revenues of 139.4 million for the fourth quarter of 2018” (Tivity Health 2019). This figure is expected to continue going up in 2020 with a breakeven point at month three as SpringyFeet is rolled out to SilverSneakers members.

Financial Analysis: Revenue Streams

As part of our analysis and funding plan, Tivity Health Inc. will consider anticipated sources of funding. For the podiatry sector of the business, revenue will be produced through income associated with contractually established figures per visit in a similar structure to the current co-pay system Medicare and Medicare Advantage. In this case, a member will pay a straight fee of $48 annually which will waive additional copay for the members themselves. As a contracted vendor a podiatrist can bill for services under the affordable care act and receive a portion of income for services through the SpringyFeet program. The heightened volume of customers using this program will enhance payments received through contractual agreements of shoe service vendors, and reflexology or massage therapy with associations to gyms where SilverSneakers programs are serviced. As a company SpringyFeet has an affiliation with Tivity Health Inc. which has financial strength as it reports Total revenues in the first quarter of 2020 of “$337.7 million increased $123.6 million, or approximately 58%, compared to the first quarter of 2019 driven by a full quarter of Nutrition segment revenues, representing an increase of $120.4 million, and an increase in Healthcare segment revenues of $3.2 million” (Tivity Health, 2020).

For outside funding sources, they partner with CareFirst which is a not for profit non- stock health services company. CareFirst also has a stake in this by bringing market brand and customers from Tivity Health's programs to customers in Maryland, the District of Columbia, and portions of Virginia and is also associated with Blue Cross insurance and outpatient wellness clinics. “Historically CareFirst has helped Tivity Health enable 20 million dollars in additional funding since 2013” (Crunchbase, 2020).

From this funding program, SpringyFeet Tivity Health will distribute one million dollars to SpringyFeet over three years with $250,000 enabled at startup, and $375,000 in year 2 (2021) and year 2 (2022). These funds will be used to establish a new contract with vendors and a portion of the funds will assist members who are of low income with affordability options as part of Tivity Health’s “movement to transform rural aging and affordability initiative” (Tivity Health, 2019).

Financial Analysis: Net Present Value

The funding plan for SpringyFeet includes two sources of capital, current cash assets, and capitalization funds such as those obtained through CareFirst. Net present value “expresses in current value the sum of all future cash flows of an investment proposal: (Stevenson, 2018). The existing cash assets of one million paid out over the three years has a current net present value is calculated using NPV= Cash Flow/(1+i) to the t where I = required return and t= the number of periods. (See Appendix B for Net Present Value) SpringyFeet’s assumptions include a three-year average return of 15% with consideration of an inflation rate of 1.3%. This yields an attractive ROI to investors.

Analysis Parts

"The forecaster's job is to define the cone in a manner that helps the decision-maker exercise strategic judgment. Many factors go into delineating the cone of uncertainty, but the most important is defining its breadth, which is a measure of overall uncertainty" (Saffo,2007).

A factor to consider as enrollment is started for the program is that podiatry is not a covered service under Medicare, but for “patients with chronic conditions and who have been referred by a physician under the "enhanced primary care scheme" (EPC) some patients may then be eligible for a rebate under this plan” (Entirepodiatry, 2020).

Tivity Health realizes that “the forecast is an integral part of the annual budget process. An effective forecast allows for improved decision-making in maintaining fiscal discipline and delivering essential community services” (Gfoa,n.d.). The initial forecasts for SpringyFeet are based on market estimates of what Tivity Health intends to sell, which for SpringyFeet is the service product of podiatry and foot-care wellness. Based on market forecasts the business market share of SilverSneakers, the parent program to SpringyFeet has gained revenues increase by 9.8% to $153.0 Million compared to revenues of $139.4 million for the fourth quarter of 2019. (Tivity Health, 2020). This figure is expected to continue to go up as enrollment increases. The advantage is that SpringyFeet is a unique product that doesn’t exist singularly through insurance plans. Based on market forecasts we will estimate a demand and sales forecast (See appendix B for Tivity Health’s SpringyFeet demand forecast).

Financial Reports

For Tivity Health SpringyFeet the key financial reports to present to investors and other stakeholders are the Balance sheet, income statement, sales forecasts, and income projections as well as other associated costs for the concept of the SpringyFeet project. These financial considerations are important because financial sponsors must be selective of the projects they wish to invest in. As stated by Goel and Hasan (2004), “debt financing may not be available to organizations without a proven track record, because this financing typically evaluates the track record as one of the considerations to sponsor the project”.

The balance sheet for SpringyFeet shows detail which includes assets, liability, and equity.

The income statement displays the revenue, expenses, and net income associated with the project. Income projections will then be made concerning sales forecasts for SpringyFeet from launch until two years after the breakeven point. For SpringyFeet, Calculating The Break-even will be the point at which sales revenue equals your total expenses. To determine fixed Costs the company will evaluate costs that do not vary directly with sales. Examples are Utilities, salaries, and advertising. Variable Costs (Cost of Goods) are minimal since SpringyFeet is a service and not an actual product. Examples are labor expenses and billing. To calculate the break-even in units we use the following formula: “Total Absorption Costing because dividing the total cost by the units sold absorbs the fixed costs. Every business plan – be it for growth or start-up – needs to establish project and business costs before proceeding. Note: For planning purposes treat the entire term loan payment, both principal and interest, as a fixed cost to the business. Fixed Costs (Unit Price - Unit Cost) = Break-even in Units” (Small Business, n.d.) For SpringyFeet the turnaround for the breakeven point is projected to be between months three to four due to the high volume of SilverSneakers eligible member enrollment and sales projections with an expected ROI of 15% in the first year of the program as the project has low overhead costs and high enrollment potential. Financial sponsors will realize the positive quantifiable outcome and that they can expect a good ROI when investing in the project.

Assumptions

To have a successful business plan Tivity Health has outlined a few key assumptions that point to specific areas of the business and how it will function. These assumptions will help to attract potential investors, secure financing as needed, and help put SpringyFeet on a path to be a profitable venture. The key assumptions for SpringyFeet to consider are finances, consumer base, product needs, resources, and profitability.

Assumptions: Finances

Many of the financial resources allocated for SpringyFeet are shared resources with Tivity Health’s Inc’s programs such as SilverSneakers and Whole Health Living. As a company, they use a lean system approach where fewer resources are needed with each of their products related to space, inventory, and workers to produce maximum output as a service industry in healthcare. Company strength is resources for SpringyFeet through affiliation with Tivity Health Inc. The company reports revenues in the first quarter of 2020 of “$337.7 million increased $123.6 million, or approximately 58%, compared to the first quarter of 2019 driven by a full quarter of Nutrition segment revenues, representing an increase of $120.4 million, and an increase in Healthcare segment revenues of $3.2 million” (Tivity Health, 2020). Capital funding resources include contributions from Tivity Health’s finance companies such as CareFirst. Which is associated with shared wellness clinics. “Historically CareFirst has helped Tivity Health enable 20 million dollars in additional funding since 2013” (Crunchbase, 2020).

Tivity Health Inc. will distribute to SpringyFeet one million dollars over three years with $250,000 enabled at startup $375,000 in the second year, and $375,000 in the third year. Capital contributions such as these will increase SpringyFeet’s startup equity. Organizationally, SpringyFeet will continue to seek funds from this financial sponsorship for the project from Tivity Health’s fiscal foundation fund.

Assumptions: Consumer Base

A large consumer base is established through the current members that are eligible for SilverSneakers through Medicare and Medicare Advantage Plans. The advantage SpringyFeet will have is that the member portals and apps as well as the SilverSneakers website which is already in place. Millions of members are eligible for SilverSneakers which is America’s leading fitness program for older adults as it is “designed for older adults and promotes vital physical and social activity through 14,000 facilities nation-wide” (Tivity Health, 2019). SilverSneakers members will partner with SpringyFeet and have a” customer base of 13 million eligible members with more than 10,000 people tuning 55 each day” (Tivityhealth.com, 2019). To be eligible for SilverSneakers and SpringyFeet members must be “65 or older, living in the U.S., enrolled in a private Medicare”.(medicareadvantage.com).

Assumptions: Product Need

SpringyFeet will be marketed as a unique service product. For Medicare recipients there is a lapse in coverage for foot services as “routine foot care is excluded from coverage in the absence of localized injury or symptoms involving the foot” (Center for Medicare Services, 2019). SpringyFeet Tivity Health addresses the problem of accessibility and affordability to podiatry services by providing an alternative resource. This is a unique solution that provides podiatry services, shoe fittings, and foot massage therapy for an affordable price to members of the SilverSneakers program. This especially important for people with conditions of arthritis and diabetes and to prevent injuries such as falls or ankle damage from improperly fitting footwear during exercise. Market analysis reveals a program that will benefit millions of members and will present a great opportunity for enhanced revenue, while at the same time improve health outcomes and reduce healthcare costs.

Assumptions: Resources

Resources for SpringyFeet and resulting Profitability will be realized as enrollment increases. SpringyFeet will make “Clicks or Bricks” decisions which will be based on already established locations of SilverSneakers and geographical trends of members and vendors such as podiatrists. “The term “clicks-or-bricks” refers to a business model in which a company has either an online (clicks) or an offline (bricks) presence” (Stephenson, 2018). Tivity Health has many established resources and uses an online presence with websites and apps, and a bricks approach via various locations and vendors. Resource allocation and decisions will be based on data analysis and trends. “The rationale for these clicks and brick decisions is that SpringyFeet already has an established member base through the SilverSneakers program so a lot of the decisions will be based on trends regarding locations and podiatry services. Clicks have to do with the large website, response to online activity and surveys, and applications based on usage of the SpringyFeet phone app. As a result, Tivity Health will optimize advertising to enhance demand through association with community groups, SilverSneakers established gyms and other platforms, and notice boards and the media in addition to apps and their website” (Gershkoff, 2020).

Assumptions: Profitability

SpringyFeet will present the assumption of a breakeven point for investors between months three to four of the project start-up due to high member enrollment of eligible SilverSneakers members enrollment and sales projections of 500,00 new members in the first three months, an increase in member enrollment of 10% per month, and an expected ROI of 15% in the first year of the program. (See Appendix A for the SpringyFeet demand forecast). As enrollment increases, profitability will continue to increase as SpringyFeet has low overhead as a service product that utilizes many shared resources throughout Tivity Health Inc’s corporate structure.

Assumptions: Contingency Plan

For each assumption, any of these can be affected by the market, the healthcare environment, or several other factors that can impact the success of the project.

Examples of contingency planning for our assumptions relating to finance are shifts in the market or economy. SpringyFeet’s contingency plan will include financial analysts who watch the finances closely and determine market trends. PEST analysis has also been conducted by Tivity Health Inc. for the implementation of SpringyFeet and is a useful tool for

In 2020 Tivity Health Inc. will face challenges as a large contract will end with United Health. This will decrease member enrollment eligibility for SilverSneakers as United Health services 16 million new members. Once the contract ends there will be competition as United offers its own Optum Fitness advantage program for the fitness market. A contingency plan for SilverSneakers to enhance catering to the Medicare and Medicare Advantage market through SpringyFeet. This contract ends will reduce the customer base by about 15% but with a contingency plan to increase market strength to the Medicare client’s overall revenue will be adjusted as the program is implemented. The finance and billing department is available to assist new or existing members with financial knowledge to enroll in the program and to answer any billing questions or otherwise during financial hardships.

Cross-Cultural, Economic, and Geopolitical Factors

Tivity Health’s program SilverSneakers is a U.S based program but considerations should be made as SpringyFeet plans for production given the multi-cultural environment in the U.S due to immigration. SpringyFeet should plan as it realizes that “language and cultural differences increase the risk of miscommunication and may also interfere with developing trust that is important in business relationships” (Stevenson, 2018). “As the website and the geographical locations are developed, consideration should be taken to include Spanish and other popular language options for members. Consumer surveys should also be available in multiple languages and a “language line” will be in the planning phase as an option for podiatrists to see and communicate with their clients in different languages besides English” (Gershkoff, 2019). “A Location team will be established to globally plan for areas of the country that would most benefit from SpringyFeet’s services. This will include strategic planning using market data to determine regions within the country, communities, and site locations. This presents a large opportunity for human involvement and globalization throughout the U.S. and includes Peurto Rico and the U.S Virgin Islands” (Gershkoff, 2019)

Legal and Ethical Environment

SpringyFeet will operate in a legally and ethically compliant environment as Tivity Health Inc. rolls out this program. Because Tivity Health provides services to Medicare and MedicareAdvantage members they are subject to various federal laws and regulations. These include laws such as the federal False Claims Act and other billing and reimbursement requirements from Medicare-related to fraud and abuse. Consideration of legal issues is an important part of the production process for SpringyFeet. The company realizes there is a significant risk of a cyber breach and can vary from privacy security and hackers of computer systems, to breach of security laws from HIPAA (Health Insurance Portability and Accountability Act). Additionally, there is the risk of injury lawsuits and other legal issues that may result in vendor contract issues. Organizations must pay special attention to their potential liability due to damages or injuries resulting from either faulty design or poor workmanship.

Stakeholder and Customer Diversity

Stakeholder and consumer diversity will be at the forefront of SpringyFeet’s implementation plan. Tivity Health Inc. notes that “the diversification of Tivity Health’s portfolio and increased scale benefits all the company's stakeholders including health plans, fitness partners, and members and consumers as these offerings support healthier lifestyles and can lower medical costs” (Tivity Health, 2019). Tivity has the opportunity to expand its stakeholder base and has continuous opportunity to develop new partnerships with health insurers, government health programs, and businesses. SpringyFeet will work with Medicare and MedicareAdvantage plans and thousands of gyms and podiatry groups around the country as it expands the program. As an example of stakeholder diversity, Tivity Health Inc. extended an existing partnership through 2022 under which “ Humana will offer SilverSneakers to Humana’s Medicare Advantage individual and group members”(Financeyahoo, 2018).

Corporate Social Responsibility

Corporate social responsibility is a factor that Tivity Health Inc. takes seriously as it promotes its products and has long been an organization focused on giving back to society. Rural again and a society where there is accessible healthcare for all is highly important in the culture of the company. Corporate executives over the years have transitioned in their thinking about the role of corporations not just for themselves, but in a global society. Newell (2014) proposes that “Corporate Social Responsibility initiatives, once a nice-to-do‘ for the marketing benefits, are now necessary to convince consumers to support their businesses. The current definitions of corporate social responsibility (CSR) have different foci, but most include improving the quality of life for people and the planet, as well as making a profit”SpringyFeet will implement a charity care plan in giving back to society through a partnership with eVillages and the rural aging initiatives that Tivity Health has in place. Tivity Health’s goal is to “make life easier for individuals, at all stages of life. Whether that is through providing access to affordable fitness and social engagement programs and nutritious foods, addressing the social isolation and loneliness crisis, or pushing up our sleeves to rebuild homes in weather-ravaged parts of our nation” (Tivity Health, 2020).

Conclusion

SpringyFeet is a new opportunity for Tivity Health Inc. which will align with the company’s abilities and willingness to develop, organize, and grow the business and extend to develop opportunities toward health promotion. The impact is to enable healthy aging both in the workplace, and the community by offering streamlined podiatry services. The implementation plan of SpringyFeet will be a successful program when evaluating all these factors and will allow membership enhancement of podiatry services to the healthcare options for millions of Medicare and MedicareAdvantage members. This will enable SpringyFeet to allow members to “lead their best lives” and take care of their feet affordably and with superior quality. (Tivity Health, 2019).

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Appendix A

SpringyFeet Contingency Plan

Springy Feet Implementation Team
							Contingency Coverage
Project Manager		Ansje Gershkoff		Alternate		Tommy Lewis

Marketing and Strategy	Tommy Lewis		Alternate		Ansje Gershkoff

Product Service Design	Adam Holland		Alternate		Bonnie Sharito

Insurance and Podiatry Support	Bonnie Sharito		Alternate		Adam Holland

			Contingency Plan

Marketing and Strategy	Meet weekly with the Project manager
		Tasklist to each team member

Product Service Design	Meet weekly with the Project manager
		Tasklist to each team member
Insurance and Podiatry Support
		Meet weekly with Project manager
		Task list to each team member
		List of insurers and Podiatry groups
		List of foot service vendors


Marketing and Strategy


Product Service Design

Insurance and Podiatry Support
Weekly notifications to team


Weekly notifications to team


Weekly notifications to team

If delay by more than one week- obtain 2 people from Product Service Design
If task list not completed by one team member , reassign to stay on schedule

If product design delayed by more than one week (ie app, website) outsource


if insurance regulatory changes- contact legislators/lobby
If vendors don't respond in a week, assign to cross-over team member
If insurance verification staff call out, use cross-over staff
If contracts aren't signed in a timely manner, outreach to legal team
If injury occurs of staff or other , outreach to risk management team

GOAL	to have each department meet deadlines as established

Appendix B

SilverSneakers SpringyFeet Demand Forecast

Tivity Health SilverSneakers SpringyFeet Demand Forecast

Period

Number of Members

Price per member

Calculation

Revenue

Forecast

Mar-20

500,000

$48

$24,000,000

$23,329,500

Apr-20

505000

$24,240,000

$23,569,500

May-20

555500

$26,664,000

$25,993,500

Jun-20

611050

$29,330,400

$28,659,900

Jul-20

672155

$32,263,440

$31,592,940

Aug-20

739370.5

$35,489,784

$34,819,284

if 500,000 members sign up for SpringyFeet in the first month at $48/year (since millions are eligible for SilverSneakers as members, then total sales

500,000 members X$48. $24,000,000. Less variable costs, 24,000-145,000= 23,855,000, less fixed costs=23,329,500. projected sales of an increase of 10% per month are predicted with our demand forecast based on SilverSneakers member #s number projections.

Student Gi:

Rationale

The idea in development is a veterinary telehealth platform for Ethos Veterinary Health, a corporate emergency and specialty veterinary hospital group based out of Massachusetts. The group has about twenty hospitals nationwide between the east coast, Midwest, and west coast as a result of a merger of four hospital groups and further acquisitions. The proposed telehealth service would be piloted by the flagship hospital in Massachusetts and would focus on a few key specialties as champions of the service before potential expansion through the hospital and network of hospitals. The motivation to consider such a service offering is largely in response to current challenges facing the veterinary community. These include limited support staffing, reduction in face-to-face consults from the CDC guidelines on safety during the global pandemic, and increased demand for emergency and specialty care. A telehealth service would capitalize on the strengths of the flagship hospital and network, solve current issues facing veterinary healthcare, and continue to keep Ethos at the forefront of innovation as is the goal of their corporate mission and vision.

Market

With higher demand and less supply of clinics and support staff the next logical step to keep in line with necessary adaptations is to begin offering telehealth. Ethos is well positioned to do this with their network of clinicians across the nation to leverage. Consumers are already comfortable and familiar with services moving to online platforms. The adaptations businesses have needed to make during the COVID-19 pandemic has only furthered this drive towards online and contact free services even more than before. Some analysts believe that these adaptations will also lead to long term change in consumer behavior (Ziady, 2020). Telehealth is also becoming more common place in human healthcare leading more clients to adopt the idea for their pet’s health as well. Though it is a newer concept veterinary medicine also has the opportunity to grow in this area. A telehealth platform also solves for some of the staffing issues plaguing the industry as it does not require the same ratio of support staff to doctor as a brick and mortar location. It is a prime opportunity as it still allow for direct client facing visits and collaboration between specialists and wellness clinicians throughout the Ethos network.

Competition

There are standalone companies that offer veterinary telehealth such as VetNow who employ specialists and emergency clinicians for direct to client or direct to veterinarian consults. None however are backed by the large network of colleagues and have had enough time in the industry to build a strong reputation as Ethos has. Standalone practices are also unable to provide a full complement of care internally and rely solely upon partnerships with general practitioners to be successful. The issue there is the VCPR or veterinarian, client, patient relationship. This is a legal requirement for a veterinarian to have had an exam on the patient to establish a relationship of medical care within the past twelve months prior to making any further recommendations. Therefore, a pet that has never been seen before by a veterinarian at that practice cannot be diagnosed, prescribed, or otherwise treated without a physical or in person exam (AVMA, 2020). As Ethos has general practice under their umbrella, they can leverage this advantage and avoid the VCPR restriction through specialist consults coordinated at regular visit times to allow the hands-on care by the general practitioner. This would be enough to establish the necessary relationship for continued follow up care and keep revenues under the same brand.

Innovation

This service is innovative and new to the veterinary healthcare sector as it is not something that is routinely offered. However, it is only a matter of time before it becomes a demand of consumers making now an ideal time to capitalize on the growing market of telehealth for pets. Previous restrictions put in place by the AVMA have loosened in light of the recent events of the COVID-19 pandemic. Such changes have set a precedent that has shown the need and demand for such services to be offered (Wells, 2020). Having a large network of specialists and wellness practitioners all around the nation can help advance techniques and treatments far faster if they are all able to connect and share best practices with one another working on real time clinical diagnoses for a patient. For example, a wellness practitioner may call upon a radiologist to guide them through performing a diagnostic ultrasound from thousands of miles away. Similarly, that radiologist could then collaborate with an internal medicine specialist or surgeon to determine the next best course of action for this patient while the owner is still in the comfort of their primary veterinarian’s office. Medicine of any kind is a collaborative service. Many veterinarians seek to work in a large specialty clinic in order to gain that collaborative environment for their own continuous learning and to ensure the best outcomes for their patients. This is not always feasible for one’s living situation and those who are unable often feel isolated and unengaged after period of time working in remote or single doctor clinics (Simon et. al, 2019). Highlighting the differentiator of being able to have a collaborative environment without having to make sacrifices such as relocation can be a great recruitment technique in both hiring employees to more remote locations as well as attracting more hospitals to join the Ethos brand.

Physical and Technological Resources

As this is an entirely online service-based business the physical resources such as property, supplies, inventory and workspaces will be minimal. There will be no true raw materials to convert into an end product to sell, the service will be the product and revenue will be captured at the time of providing such service. The main area of resources will come from people and technology.

Physical Resources

Physical spaces necessary will be home offices for those that are working remote or the existing office space in hospital for those who are managing in-network consults. Other physical space needs will include not only the areas for the clinicians and support staff to work out of but also for those in the corporate space managing this division of the veterinary services. The changes brought on to the traditional office structure in light of COVID-19 may make this obsolete however a plan should be in place if a return to normalcy necessitates a normal work space environment (Richtel, 2020). It will be ideal to keep all employees in this division remote as it will help attract the right culture of likeminded individuals. It will also reduce or eliminate costs of rent, property, utilities, and other associated expenses of a physical plant.

The people resource necessary will be the clinicians and their support staff. The service will not be able to function without a spread of clinicians from both wellness and a variety of different specialty care services. At the heart of this will be the support staff coordinating the schedules and providing both the clients and clinicians the necessary information in order to perform the consult to a satisfactory level on both ends. Another large component to the support staff will be the information technology (IT) team members, both in development and support. As will be discussed further, the technological resources will be the largest part of this business. It will be integral to the plan that highly capable and trained IT team members are involved in the development, execution, and ongoing management of the proprietary software of this service. There will also need to be helpdesk staff who can troubleshoot and resolve issues end users face, both for the internal client of the clinician and support staff as well as the external clients, or the public. Legal council will also be necessary to ensure all proper software licensure registration is done to protect the brand from a competitor mimicking this platform.

The people resources will be leveraged through a combination of recruitment and current employees. For the doctors internal candidates will be the preferred resources to start this service due to their knowledge of the business, operations, and culture. Internal postings as well as discussions with local leadership will help to make strategic decisions about what clinicians already in network would be ideal for a role of this nature. This will reduce the lead time for training as well as the risk of costs associated with external hires that are not champions of the service. As internal candidates are selected their replacements can be backfilled to allow for continued service offerings at those hospitals. As the business grows external postings will also allow for any candidates interested in a remote position to apply however this will be in the later stages. Support staff and IT staff will need to be external hires as they will be staff adds and require their full dedication to this project.

Technological Resources

Technological resources will be much more involved in this service. First and foremost, the software must be developed, beta tested, and launched for the cloud-based service. This will be a more involved product as it will require integrations for video conferencing, payments and the necessary security measures to do so safely, record and image sharing, and integration with the current hospital information system (HIS) that holds patient records across the Ethos hospital network. If there are multiple software platforms the system must be able to ‘talk’ to them all to allow a seamless experience. This will also include third party applications such as integrations with payment and image sharing software. The most important end goal of the service is that it not only performs all of these tasks but it does so in a simple and user-friendly way that makes the experience as easy and convenient as possible for the client. If the software is too complicated or hard to use the future of the service will be in jeopardy of failure through lack of adoption of the new offering. Developing a proprietary software program will be the ideal route for this service as it will allow for full adaptation to the needs of the business.

The only true inventories would be hardware and software licenses. Each clinician and support staff member assigned to scheduling or other support services would need a work station and licenses to the software necessary to perform their duties. An inventory of these items should be on hand in anticipation of increased staff additions as the service grows. These items would need to be purchases from current vendors for workstations so the systems are compatible and easy to use for current employees. Technology also needs to be updated to remain relevant therefore other inventories would include servers, upgrades, and enhancements to security systems such as firewalls are necessary (Chaitan, 2014). This is especially important as client personal and financial data as well as patient medical records are sensitive documents that need to be kept confidential and avoid any potential openings for cybersecurity breaches and associated fines and legal fees (Culnan & Williams, 2009).

Implementation Schedule

Implementation will require a scheduled of order of operations identifying key tasks, critical to success and personnel needed to perform such tasks. Figure 1 details the project timeline and breakdown of task assignments by functional group and sponsor. The national and local operational leadership will collaborate on overall operations and cost structures and oversee the work performed by the other functional areas. Medical leadership will primarily manage medical operations and each subcategory therein. They will be assisted by operational leadership in development and review of all medical SOPs (Standard Operating Procedures). Similarly, medical operations will ensure operational leaders are in compliance with medical standards and compliance for operational standards developed. Finance will be consulted and involved on all appointment cost structure, full time staff salaries, forecasting and all other budgeting requirements. HR will manage recruitment both internal and external for veterinarians assisted by the appropriate functional area for the staff adds. The IT department will manage all IT operations, including development of the software, integrations, and implementations. The final necessary functional area to assist with this project will be Marketing. They will work with the appropriate groups for internal and external communication plans and marketing campaigns. They will also collect and report data from feedback loops and relay to operational and IT teams. These will then be analyzed and any suggestions or major themes will serve as for adjustments prior to the final launch.

Figure 2: 36-month Project Task Assignment, Sponsor, and Timeframe

Task	Project Timeframe	Group Performing	Sponsor
Overall Structure	Months 0-6	Ops - National	Ops - National
Cost Structure	Months 0-6	Finance	Ops - National
Medical Operations	Months 2-8	Ops - Medical	Ops - National
IT Operations	Months 2-8	IT	Ops - National
Recruit IT Team	Months 3-6	HR & IT	Ops - National
Develop App & Integrations	Months 6-18	IT	Ops - National
Recruit Medical	Months 6-10	HR & Ops – Medical	Ops - National
Communication & Change Management Plan Development	Months 6-10	Marketing & Ops - Local	Ops - National
Internal Marketing & Change Management Plan Development	Months 7-10	Marketing & Ops - Local	Ops - National
External Marketing Plan Development	Months 7-10	Marketing & Ops - Local	Ops - National
Internal Marketing Campaign Launch	Months 12-18	Ops - Local	Ops - National
Checkpoint Team Response	Month 18	Marketing & Ops - Local	Ops - National
Recruit Support Staff	Months 18-22	HR & Ops –Local	Ops - National
Train Internal Users on Application	Months 20-24	IT & Ops –Local	Ops - National
Gain User Feedback Internal	Months 20-24	IT & Ops –Local	Ops - National
External Marketing Campaign	Months 22-26	Marketing & Ops - Local	Ops - National
Soft Launch	Months 26-30	IT & Ops - Local	Ops - National
Gain User Feedback External	Months 26-30	Marketing & IT	Ops - National
Adjust Application Based on User Feedback	Months 26-32	IT	Ops - National
Final Checkpoint & Reinforcement of Change	Months 32-34	All Functional Areas	Ops - National
Final Adjustments	Months 32-34	All Functional Areas	Ops - National
Final Launch	Month 34-36	All Functional Areas	Ops - National

Project Review Process

Throughout the timeline checkpoints are built in to ensure the change management plan is working as anticipated and that all aspects of the project plan are functioning efficiently, on budget, and on time. This will be the primary responsibility of the national leadership team overseeing the project plan. Key questions to ask in the project review process will be set up in the outset of the project plan during the overall planning phase in months 0-6.

Profitability will be the most important indicator of the business venture, as it is in many other business decisions and key performance indicators (Mullins & Walker, 2013). One of the key questions that must be asked at the outset of the project implementation plan when developing the structure is how does this service bring value to the business? That question will also need to be asked throughout the project and beyond the launch of the business to ensure the service is being utilized to its fullest potential. If the cost structure is properly developed at the outset the clinician time can be maximized through a higher rate of consult to doctor than what would be done in a traditional veterinary clinic (Green, 2017). Reduced overhead of physical space and support staff will also help offset the costs associated with initial startup costs of application development and hardware purchases. The first checkpoint in the project plan will be after developing the initial framework where the operational leadership will revisit the value question and ensure their plan allows for maximized profitability.

The next major checkpoint will come following the internal communication and change management plans have been implemented. Targeted focus groups, team surveys, and town hall style meetings will introduce the plan to the staff allowing for free communication and sharing of how the service will be offered and implemented. The theme in each of these communication methods will be reiterating the role each team member plays in the plan as well as how the service will be beneficial to them and their clients. As these are events are happening the question to ask here is, how is the staff receiving and adopting the changes being communicated to them? Internal team members will be relied upon to market this service to their clients therefore it will be imperative they see and understand the value of this service. If they are not clear on the organizational strategy or how the service fits into the goals for their own service and hospital they will not be able to help promote this service effectively. If the messaging is off target or not being received as intended the approach will need to be adapted.

The next important checkpoint will be internal and external feedback on the service. Feedback loops will be one of the best ways to gain insight that only data analysis would leave out of the equation (Mullins & Walker, 2013). Some examples of these feedback loops will be reporting on clinician time on the service to best balance scheduling. After the identified team members are able to utilize the platform their feedback on the ease of use of the system will help tailor further updates to staff needs to make their time most efficient. During the soft launch clients who use the service will be asked to participate in a survey reporting key indicators such as ease of use, likeliness to use again, and likeliness to recommend to a friend. With the veterinary industry being a service industry and competitive it will be vital to manage client expectations and provide the level of service they are anticipating. Statistics also show customer experience is an important link to gaining customer loyalty, better brand reputation, and increased profitability. It also has ancillary impacts on the ability to keep employees engaged and retain talent (Morgan, 2019).

Intrapreneurship Opportunity

Intrapreneurship is the key in this project implementation plan. Many of the resources being utilized are stemming from the current legacy employees and corporate teams. This ensures that this is a seamless offering with the feel, the culture, and the quality medical care that is expected from an Ethos branded hospital. It will be essential that the management team ensures the corporate values and beliefs are coming through in every aspect of the service profile. This can be achieved by clear and effective communication of each aspect of the implementation’s goals to the teams as a whole. If this is not achieved the branch of the hospital will detract from the reputation of Ethos as a whole.

Company and Core Competencies

In the case of Ethos Veterinary Health there are a few core competencies that make this company unique and play well into the proposition to develop a telehealth business. The first of the core competencies is the way the business was founded. Other competitors such as Mars have built their network of hospitals through acquisitions. Their sheer market power has been powerful to convince standalone practice owners the monetary value of selling their practice (Nolan, 2018). Ethos began in a more collaborative way which is a thread in the fabric of the corporate identity. Four hospital groups were part of an idea sharing business group for veterinary practice owners called Moon. The teams initially found value in collaborating for better vendor pricing, sharing best practices, and discussing goals for the veterinary industry. As many were like-minded the discussion of a merger was opened and eventually came to fruition in 2016 (VPN, 2016). The ideals of this group have gone on to define the core values, mission, and vision of Ethos. This collaborative approach is essential to ensuring a proper project implementation and the success of the idea of multiple practitioners collaborating on patient care over a network of hospitals.

The second core competency unique to Ethos is centered around their flagship hospital in Massachusetts. This hospital is known in the veterinary community as one of the largest and highest volume veterinary hospitals in the New England Area. The hospital holds the distinction of a Level 1 Emergency and Critical Care Facility, which is the highest standard awarded to a veterinary hospital by the Veterinary Emergency and Critical Care Society (Parece, 2017). The hospital is uniquely able to manage and withstand any challenge presented by the patient’s condition or local community events. This strong reputation is a foundational basis to work upon when launching a new and innovative product offering as the business already has a good rapport with the clients and veterinary community.

Another core competency is the commitment the business has to innovation and education in the veterinary healthcare space. Two branches of Ethos are dedicated strictly to the growth and development of veterinary medical practices and education, Learning and Development with their platform Vetbloom and Ethos Discovery, the research and development arm of the company (Ethos About, 2020). The focus on learning and development has led to an educational focused structure that is not commonly found in private practice veterinary hospitals. This distinction has been recognized in the veterinary community and has set Ethos apart as a leader in education. One such example is the partnership with Lincoln Memorial University (LMU) that was begun in 2017. Two years later Ethos was recognized as a Distinguished Clinical Affiliate due to their excellence in educating LMU students. LMU-CVM Vice President and Dean Jason Johnson stated that “Ethos prioritizes education, and we are proud of our partnership with this outstanding organization” (Weiss, 2019 para. 2).

Corporate Culture

Mission and Vision

Ethos has a corporate culture centered around their mission and vision. These include a mission to provide “unsurpassed veterinary health care for patients and their human companions” and a vision that in part is focused on using “science-focused and evidence-based decision making” in order to “revolutionize the veterinary industry” (Ethos About, 2020 para. 2). This translates into a culture focused on a collaborative approach to ensuring the best outcomes for patients and continued work towards innovative ways of doing this. Telemedicine fits right into this service profile. The company also has a wide spread of subject matter experts and renowned clinicians in their hospitals which would allow for a wide compliment of services offered for consultations within the network and to outside clients.

Wellness and Caring

Another portion of the corporate culture within Ethos is caring for one another. The core values include continuous development and teamwork, both of which are described as improvements for team members and caring for one another in order to contribute to the overall future health of the business (Ethos About, 2020). This will be essential when considering the impacts of an online only service along with trends in the veterinary industry. Namely, a disturbing trend of high rates of suicide in veterinary medicine due to contributing mental health issues such as compassion fatigue and burnout. The CDC reports that the rate of suicide in the male population of veterinarians is 2% higher and the female populations is 3.5% higher than the average corresponding gender of other professions (Simon, Balaban, & Doubek 2019). A large contributor to such difficult statistics are financial burdens but also abusive behavior from pet owners, especially on public forums online that allow for a large audience and general freedoms of anonymity to speak plainly (Larkin, 2016). A notable example of the impact of this behavior was reported by news sources when a veterinarian was bullied online due to a difficult patient care decision and eventually took her own life (Shahrigian, 2014). Considering this business platform is centered upon entirely online access to a veterinary team member this is a concerning trend due to the potential to open the veterinarians up more to such negative impacts.

Key Roles, Responsibilities, and Qualifications

The national operational and medical teams will be the main drivers of this project across the network of hospital as project sponsors directing and managing all aspects of the implementation team. This will be led by the Chief Operational Officer and the Chief Medical Officer. On the local level they will direct project implementation plans to the Regional Vice President of Operations and Regional Medical Director first of the East Region as the project will be piloted in the flagship hospital in Massachusetts. The regional team will involve the local hospital leadership including the Hospital Director, Medical Director and individual managers of the Surgical, Emergency and Critical Care (ECC) and Medicine services (Ethos Team, 2020).

The national operations team will define the overall structure of the project plan and business goals for the new service. This will include setting KPIs, budget targets, and delegating tasks to the appropriate team leads. This will require individuals with historical business and industry knowledge, an understanding of the competitive market, and understanding how to identify the best team members for delegation of tasks. The finance team, primarily the Chief Financial Officer, will consult on current status of cash flows, available funding, and financing options to execute this project. The current Ethos team members in place are well equipped to manage a project of this design. In the above list of individuals there are many legacy employees who have ten or more years tenure with the company in their respective roles. Those who are newer with the company have all been in their respective roles within the industry for many years prior to beginning their career with Ethos (Ethos Team, 2020).

Local team leadership will collaborate with the regional leadership to help select the best departments and team members to help champion this service. The Hospital Director will work with each Service Manager to build the staff needs, day to day operations and service profile, and equipment needs to begin the service in their respective departments. They will also have the primary hiring conversations and decision with collaboration from HR to define the clinicians that will begin this service. They will need to have skills in understanding their unique department workflows, the personalities of their key staff members to select the best options for champions, and strong people management skills to properly manage the added challenge of a remote employee. They will also have to take into consideration the customer profile of each service to tailor the daily operations to what their clients will want and need from it. At the flagship hospital the local leadership team has a combined 25 years’ experience in leading a veterinary hospital and hold degrees in either veterinary medicine and/or business leadership. They have each been leading in their respective departments for over five years as a team and have been the leads on executing other major initiatives for the hospital in the past including a full change in the hospital information system and adding four new clinical services to the hospital (Ethos Team, 2020).

The author of this document is currently the only team member in the local leadership with both veterinary and business degrees. As the author is currently in a management position at the flagship hospital and has over ten years with the company in various leadership roles it is proposed that the author will be the primary on project management from the local leadership level. The remainder of the local management and medical team will assist with assigned tasks and areas of expertise and the regional and national teams will sponsor initiatives. Upon successful completion of the service roll out the author will be the lead in managing the service, including defining and overseeing the roles of the clinical staff and non-clinical support staff throughout the life of the service.

Medical leadership on the local hospital level, specifically the Medical Director and Associate Medical Directors, will collaborate with Regional Medical Director to develop standard operating procedures for the medical team members who will be working in this service. They will define the standards for medical record keeping, proper patient care and client communication, standards for diagnosing and prescribing, workflows for requesting and completing internal and external consults, and educate the clinicians selected for these roles in expectations and best practices. These will be made to ensure compliance with all standards set forth by the American Veterinary Medical Association (AVMA), the governing body that sets standards for veterinary medicine in the United States. They will also need to ensure compliance will all regulations set forth by the Drug Enforcement Agency (DEA) and Food and Drug Administration (FDA) regarding the dispensing and prescribing of prescription medications, controlled substances, and prescription foods (AVMA, 2020). This will require team members with a strong medical acumen beyond their own respective department and the ability to collaborate with subject matter experts in fields outside of their own clinical training. The current Regional Medical Director and Medical Director are both board certified internal medicine specialists who still practice in addition to their administrative duties. The Associate Medical Directors are also board-certified specialists practicing in their respective fields. They include Diagnostic Imaging, Emergency and Critical Care, and Anesthesiology and Pain Management (Ethos Team, 2020). This combination of specialty representations allows for a good spread of clinical knowledge and expertise to best consider the aspects of each respective college of medicine that will be represented in this service.

The next largest section of team operations will come from the Information Technology resources, or IT team. The current Ethos IT team is small and in the process of better defining their structure and increasing staffing since the addition of a Chief Information Officer in 2020 (Ethos Team, 2020) The CIO will be part of the initial phase of planning with the operations teams on the national level. From there they will branch off to working with their own team and HR to identify the right internal team members and recruit the right external candidates for the development and integration of the new platform. These new team members will report to the CIO during the initial phases of development. They will teach local IT team members at the regional level the features of the program including troubleshooting so they may take over future roles in supporting the internal customers with application issues.

Ideally, the additional team members will be able to apply their skills to future application developments once they have built the program and hired and trained the team that will manage it going forward. These individuals would need to possess a well-rounded skill set. One important role to fill is the team member primarily in charge of the development of the product and acting as a liaison between the operations team and the IT team to help execute the project plan. This individual will need to have strong communication, project management, team management, and overall IT engineering skills. Other team members will need to have skills in cloud-based technology and integrations, ability to keep the software agile with the ever-changing technology environment, design for ease of use, data analysis and coding to make the product run efficiently and smoothly (Firenze, 2016).

Contingency Plans

As all projects must have contingency plans for possible changes in team member involvement there will need to be backup options for team members assigned as leads in the project. As defined in the project plan there are multiple individuals collaborating on each portion of the project in the three lead areas. At the outset each team lead and the project manager will define a secondary who will be involved in each step of the project plan with them. Should the primary have to step away from their role at any point in the project implantation the secondary will be prepared to step in and take over their responsibilities seamlessly. Each secondary team member will need to possess a similar skill set as the primary in their respective roles so there is no gap in ability to manage their assigned tasks.

As another part of a project implementation plan is preparing for the unexpected there will be cushions built into the project plan timeline to allow time to manage for unanticipated problems that may arise. These are most likely to occur during the IT development and/or recruiting processes therefore those timelines are the most robust. Frequent check ins will help catch any possible timeline delays or work to resolve any issues that have already risen

Budget

Startup Costs

One of the first steps in determining budget and breakeven will be determining startup costs and a proforma analysis of potential revenue for additional services. Startup costs during the planning phase will be primarily the research, development, and IT infrastructure. The second largest cost will be surrounding payroll and labor costs. As the planning and post implementation management will be done by national, regional, and local leadership their salary costs are already factored into ongoing forecasts and annual budgets and will not incur any further costs specific to this project.

Figure 3. Startup costs

Startup Costs	Cost	Notes
Research and Development	$30,000	Client and staff surveys, adaptation of current application or development of a new program to fit needs
Application Engineering/integration	$50,000
Software	$50,000
Programing	$50,000
Salary for veterinarians	$96,200	3 veterinarians to start average salary of $150,000 or $85,000/y prorated for 3 months (2 specialty, 1 wellness)
Veterinary Support Staff	$25,000	3 support staff members at $16/h 7 days a week
Technical Support & staff training	$20,000	2 dedicated team members at $20/h for 3 months for 5 day/week internal IT support
Marketing	$10,000	Generally, in house marketing campaigns and online ad presence
Legal/licensure	$5,000
Startup Assets	Cost	Notes
Hardware	$7,000	dedicated workstations and headsets for veterinarians

	$343,2000	Total Costs

Sourced: Healy (2020)

Figure 3 shows anticipated startup costs from months 0-30 in the project implementation plan including the three-month snapshot of ongoing payroll and labor costs for the trial soft launch period. Salary ranges for clinicians are based on U.S. Bureau of Labor and Statistics 2017 assessment of median salary for a veterinarian at $90,420 (DePietro, 2019). State and regional differences as well as general wellness versus specialty clinician salaries will lead to variances in this statistical measure. With the East coast having generally higher costs of living and salary ranges and the target clinicians participating being specialists the payroll costs will be on the higher range. Estimated salaries will be $150,000 per specialist and $85,000 per wellness clinician added to the service. The snapshot has salary rates prorated for the three-month trial period.

Similarly, support staff will be scaled based on market differentials and competitive rates. National surveys in recent years have shown that the average salary of a veterinary technician ranges between $15-20 per hour in the United States (Wogan, 2018). The remote support staff for the clinicians will not need to be highly trained in medical techniques, rather a general knowledge of veterinary medicine will be preferred along with administrative and communication skills. Therefore, the salary range is factored on the lower end of the range. Other support staff costs include dedicated IT staff for internal and external helpdesk troubleshooting and ongoing maintenance of the program. Glassdoor estimates the annual salary of an IT Desktop Support specialist in the Boston, MA area is about $42,000 per year therefore a salary of $42,000 per IT team member is factored in (Glassdoor, 2020).

Proforma Analysis

The proforma analysis (see appendix) as a next step helps build out anticipated sales revenue along with labor expenses to determine an anticipated break-even point. The proforma gives an estimated plan of additional revenues and expenses specific to the departments associated with this expansion project. The forecast budget will provide greater detail into full department and hospital finances for budgeting purposes. The proforma is focused on the specialty departments that will begin this service, Nutrition and Oncology. Wellness or General Practice (GP) consults will factor into the new source of revenues as it will be telehealth specific. The Oncology and Nutrition departments have been established in the hospital for six years and two years respectively therefore there is historical data to pull from unlike the GP department. The historical data has helped inform the projected revenues while the GP department is based on assumptions of revenue returns.

As the proforma outlines the goal is to start with three doctors and three support staff making it a ratio of one per doctor. The IT support will also be at a higher ratio to start with two dedicated team members for all IT needs on this program. The future costs savings will come as the staffing model can be leaner than a tradition veterinary hospital. Therefore, the existing startup staff will be used with each subsequent doctor addition within the first five years. The plan will hinge on doctor revenue offsetting labor costs of support staff and still make enough revenue gains to recoup startup costs. This should be attainable if each doctor is able to generate $250,000 in revenue per year or an average of $21,000 in revenue per month. This can be accomplished if the specialists are structured with a schedule of six consults per day for five days priced at $190 per consult. Wellness doctors will have a lower price point at $100 per consult and see and ten wellness visits per day. Specialists consults will be scheduled for 45 minutes with 30 minutes direct face time with the doctor and 15 minutes as a cushion for any review of records or technical troubleshooting. Wellness visits will be scheduled at 30 minutes with the same 15 minute cushion and 15 minutes of direct face time.

Budget Forecast Analysis

The next area is the budget forecast from years one to six. For reference historical department data is also included as it has helped inform forecast assumptions for the Oncology and Nutrition departments. On the historical period of the forecast year over year revenue grew by $668,000 in Oncology and $108,000 in Nutrition. This was due to an additional doctor added to the Oncology service in 2020 and an increase in price structure in Nutrition at reevaluation of the service after one year. As was mentioned previously, the Nutrition service is a newer service to the hospital at only two years. Within the first year some initial startup lag time was anticipated however demand showed that the service could be more profitable with a strategic adjustment to pricing structure.

An overall 7% price increase was applied at the start of fiscal year 2020 to adjust for vendor costs and increased expenses. Nutrition saw a higher overall increase due to adjustments in schedule and costs of consult fees as market comparisons showed room for adjusting. Price increases are strategic year over year to maintain competitive with widely available specialties such as Oncology and target prices for more niche market service such as Nutrition.

Other factors to explain the increased sales was annual sales growth. Sales growth is anticipated to increase year over year due to general environmental factors such as housing and infrastructure development in the immediate area and an increased focus on pet ownership among the millennial generation. Price increases will also will continue at an annually at a rate of 3% to keep on pace with increases in expenses and vendor pricing.

Costs of buying/occupancy or operating expenses are also anticipated to increase on a standard rate of 1% annually however with additional services this is forecast to increase expenses of operations marginally by and additional 1% per doctor added to the service. As can be seen with additional review of an annual budget (see appendix) the forecasted operating expenses, total labor and benefits expense are based on allocations to the specified departments for overall expenses.

Budget

The budget in the appendix is an adapted preliminary budget for fiscal year 2021. The proforma and forecast information has been infused into the budget to flesh out how the proposed project will impact overall hospital revenue and expenses beyond just the proposed departments. The budget is done in a top-down approach and built around anticipated doctor production revenue, or top line, as the main basis for goal planning. Each department is then reviewed based on anticipated trends in revenue month to month based on high or low volume months. In general, the summer months tend to be higher revenue producing due to higher case volume through the ER and ER driven specialties such as Surgery and Neurology. Dips in revenue on some of the summer months and end of year in specialty departments with fewer clinicians, such as Nutrition and Oncology, are due to planned or anticipated doctor vacation time and closures due to holidays. As there is no current historical data the General Practice department is averaged in revenue across the full year.

Direct materials expense, or items purchased for use in the hospital is forecast at general hospital goals of 10% of overall revenue. Costs savings can be appreciated with an increased revenue return from remote clinicians that are not utilizing materials and supplies in order to generate that revenue. This allows budget targets to be more aggressive at just below 9%. Similarly, wages for technicians and support staff assistants are also an area of cost savings. As the model is lean to have fewer team members per doctor for the remote positions the overall budget target is set at under 12% of revenue. Doctor wages will be the highest area of monitoring as the increase in salaries for the remote doctors increase to over 28% of revenue, generally the hospital prefers to maintain this goal at 27% or below however the hope is that the increased revenues and costs savings in other labor and expenses will help offset the additional percentage. Hospital management will need to ensure each remote doctor is able to produce at the anticipated revenue target level or higher to offset their own costs.

Direct labor and benefits will remain the highest budgeted category of expense. With a hospital staff of over 250 employees a large portion of overall expenses must be allocated to this area. Regardless of the impact from the additional services and support staff the overall budget targets are still on track to produce a health gross margin percentage of 39.8% due to the gains appreciated from additional top line revenue from expansion of key departments.

Assessment of Assets and Liabilities

Current Assets

Being that this is a private service based business current assets are not as robust as a public or production based industry. Assets include cash and cash equivalents on hand, inventories, securities, and prepaid debts. Primarily most assets on hand are fixed assets such as equipment in the hospitals as most properties held by Ethos are leased. The cashflow statements will show the annualized asset payments with anticipated impacts from the additional staff and revenues at years one, three, and five.

Current Liabilities

Similar to current assets liabilities are less substantial to Ethos. These would include accounts payable, income tax expense, rent for properties leased, and any interest and debt expense owed on bank loans. Budgeted operational expenses for 2021 including these categories are outlined in the budget and estimated as general operational expenses throughout the forecasted years of the project lifespan (see appendix). The cashflow statements show more details regarding ongoing expenses on an annualized basis.

Funding and Capital

Sources of Funding

The primary source of funding for this project will come from current hospital revenue streams. In the past three years the hospital has consistently produced profits allowing for reinvestment into physical space through renovations and purchase of capital equipment. Part of the funds generally allocated for this category can be shunted to help fund the startup costs associated with the capital equipment purchasing for IT needs. In order to assist with such efforts in the past Ethos Veterinary Health entered an agreement with Brown Brothers and Harriman (BBH) as investment partners (BBH, 2019). Their equity stake in the company has provided cash infusions to fund capital improvements and other necessary investments into the business. If there are gaps in what the current hospital revenue streams can provide to cover costs associated with the new service expansions further equity infusions can be utilized. Ethos Veterinary Health has also obtained debt financing from Citizens Bank in the past however, this will be the last choice for funding options due to the additional interest costs associated with this form of capital. In recent years the partnership with BBH has made this no longer relevant to necessary operations.

Costs of Attaining Capital

Should hospital revenue returns be sufficient for reinvestment into the company to fund this endeavor there will be no cost of obtaining capital. The funds will be allocated as deemed necessary and no additional debt or interest expense will be incurred. Should an equity infusion be required by the investment partners BBH then the costs associated would be equal to the cost of equity acquired. Though Ethos is a private entity BBH does have stake in the company through a minority share and minority representation on the executive board from the initial investment partnership agreement.

Key Assumptions

There are three main assumptions made in the planning of this business opportunity. The first assumption is that the current economic climate in the United States is favorable for business expansion, especially in the veterinary industry. Though the recent pandemic has affected the historically low unemployment levels the overall impact has been minimal to spending on veterinary care.

The second is the factor of the new normal that the COVID-19 pandemic has brought on. This new lifestyle seems here to stay for a period of time so it is reasonable to assume there will continue to be the same issues that the hospitals are experiencing from it for the foreseeable future. Social distancing mandates will increase the necessity for telehealth rather than in-person visits. It is also assumed that the business will need to find ways to be lean with staffing models as support staff will continue to be a challenge to hire. The American Veterinary Medical Association (AVMA) is a branch of the Food and Drug Administration that oversees all standards in regards to veterinary care of companion, production, research, and farm animals in America. Previously the AVMA has been restrictive on their allowances for telehealth in the veterinary sector however the demands brought on by the pandemic forced a revised outlook on some barriers that previously existed (Wells, 2020). The assumption is that those changes will continue to a more permanent outlook considering the length of time that has passed with successful telehealth operations across the nation.

The last assumption is that both socially, generationally, and culturally there will continue to be an increased focus and dedication to pets as members of the family who deserve top notch healthcare. Previous generations always held their companions as important but more recently pets have become more of a view of children than companions. Surveys have shown that pet owners will put themselves and families at financial risk in order to provide for their pets as they are devoted to their wellbeing at all costs (Horch, 2019).

Factors That Affect the Assumptions

The factors that will impact these assumptions come from external impacts of political, social and scientific trends. In regards to political and economic factors the general industry success in the difficult times may come partially from continued economic stimulus from government and adaptations in business operations that are allowing other industries to remain effective enough to retain jobs. Should this pandemic continue on for much longer and businesses are severely impacted either by further revenue losses or mass outbreaks effecting their bottom lines more jobs may be lost and unemployment will rise.

Should a COVID-19 vaccine be produced in the near-term future then some factors impacting the necessity for telehealth may become less severe. As businesses may be able to open for more services then some normalcy will return to the veterinary industry as well. The demand for the service may diminish as in person visits return. In person visits will require more staff for support but it is unknown at this time if staff that left the industry during the pandemic will return. The assumption is that creative staffing models will need to continue due to previous trends in diminished labor pools for veterinary nurses.

There is speculation that the behaviors learned by consumers during the pandemic will become new ongoing expectations of how they choose to shop, work, and seek medical care long after this is all over (Bakhtiari, 2020). Convenience has been a driving factor for many online businesses and veterinary telehealth is no exception. The pandemic highlighted the need for a safe and convenient way to still continue to operate as one normally would. Telehealth became more prevalent and previously restrictive regulations lessened to allow options for veterinarians and their clients. If the client demand is still there beyond the pandemic timeframe the regulations will need to be adjusted more permanently to meet consumer demand.

Factors That Affect the Success

The key factor in the success of this business model will be the pet owner’s willingness to adopt telemedicine as viable alternative to a classic visit. Pre-pandemic client surveys did show a demand does exist for telehealth options, in fact 85% of veterinary clients find the idea appealing (Green, 2017). However, it may not be the preferred method due to lack of human connection and communication barriers that can happen with an online service. If the application is not as seamless and easy to use for the client or doctor any technical glitches may make it less appealing to a client. They may feel they are unable to focus or properly gain the care they need for their pet if the technological issues or communication barriers distract them. If these issues are realized then the service may not produce as optimistic revenue gains as forecasted.

Should the service not be marketed correctly internally or externally the second factor that may impact success is the client’s perception of value of service. This would also be true if the above technical or communication issues are not addressed. The service model will need to be structured in a way that the clients feel they are not missing any part of a normal visit and getting the focused one on one doctor time they need in order to feel the value of this visit and return again.

The last factor that will impact success is if the assumed relaxation of AVMA regulations does not remain post pandemic. If the AVMA were to pull back on what they have previously allowed the service would still be able to operate however it would not be able to provide as wide a compliment of services as currently allowed. This may impact the ability for doctors to operate in ways that will bring value to the client and patient.

Contingency Plans

Increased focus on internal support for the hospitals within network or within the referring veterinarian community network will be one contingency plan that can solve a few of the potential factors that may impact the success of the business model. Currently the model is to offer direct client visits as well as internal visits to the network of hospitals and referrers. If staffing issues make in person visits difficult to accommodate a shift towards more telehealth options with a direct partnership with referring partners will help alleviate that pressure. This is also a win for the client and referring veterinarian as they will not have to disappoint their client with a long wait time for a specialist if schedules are booked out for weeks or months. If the economic downturn does happen then this could be a way to still care for the patient and partner clinicians with a lower cost model as the client will not have to pay for diagnostics at traditionally hire priced emergency/specialty clinics. It will also capitalize on the convenience and on-demand trend clients have become accustomed to.

Another option for telehealth should it be struggling in the more urban and populated areas due to strong competition is a shift focus to rural areas where care is limited. Partnerships with underserved communities or areas far from the main hospital operations will bring a larger demographic of clients and patients that may not have been able to receive such care in the past due to travel constraints. This will play into the corporate social responsibility factor discussed further on by providing for communities that otherwise would be lacking in high quality veterinary care services.

If clients are not finding the value in the service and not booking as many consults as forecast an increased shift towards an internal support model will also help continue revenues while the service is reevaluated. As part of the soft launch period ongoing surveys will help capture the wants and needs of client from service and adapt to their requests. This will continue beyond the launch with targeted questions to determine what makes them feel the value of the service. As a preemptive measure doctors will also need to be initially and continuously coached on active listening and compassion techniques to help mitigate any of the lost human connection with a telehealth service.

Factors Impacting Business Environment and Concept

Cross Cultural

Cultural views of pet care differ widely among various groups of individuals throughout the world. As the United States has become more diverse with immigration from various developing nations there may be a change in what the average customer is expecting out of veterinary care. As was discussed previously the Millennial generation of pet owners is more likely to treat their pets as if they were their own children. They are much more conscientious than previous generations about following recommendations from veterinary staff and may invest a significant amount of their income towards their pet’s comfort and wellbeing (Vetsource, 2019). This is a global trend also seen in European countries including France and in Latin America. French animal welfare groups have successfully lobbied for politicians to change legislations to allow pets a higher protective status than pets even in the United States where they are still considered property by the law (Dogtime, 2019). In Latin America as rising wealth leads to more of a middle class pets are becoming less for protection and more for companionship. However, many still may not feed their pets a balanced diet which may lead to concerns surrounding cultural views of what constitutes proper pet care (The Economist, 2011).

Economic

Economic factors impact both the veterinary community as well as the clients they serve. As a whole, the veterinary industry is dependent upon disposable income. Though emergency care and certain specialty services such as emergent surgeries are considered an essential service they are also dependent upon the client’s ability to pay for such services. Though many pet owners are dedicated to doing what is necessary for their pets, including putting themselves into financial risk, not all will do so and may elect what is called “economic euthanasia” (Tremayne, 2009 para 1). A study done in a Chicago animal shelter compared statistics before and during the Great Recession and found that there was a higher incidence of surrendering of senior animals due to increased cost of care (Weng & Hart, 2012). Veterinarians also reported a higher incident of clients refusing treatment and increased rate of euthanasia during this timeframe (Tremayne, 2009). Veterinary visits may average a few hundred to a few thousand dollars depending the type of visit and what diagnostics may be done. When asked in a survey in 2018 12% of pet owners responded to say they would not be able to afford any costs associated with an unplanned veterinary visit and 27% said they would need to go into debt or sell something personal in order to afford such costs (Horch, 2019). In human healthcare insurance coverage is more widespread whereas in veterinary care an estimated 10% of dog and 5% of cat owners have some form of insurance coverage for their pet (Moser, 2018). This may only be for emergent care and not for elective procedures or routine wellness visits. There is a push in the veterinary community to advocate for clients to consider insurance and this is showing positive increases in amounts of patients covered considering about a decade ago the rate of insurance in the nation for all species of pets was only about 3% (Tremayne, 2009).

The other economic factor that impacts the veterinary community directly is the consolidation of the industry. As was mentioned previously many graduating veterinarians are carrying large amounts of debt from their years of schooling. This debt is often prohibitive to starting a practice or buying one from a retiring veterinarian, which is also on the rise. Corporate entities, including Ethos, have been buying practices and consolidating smaller independently owned clinics into corporate conglomerates. The largest and most aggressive with this trend has been Mars Inc. Corporate entities are then able to pool resources and funds in order to provide the advanced diagnostics and treatment options that a small veterinary practice is not able to afford to invest in. It is also appealing for a new veterinarian to come into an already established corporate practice and not have to struggle to build clientele and a reputation (Nolen, 2018).

Geopolitical

The veterinary industry is less holden to issues with trade, tariffs, or global unrest however as was discussed previously overall global impacts of economy and the pandemic has caused concerns for the industry. Resurgences of the pandemic in Europe are causing concerns for further economic impacts in the United States which may lead to more unemployment (Bakhtiari, 2020). With a service industry that is dependent on disposable income high rates on unemployment would impact the revenue coming into the service if clients are either unable to afford a consult or the follow up treatment. Unlike veterinary medicine human healthcare has some provisions through government assistance and regulations to help cover high costs of care. Despite those medical bills can still become a hardship for a family during economic crisis. If unemployment were to rise the decision to pursue any form of emergent or elective veterinary care would be difficult to impossible for lower income families. There would then be less compliance with medical recommendations leading to losses to the bottom line of the hospital.

Legal and Ethical Environment

Relevant Laws and Regulations

The main area of compliance a veterinary telehealth business will need to ensure is their adherence to the AVMA’s restriction of a VCPR or veterinarian client patient relationship. The VCPR requires that all patient care must be done under the direct supervision of a veterinarian that has examined the patient in their clinic within the past year. This must be done prior to making an official diagnosis or prescribing a treatment plan. The recent events of the COVID-19 pandemic have allowed some leniencies in the restrictions set forth regarding telehealth and the VCPR however it is unknown if these leniencies are only temporary provisions due to unprecedented times (Wells, 2020).

Patents

Telehealth is not a new service or idea that would require a specific patent on the idea however the proposal is to develop proprietary software specific to Ethos Veterinary Health. This intellectual property will need to be protected in order to ensure it is not able to be utilized by competitors. It will also be wise to ensure all practicing clinicians and software developers agree to terms of non-disclosure and non-compete for a determined length of time in line with industry averages to ensure protections of insider information.

Diversity in Planning and Implementation

The planning and implementation of the business project will need to have adequate diversity in the groups of individuals involved and consulted to ensure all aspects are well thought out. It would be a failure of the plan to only consider the viewpoints on one subset of individuals rather than gaining a global perspective from multiple avenues. Such a plan will allow for increased understanding of all areas of potential views from various stakeholders and clients.

Stakeholder

In the initial planning phases many aspects of the implementation plan require collaboration from multiple functional areas of the hospital and corporate teams. Internal stakeholders will be important to consider as any failure in considering the crossovers of their roles may lead to delays and stopgaps in the final success of the full implementation. The other large group of stakeholders that will need to be consulted are the external partners to this plan. This is mainly the referring veterinary community and their ideas on what will and will not work for them and their clients. If they are not consulted then both the primary and contingency plans the project is based upon will be in jeopardy. Though it may be tempting to only consult with the top referring partners in order to gain full diversity of the potential field of stakeholders there should be a wide group of referring and non-referring veterinarians consulted. This can be done through surveys, focus groups, and trial use of the beta version of the product for input.

Customer

Similar to the external stakeholders there will need to be diversity in the customer base considered as well. The same technique will be taken with surveys, focus groups, and trial use with a wide variety of clients. Ideally the customer base will be from various socioeconomic and cultural backgrounds to ensure the needs of all types of potential customers are considered in development and implementation.

Corporate Social Responsibility

Corporate social responsibility is a new concept to Ethos Veterinary Health as a newer corporation however that does not stop the company from considering their responsibility to the community they serve. Even as a small business it is important to incorporate CSR practices into a business plan. Companies that successfully do so often appreciate increased revenue gains, higher rates of recruitment success and retention, and lifetime value of clients (Weiss, 2014). This is not unique to production or retail, service industries such as veterinary medicine also can benefit from CSR. Dr Mehran Nejati from the School of Business and Law at Edith Cowan University sates that a veterinary practice with a CSR plan benefits from “better relations with stakeholders, leading to improved brand equity and positive image, improved bottom line through efficiency improvements and environmental practices, improvement in working conditions of employees leading to higher satisfaction and productivity” (Tufvesson, 2017 para 9).

Understanding that veterinary patients are faced with many afflictions that are still uncurable Ethos currently works towards a goal to advance medical standards and care for patients they care for with a focus on science and technology. It the belief of the top leadership that it is part of the social responsibility of the corporation to use their network of hospitals to help test and develop clinical trials for such conditions. Casting a wider net of potential patients to treat and learn from will help drive this initiative forward. Incorporating telehealth into the portfolio of services can help bring this care to patients in rural communities and further reaches that would otherwise be prohibitive for travel.

The other important part of CSR is protecting the employees who work for Ethos. This includes a focus on mental health and burnout in the veterinary industry. There is a disturbingly high rate of suicide and other mental health issues that plague the industry. Many of these are brought on by the stress, difficult decisions, and debt associated with the career path (Simon, Balaban, & Doubek, 2019). Ethos advocates for the growth, development, and personal care for each employee. At two of their largest hospitals they employ full time social workers to assist both clients and employees with difficulties in their life. These same principles will need to be carried into the telehealth division especially considering the tendencies for lower inhibitions online platforms may allow some users.

Conclusion

Telehealth is still a new service in human healthcare with some challenges to overcome however much of what has already been pioneered in this sector can be translated into veterinary care. As the current model is facing its own set of roadblocks the only way to move forward is to continue to innovate to find ways to meet consumer and patient demand. Despite a proper strategy improper execution accounts for 67% of business failures (Carucci, 2017). Throughout the project plan the success will depend on each individual and group’s understanding of their role in the success of the project. Clear expectations of the project plan and timeline along with checkpoints to reevaluate current status of the plan will help reduce waste from inefficiencies and setbacks. Ideal resource management and identification of the best options for the business will also be important for overall success. Should all aspects of the project implementation plan be managed appropriately Ethos Veterinary Health has the potential to be the first to market on a unique and profitable service offering of telehealth.

As the future of veterinary medicine is in the hands of those that are innovating and educating today Ethos Veterinary Health is positioned well to be a leader in this regard. Their focus on education, innovation, advancing medical standards, and team wellbeing are strong strategic differentiators. If the company stays true to their culture and core competencies they will be pioneers in the realm of veterinary telehealth and realize future gains from such a unique position.

An overall strong proforma and forecast for the hospital show that targeting three key departments for expansion with telehealth services has potential to be highly profitable with minimal expense impact. Some capital funding is anticipated to be necessary should hospital gains not be sufficient or be needed in other areas of high priority for investment back into the hospital and there will be associated costs with obtaining that capital. If veterinary management is able to ensure each clinician produces at a revenue target that offsets their expense the budget shows strong percentages both in gross profit and EBITDA. Overall, this makes further exploration into the viability of this project appealing as the service will add diversification to an already strong and profitable profile of services.

Ethos Veterinary Health’s success in the telehealth division is based on the accuracy of the key assumptions such as decreased AMVA telehealth regulations, increased consumer demand and decreased staff availability from the pandemic. These factors will help to drive the innovation forward however if they fail to come true then contingencies are in place to shift gears towards a more internally focused supportive rather than external service based business model. Stakeholders and consumers will need to be considered in either approach to ensure there is a diverse range of perspectives in order to plan for all possible types of customer groups. It will also help to consider cultural differences in various groups of pet owners and how those may impact the service profile. The business is mainly focused on the Greater Boston and Merrimack Valley area of Massachusetts however national and global impacts such as economies abroad and their impact on unemployment will have repercussions for revenues. Keeping in touch with current trends will be essential for proper planning and potential pivots needed in the business. Legal and social responsibilities are also key to the success of the plan and proper steps will be taken to ensure compliance and ethics are at the focus in each step of the plan.

Appendix

Critique

Strengths

The strengths in the plan come from my own insider knowledge of the business industry, clientele, and clinicians that would make this business model a success. The hospital is currently facing an unprecedented volume of cases primarily in the emergency and critical care sector however many other specialty departments are also experiencing increases as well. Simultaneously the industry as a whole has been facing the challenge of a diminishing labor pool of qualified nursing and support staff. Now the issue is being felt even more acutely as they attempt to manage such high case volumes. Some hospitals are reducing availability of appointments or redirecting emergencies due to this challenge. When your continued revenue stream is based upon your client’s satisfaction and reputation with the referring veterinary community the balance must be carefully struck of caring for the patients you can without overcommitting and underdelivering due to decreased efficiencies. The first hospital or group of hospitals to solve the challenge of providing personalized care to the community in a way that does not require a high level of staffing will not only survive the current crisis but thrive going forward due to their ability to maintain positive relationships with their customers. This plan does that.

The industry is also a financially sound and attractive to investors. Generally anything in a healthcare sector will continue to do well regardless of the economy however it often comes with the burdens of regulations. Overall veterinary medicine has proven it is fairly recession proof but lacks much of that red tape. Considering how much spending and growth the industry has realized in the past decade there is a clear trend that this many other corporations and investors are turning their eyes to veterinary medicine and the pet care field in general as an industry to watch.

Weaknesses

A weakness in the plan is in the IT implementation this is not my greatest area of knowledge and expertise. In real application of this plan I would rely heavily on my IT team to ensure they have considered all aspects of what would and wouldn’t work, what could go wrong, and if the timeline is too optimistic for development. To adequately explain these details to an investor there would need to be further research in this regard. On review of the implementation plan another weakness also centers around the bandwidth of the leadership team to accomplish this plan. On review of current financials and year over year growth it may stand out that though the hospital and region is experiencing such a high revenue yield it is not with any additional leadership or support staff. The intention is to utilize current regional and hospital leadership staff and only bring in additional IT and designated support staff. This will save on labor costs however it could cause delays or gaps in the implementation process if current demands overshadow the focus on the implementation plan. It may be wise to consider a dedicated project manager on a contract basis to help keep the project on time and on task. The contingency plans should also include a larger group of backup team members that may be able to take on a portion of the regular duties of the internal management team to allow their focus to remain on the project. A further review of cost of increased labor versus cost of the timeline being prolonged may be beneficial in the initial planning phases so the decision can be made early on to add more support if deemed the better approach for the business.

Challenges to Assumptions

One challenge that may be brought up is the viability of this service with client’s accepting it as a valuable alternative to standard veterinary care. It may also be challenged that a key assumption rests on the current pandemic lasting long enough to implement this plan and learned behaviors will remain. Both of these are difficult challenges to answer as they are asking questions that are yet to be realized. To the concern over the pandemic’s course and how it will impact consumer behavior one can only speculate however a leading indicator in veterinary care that has proven true over the years is the trends in human healthcare. Veterinary care tends to follow on the heals of human healthcare trends and advances in treatment. Telehealth is still relatively new to human healthcare however advances in communication technology have helped to drive this service forward. Now that it is in place during a pandemic it is proving to be a key way to keep wellness care available safely. It would stand to reason that as people become more familiar with it for their own healthcare then they would accept and expect it for their pets.

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