Health Care Agenda for Business Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Health Care Agenda for Business case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Health Care Agenda for Business case study is a Harvard Business School (HBR) case study written by Leonard L. Berry, Ann M. Mirabito, Donald M. Berwick. The Health Care Agenda for Business (referred as “Health Care” from here on) case study provides evaluation & decision scenario in field of Organizational Development. It also touches upon business topics such as - Value proposition, Joint ventures, Personnel policies, Policy.

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment

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Case Description of Health Care Agenda for Business Case Study

This is an MIT Sloan Management Review article. The health care system in the United States is in crisis, and the implications for businesses and their employees are profound. As employers struggle with unrelenting double-digit health-insurance cost increases, some firms have decided to drop coverage entirely, and many others have shifted costs to employees. Meanwhile, the quality of the health care being paid for by companies and their workers remains highly uneven. On its own, business cannot solve the health care crisis in all its aspects, but that doesn't mean it can't do a lot to improve the system. Some companies are taking more active control over the issue and getting better results on both cost and quality. To learn from such companies and from those who influence and deliver health care services, the authors conducted in-depth interviews with thought leaders in business, health care, and related sectors. The overriding lesson from their research: Companies must build bridges to other players in the system to address the systemic problems that transcend even the most powerful corporations. They propose a partnership-based health care agenda for business that will benefit not only companies and employees but also health care overall by strengthening the market mechanism and encouraging fruitful collaboration.

Case Authors : Leonard L. Berry, Ann M. Mirabito, Donald M. Berwick

Topic : Organizational Development

Related Areas : Joint ventures, Personnel policies, Policy

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Calculating Net Present Value (NPV) at 6% for Health Care Agenda for Business Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10002344)	-10002344	-	-
Year 1	3463803	-6538541	3463803	0.9434	3267739
Year 2	3967093	-2571448	7430896	0.89	3530699
Year 3	3973912	1402464	11404808	0.8396	3336573
Year 4	3239454	4641918	14644262	0.7921	2565951
TOTAL			14644262		12700961

The Net Present Value at 6% discount rate is 2698617

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting

What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.

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Capital Budgeting Approaches

Methods of Capital Budgeting

There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Profitability Index
2. Internal Rate of Return
3. Payback Period
4. Net Present Value

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Health Care shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
2. Timing of the expected cash flows – stockholders of Health Care have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.

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Formula and Steps to Calculate Net Present Value (NPV) of Health Care Agenda for Business

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Organizational Development Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Health Care often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Health Care needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 15 %	Discounted Cash Flows
Year 0	(10002344)	-10002344	-	-
Year 1	3463803	-6538541	3463803	0.8696	3012003
Year 2	3967093	-2571448	7430896	0.7561	2999692
Year 3	3973912	1402464	11404808	0.6575	2612912
Year 4	3239454	4641918	14644262	0.5718	1852168
TOTAL					10476775

The Net NPV after 4 years is 474431

(10476775 - 10002344 )

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Calculating Net Present Value (NPV) at 20%

If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 20 %	Discounted Cash Flows
Year 0	(10002344)	-10002344	-	-
Year 1	3463803	-6538541	3463803	0.8333	2886503
Year 2	3967093	-2571448	7430896	0.6944	2754926
Year 3	3973912	1402464	11404808	0.5787	2299718
Year 4	3239454	4641918	14644262	0.4823	1562237
TOTAL					9503382

The Net NPV after 4 years is -498962

At 20% discount rate the NPV is negative (9503382 - 10002344 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Health Care to discount cash flow at lower discount rates such as 15%.

Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Health Care has a NPV value higher than Zero then finance managers at Health Care can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Health Care, then the stock price of the Health Care should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Health Care should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

Understanding of risks involved in the project.

What can impact the cash flow of the project.

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

What will be a multi year spillover effect of various taxation regulations.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.

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Negotiation Strategy of Health Care Agenda for Business

References & Further Readings

Leonard L. Berry, Ann M. Mirabito, Donald M. Berwick (2018), "Health Care Agenda for Business Harvard Business Review Case Study. Published by HBR Publications.