eClinicalWorks: The Paths to Growth 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 eClinicalWorks: The Paths to Growth case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. eClinicalWorks: The Paths to Growth case study is a Harvard Business School (HBR) case study written by Robert F. Higgins, Mark Rennella. The eClinicalWorks: The Paths to Growth (referred as “Ecw Eclinicalworks” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. It also touches upon business topics such as - Value proposition, Entrepreneurship, Financial management, Growth strategy, Health, IT, Organizational culture, Strategy execution.

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

Case Description of eClinicalWorks: The Paths to Growth Case Study

In January 2006, eClinicalWorks (eCW) had an acquisition opportunity that could fundamentally change the way they had done business since the inception of the company in 1999. eClinicalWorks was a privately run business in the healthcare information technology field that took in $25 million in revenue in 2005. Revenues for 2006 were projected to reach $40 million. This successful electronic medical record (EMR) company had grown thanks to their reliable software and responsive customer service. The company had achieved this growth without the help of any outside financing. The five co-founders of eCW, who treated each other like an extended family, invested years of sweat equity and hard work to shape eCW as they wanted. They were also proud of their company culture, which de-emphasized traditional company hierarchies and encouraged independent thinking and cooperative working arrangements across departments. Keeping the company private, in their view, had helped them to maintain this culture. The opportunity to acquire another EMR company offered eCW the chance to grow quickly in an industry that is estimated to take in more than $40 billion in overall revenues in 2007. But this acquisition would require outside financing of some sort. Was this the moment to accelerate the rate of growth to which eCW had become accustomed-catching up with, rather than anticipating, how their customer base would expand? Or should they maintain the same approach that had worked so well since 1999?

Case Authors : Robert F. Higgins, Mark Rennella

Topic : Strategy & Execution

Related Areas : Entrepreneurship, Financial management, Growth strategy, Health, IT, Organizational culture, Strategy execution

Calculating Net Present Value (NPV) at 6% for eClinicalWorks: The Paths to Growth Case Study

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Cash Flows
Year 0 (10012312) -10012312 - -
Year 1 3462163 -6550149 3462163 0.9434 3266192
Year 2 3964623 -2585526 7426786 0.89 3528500
Year 3 3953940 1368414 11380726 0.8396 3319804
Year 4 3231693 4600107 14612419 0.7921 2559804
TOTAL 14612419 12674300

The Net Present Value at 6% discount rate is 2661988

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.

Capital Budgeting Approaches

Methods of Capital Budgeting

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

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

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. Ecw Eclinicalworks 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 Ecw Eclinicalworks have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.

Formula and Steps to Calculate Net Present Value (NPV) of eClinicalWorks: The Paths to Growth

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 Strategy & Execution 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 Ecw Eclinicalworks 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 Ecw Eclinicalworks 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 %
Cash Flows
Year 0 (10012312) -10012312 - -
Year 1 3462163 -6550149 3462163 0.8696 3010577
Year 2 3964623 -2585526 7426786 0.7561 2997825
Year 3 3953940 1368414 11380726 0.6575 2599780
Year 4 3231693 4600107 14612419 0.5718 1847731
TOTAL 10455912

The Net NPV after 4 years is 443600

(10455912 - 10012312 )

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 %
Cash Flows
Year 0 (10012312) -10012312 - -
Year 1 3462163 -6550149 3462163 0.8333 2885136
Year 2 3964623 -2585526 7426786 0.6944 2753210
Year 3 3953940 1368414 11380726 0.5787 2288160
Year 4 3231693 4600107 14612419 0.4823 1558494
TOTAL 9485000

The Net NPV after 4 years is -527312

At 20% discount rate the NPV is negative (9485000 - 10012312 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Ecw Eclinicalworks 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 Ecw Eclinicalworks has a NPV value higher than Zero then finance managers at Ecw Eclinicalworks 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 Ecw Eclinicalworks, then the stock price of the Ecw Eclinicalworks 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 Ecw Eclinicalworks 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.

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.

Understanding of risks involved in the project.

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.

References & Further Readings

Robert F. Higgins, Mark Rennella (2018), "eClinicalWorks: The Paths to Growth Harvard Business Review Case Study. Published by HBR Publications.