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LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India 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 LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India case study is a Harvard Business School (HBR) case study written by S. Ramakrishna Velamuri, Wei Zhang, Priya Anant, Monidipa Mukherjee. The LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India (referred as “Lifespring Hospitals” from here on) case study provides evaluation & decision scenario in field of Strategy & Execution. It also touches upon business topics such as - Value proposition, Strategy.

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 LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India Case Study


This case highlights the journey of an organization that was set up in Hyderabad, in southern India, to provide affordable maternal care services to women from low-income urban families. LifeSpring Hospitals grew from a single hospital into a chain of nine hospitals, all in Hyderabad, in only five years. The chief executive officer has spent this initial period trying out new methods, continuously fine-tuning the model and learning from this process of experimentation. As the company seeks to scale the business to 200 hospitals, the chief executive officer must decide whether or not the business model is defined clearly enough to warrant the start of a rapid scaling process. The case is unique because it juxtaposes a commitment to high-quality health care service delivery through processes and protocols with a commitment to making maternal care affordable to low-income urban women. LifeSpring Hospitals tries to achieve these seemingly disparate objectives by attempting to create a financially sustainable business model. Authors S. Ramakrishna Velamuri, Priya Anant, and Monidipa Mukherjee are affiliated with Indian School of Business. Author Wei Zhang is affiliated with CEIBS Health Care Policy Management Center


Case Authors : S. Ramakrishna Velamuri, Wei Zhang, Priya Anant, Monidipa Mukherjee

Topic : Strategy & Execution

Related Areas : Strategy




Calculating Net Present Value (NPV) at 6% for LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10000019) -10000019 - -
Year 1 3456437 -6543582 3456437 0.9434 3260790
Year 2 3964624 -2578958 7421061 0.89 3528501
Year 3 3949418 1370460 11370479 0.8396 3316008
Year 4 3242779 4613239 14613258 0.7921 2568585
TOTAL 14613258 12673883




The Net Present Value at 6% discount rate is 2673864

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






Formula and Steps to Calculate Net Present Value (NPV) of LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India

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 Lifespring Hospitals 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 Lifespring Hospitals 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 (10000019) -10000019 - -
Year 1 3456437 -6543582 3456437 0.8696 3005597
Year 2 3964624 -2578958 7421061 0.7561 2997825
Year 3 3949418 1370460 11370479 0.6575 2596806
Year 4 3242779 4613239 14613258 0.5718 1854069
TOTAL 10454299


The Net NPV after 4 years is 454280

(10454299 - 10000019 )








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 (10000019) -10000019 - -
Year 1 3456437 -6543582 3456437 0.8333 2880364
Year 2 3964624 -2578958 7421061 0.6944 2753211
Year 3 3949418 1370460 11370479 0.5787 2285543
Year 4 3242779 4613239 14613258 0.4823 1563840
TOTAL 9482958


The Net NPV after 4 years is -517061

At 20% discount rate the NPV is negative (9482958 - 10000019 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Lifespring Hospitals 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 Lifespring Hospitals has a NPV value higher than Zero then finance managers at Lifespring Hospitals 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 Lifespring Hospitals, then the stock price of the Lifespring Hospitals 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 Lifespring Hospitals 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 can impact the cash flow of the project.

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

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.

Understanding of risks involved in the project.

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

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.






Negotiation Strategy of LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India

References & Further Readings

S. Ramakrishna Velamuri, Wei Zhang, Priya Anant, Monidipa Mukherjee (2018), "LifeSpring Hospitals: Delivering Affordable, High-quality Maternal Health Care in India Harvard Business Review Case Study. Published by HBR Publications.


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