Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management 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 Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management case study is a Harvard Business School (HBR) case study written by Richard M. Kesner. The Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management (referred as “Phs Cpoe” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, IT.

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 Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management Case Study

This case considers the process of organizational transformation undertaken by Partners Healthcare System (PHS) since the 1990s as their hospital and affiliated ambulatory medical practices have adopted both EMR and CPOE systems. Encompassing a strategic investment in information technologies, wide-spread process change, and the pervasive use of institutional clinical decision support and knowledge management systems, this story has been 15 years in the making, culminating in 2009 with the network-wide use of EMR and CPOE by all PHS doctors. These developments in turn opened the door to the redefinition of services delivery and to the replacement of established therapies through the leveraging of the knowledge residing in 4.6 million now-digitized PHS patient records. As such, the PHS experience serves as a window into how one organization strove to address the daunting challenges of 21st century health care services information management, as a template for success in the implementation of large-scale information systems among research-based hospitals across the United States, and more broadly as a learning platform for industry executives in their efforts to transform health care delivery through data and knowledge management.

Case Authors : Richard M. Kesner

Topic : Technology & Operations

Related Areas : IT

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Calculating Net Present Value (NPV) at 6% for Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10000195)	-10000195	-	-
Year 1	3465781	-6534414	3465781	0.9434	3269605
Year 2	3981269	-2553145	7447050	0.89	3543315
Year 3	3940057	1386912	11387107	0.8396	3308148
Year 4	3223161	4610073	14610268	0.7921	2553045
TOTAL			14610268		12674113

The Net Present Value at 6% discount rate is 2673918

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

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 Phs Cpoe 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. Phs Cpoe shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.

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Formula and Steps to Calculate Net Present Value (NPV) of Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management

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 Technology & Operations 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 Phs Cpoe 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 Phs Cpoe 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	(10000195)	-10000195	-	-
Year 1	3465781	-6534414	3465781	0.8696	3013723
Year 2	3981269	-2553145	7447050	0.7561	3010411
Year 3	3940057	1386912	11387107	0.6575	2590651
Year 4	3223161	4610073	14610268	0.5718	1842853
TOTAL					10457638

The Net NPV after 4 years is 457443

(10457638 - 10000195 )

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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	(10000195)	-10000195	-	-
Year 1	3465781	-6534414	3465781	0.8333	2888151
Year 2	3981269	-2553145	7447050	0.6944	2764770
Year 3	3940057	1386912	11387107	0.5787	2280126
Year 4	3223161	4610073	14610268	0.4823	1554379
TOTAL					9487426

The Net NPV after 4 years is -512769

At 20% discount rate the NPV is negative (9487426 - 10000195 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Phs Cpoe 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 Phs Cpoe has a NPV value higher than Zero then finance managers at Phs Cpoe 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 Phs Cpoe, then the stock price of the Phs Cpoe 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 Phs Cpoe 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.

Understanding of risks involved in 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 Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management

References & Further Readings

Richard M. Kesner (2018), "Partners Healthcare System (PHS): Transforming Health Care Services Delivery Through Information Management Harvard Business Review Case Study. Published by HBR Publications.