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Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System 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 Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System case study is a Harvard Business School (HBR) case study written by Julia Adler-Milstein, David W. Bates. The Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System (referred as “Healthcare Records” 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, Knowledge management, Personnel policies.

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 Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System Case Study


For most Americans, a trip to the doctor's office or a hospital stay necessitates that medical personnel search through paper charts and records as care is administered. This remains the status quo, despite the increasingly large role that electronic communication plays in other aspects of our business and personal lives. The elevated use of information technology (IT) in healthcare settings-primarily via utilization of electronic health records (EHRs), which allow information to be readily communicated and shared among healthcare providers-has been advocated as a means of improving quality of care and helping to control healthcare costs over the long term. Yet, hastened implementation of healthcare IT will require considerable cost incursion in the near term, and will present various other challenges that must be addressed. Herein, we examine the merits and benefits of healthcare IT, as well as the costs and other challenges that may serve as obstacles to its wider implementation and use. We conclude with a set of recommendations designed to increase the likelihood that extensive expansion in the use of healthcare IT will yield the desired benefits.


Case Authors : Julia Adler-Milstein, David W. Bates

Topic : Technology & Operations

Related Areas : IT, Knowledge management, Personnel policies




Calculating Net Present Value (NPV) at 6% for Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10015545) -10015545 - -
Year 1 3445792 -6569753 3445792 0.9434 3250747
Year 2 3970802 -2598951 7416594 0.89 3534000
Year 3 3972091 1373140 11388685 0.8396 3335044
Year 4 3235482 4608622 14624167 0.7921 2562805
TOTAL 14624167 12682596


The Net Present Value at 6% discount rate is 2667051

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. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Healthcare Records 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 Healthcare Records 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 Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System

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 Healthcare Records 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 Healthcare Records 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 (10015545) -10015545 - -
Year 1 3445792 -6569753 3445792 0.8696 2996341
Year 2 3970802 -2598951 7416594 0.7561 3002497
Year 3 3972091 1373140 11388685 0.6575 2611714
Year 4 3235482 4608622 14624167 0.5718 1849897
TOTAL 10460449


The Net NPV after 4 years is 444904

(10460449 - 10015545 )






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 (10015545) -10015545 - -
Year 1 3445792 -6569753 3445792 0.8333 2871493
Year 2 3970802 -2598951 7416594 0.6944 2757501
Year 3 3972091 1373140 11388685 0.5787 2298664
Year 4 3235482 4608622 14624167 0.4823 1560321
TOTAL 9487980


The Net NPV after 4 years is -527565

At 20% discount rate the NPV is negative (9487980 - 10015545 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Healthcare Records 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 Healthcare Records has a NPV value higher than Zero then finance managers at Healthcare Records 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 Healthcare Records, then the stock price of the Healthcare Records 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 Healthcare Records 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 will be a multi year spillover effect of various taxation regulations.

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.

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

Julia Adler-Milstein, David W. Bates (2018), "Paperless Healthcare: Progress and Challenges of an IT-Enabled Healthcare System Harvard Business Review Case Study. Published by HBR Publications.