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Pleasant Bluffs: Launching a Home-Based Hospital Program 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 Pleasant Bluffs: Launching a Home-Based Hospital Program case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Pleasant Bluffs: Launching a Home-Based Hospital Program case study is a Harvard Business School (HBR) case study written by Laura Erskine. The Pleasant Bluffs: Launching a Home-Based Hospital Program (referred as “Proposal Hospital” from here on) case study provides evaluation & decision scenario in field of Leadership & Managing People. It also touches upon business topics such as - Value proposition, Developing employees, Financial management, Innovation, Operations management, Personnel policies, 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 Pleasant Bluffs: Launching a Home-Based Hospital Program Case Study


In the late 1990s, home-based hospital care started to be introduced in the United States and worldwide. This initiative seemed to lower costs, improve quality of care, and have a generally positive impact on patients. In early March 2014, the director of performance improvement at a major U.S. hospital was asked to develop a proposal, including a business case and an outline of a pilot program, for a version of home-based hospital care for the hospital's patients. The director was expected to present his proposal at the monthly session of the health system leadership team on April 30, 2014. He knew that his proposal would have to take into account various factors such as location, medical condition coverage, patient eligibility, the critical data that needed to be collected, the appropriate means of data collection, and the length that the pilot study would need to last. He also knew that his proposal would have to include projected costs and the potential benefits of such a program -- the program had to make financial sense. Laura Erskine is affiliated with UCLA - Fielding School of Public Health.


Case Authors : Laura Erskine

Topic : Leadership & Managing People

Related Areas : Developing employees, Financial management, Innovation, Operations management, Personnel policies, Strategy




Calculating Net Present Value (NPV) at 6% for Pleasant Bluffs: Launching a Home-Based Hospital Program Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10027656) -10027656 - -
Year 1 3456319 -6571337 3456319 0.9434 3260678
Year 2 3968671 -2602666 7424990 0.89 3532103
Year 3 3972383 1369717 11397373 0.8396 3335289
Year 4 3250918 4620635 14648291 0.7921 2575032
TOTAL 14648291 12703102




The Net Present Value at 6% discount rate is 2675446

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. Proposal Hospital 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 Proposal Hospital 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 Pleasant Bluffs: Launching a Home-Based Hospital Program

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 Leadership & Managing People 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 Proposal Hospital 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 Proposal Hospital 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 (10027656) -10027656 - -
Year 1 3456319 -6571337 3456319 0.8696 3005495
Year 2 3968671 -2602666 7424990 0.7561 3000885
Year 3 3972383 1369717 11397373 0.6575 2611906
Year 4 3250918 4620635 14648291 0.5718 1858723
TOTAL 10477009


The Net NPV after 4 years is 449353

(10477009 - 10027656 )








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 (10027656) -10027656 - -
Year 1 3456319 -6571337 3456319 0.8333 2880266
Year 2 3968671 -2602666 7424990 0.6944 2756022
Year 3 3972383 1369717 11397373 0.5787 2298833
Year 4 3250918 4620635 14648291 0.4823 1567765
TOTAL 9502885


The Net NPV after 4 years is -524771

At 20% discount rate the NPV is negative (9502885 - 10027656 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Proposal Hospital 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 Proposal Hospital has a NPV value higher than Zero then finance managers at Proposal Hospital 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 Proposal Hospital, then the stock price of the Proposal Hospital 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 Proposal Hospital 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 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 can impact the cash flow of 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 Pleasant Bluffs: Launching a Home-Based Hospital Program

References & Further Readings

Laura Erskine (2018), "Pleasant Bluffs: Launching a Home-Based Hospital Program Harvard Business Review Case Study. Published by HBR Publications.


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