Marketing Analysis:

Pine Rest Mother-Baby PHP

Heather Treib

Bota Kroondyk

Sandy Chen

John Straub

Olivia Lanctot

Customer Driven Marketing Management- MKTG 6130

Fall 2014

TABLE OF CONTENTS

EXECUTIVE SUMMARY1

PART 1- STRATEGIC PLANNING.2

BUSINESS MISSION.2

INTERNAL SITUATION ANALYSIS3

PROGRAM OVERVIEW.3

CURRENT PINE REST PROGRAMS3

MANAGERIAL CLIMATE..4

MARKET DEMAND.5

CURRENT MARKET SHARE..5

MARKETING STRENGTHS..6

EXTERNAL SITUATION ANALYSIS..7

EXTERNAL COMPETITION.7

INTERNAL COMPETITION..9

QUALITY OF MEDICAL STAFF/ SUPPLIERS.9

INDUSTRY ANALYSIS9

EXTERNAL ENVIRONMENTAL ANALYSIS10

SWOT SUMMARY..12

ROOT PROBLEMS.13

RETENTION OF STAFF AND PATIENTS13

CONSIDERATION OF ALTERNATIVE STRATEGIES..14

PART 2- TACTICAL MARKETING MIX IMPLEMENTATION16

SERVICES16

SERVICES/ PRODUCT LINES..16

UNIQUE FEATURES.16

AWARENESS17

BENEFITS17

PROMOTIONAL OBJECTIVES18

INTEGRATED MARKETING COMMUNICATIONS CAMPAIGN.18

SALES19

ADVERTISING.20

SPONSORSHIPS22

LEVERAGE CLIENT EXPERIENCE TO GAIN REFERRALS..22

ADDITIONAL SOLUTIONS/ RECOMMENDATIONS.22

PROFORMA MARKETING BUDGET23

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EXECUTIVE SUMMARY__________________________________________________________________

The Pine Rest Mother and Baby Partial Hospitalization Program is one of three partial hospitalization

programs in the hospital based services division of the organization. It was opened in December 2012

with an expected average daily census of 4.5 to which it failed to meet two years post implementation.

While patient satisfaction scores in the program are good, staff satisfaction is high and the community

perception of the program is positive, it still struggles to meet the targeted market share.

Nationally this program is only one of three of its kind, and the only one within Michigan or the Midwest.

Research shows that these services are needed by the community and can be supported by the number

of births per year in the greater West Michigan Region. The three major hospitals, Spectrum, Saint

Marys and Metro Health have over 11,000 births annually and with 10 -15% of women experiencing

some form of perinatal mood disorder. While there is demand in this niche market, participation has not

materialized over the last two years.

Pine Rest struggles to meet organizational volume and margin targets in this program. It has been open

for two years and has only met its targeted volume a handful to times and occasionally dips in the red

from a margin perspective. The organization and community remain committed to this program and

have made investments in the programs success. However, these investments have been inconsistent

and have failed to reach the greater segment of potential patients and referral sources.

An integrated marketing communications campaign is proposed to further the mission of the

organization, increase referrals to the program and subsequently increase volume to the program. The

plan will build on marketing efforts of the past and expound on existing efforts of today. Further

investment in a dedicated Educational Salesperson to make face-to-face calls will be imperative to

positioning Pine Rest Mother and Baby program as a top of mind resource to referral sources.

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PART 1- STRETEGIC PLANNING____________________________________________________________

BUSINESS MISSION_____________________________________________________________________

Pine Rest used existing licenses for Partial Hospitalization Program (PHP) treatment positions to expand

into a new line of service. The new PHP was developed to serve women struggling with Perinatal Mood

Disorders (a collection of mood disorders, such as post-partum depression, that occur during pregnancy

and have onset in the first year after the baby is born). The program opened December of 2012.

A recent study states that 41% of nine month old babies live with a mother suffering some form of

depression. Untreated postpartum depression is serious and can lead to suicide, infanticide, child abuse,

divorce, domestic violence and recurrent mental health issues. Further, poor bonding between mother

and baby leads to developmental delays, emotional problems, inability to regulate moods, and poor

social behavior. While postpartum depression and other perinatal mood disorders are the most

common complication of pregnancy, they continue to go widely unrecognized, undiagnosed, and

untreated. In fact, 15-20% of women will experience some form of perinatal mood disorder.

The program is the result of many avenues of exploration and is truly in response to community need:

Collaboration between three divisions, Hospital Based Services, Professional Practice Group, and

Behavioral Health Solutions of Pine Rest to coordinate services around this population.

An internal Perinatal Mood Disorders team was formed within the organization and has met

regularly since April 2009.

Discussions regarding community gaps in care for families struggling with PMD broadened to

include Spectrum Healths Postpartum Support Coordinator, the Healthy Kent 2020 PMD

Coalition and many other community members.

In 2010, Pine Rest staff sought further feedback about community needs related to PMD

through the formation of the Greater Grand Rapids PMD Advisory Team.

Multiple contacts with leaders and experts in existing mother-baby PHP programs, inpatient and

intensive outpatient PMD programs, and at several conferences concurrent with an extensive

review of PMD literature from across the nation.

There are two existing mother/baby PHPs in the United States and one mother/baby IOP. They are

located in Rhode Island; Portland, Oregon; and Mountainview, California. A unique component of the

program is the offering of a nursery to encourage mothers to bring babies to treatment. The purpose of

the nursery is not to provide day care, but to eliminate barriers to treatment that normally exist for new

moms such as feeding issues, separation from child, and trusting someone to care for the new infant.

Further, the purpose of including the baby is to work with the mom in care and bonding for the new

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infant, teach her skills for managing emotions while parenting, and to assess her interactions with the

child.

As the building was renovated several safety features were built to accommodate the program such as;

The mother-baby program will not be accessible to others in the building who are not a part of

the program.

These women will have a separate entrance into the program.

The nursery will have an attendant with appropriate staff to baby ratios (though mothers will be

invited to bring babies to group).

Babies and moms will have security bands as on postpartum units in medical facilities.

Research supports the treatment of mothers with babies present. Mothers heal more quickly when

receiving treatment with their babies and the treatment help prevent the baby from experiencing the

negative impacts of the mothers illness.

INTERNAL SITUATION ANALYSIS__________________________________________________________

PROGRAM OVERVIEW

PHP is designed to treat women with Perinatal Mood Disorders (PMD). PMDs encompass mental

illnesses that develop during pregnancy and within the first 12 months following delivery. At the Mother

and Baby PHP an on-site nursery will allow women to bring their babies with them, into the treatment

setting. Babies are welcome to come to group sessions and other planned activities with the mothers or

the babies may stay in the nursery (staffed by an attendant) during group times. Women who are

pregnant or postpartum attend the program for at least 4 hours per day, 5 days per week. Each day,

women will attend a 90 minute group therapy session led by a licensed clinician (MSW, MA LLP, PhD).

Following the more open ended therapy group, didactic/teaching groups occur, also led by licensed and

PMD trained clinicians. Didactic topics include relaxation, communication, anger management, role

transitions, and other groups appropriate for the patient population. Additionally, groups will educate

mothers about parenting and teaching skills to care for and bond with their baby. The mother will meet

with a psychiatrist trained in PMDs upon admission and as needed at times scheduled before and after

the planned program.

CURRENT PINE REST PROGRAMS AND HOW THEY LED TO THE PHP DEVELOPMENT

Current inpatient and PHP models lead to the separation of mothers and babies during treatment.

Separation of mothers from their baby often results in women resisting or forgoing valuable treatment.

Further, feedback from women who have obtained services in Pine Rest inpatient and PHP is that groups

and education were not specific to their needs. These women stated that patients in the existing

programs have very different needs from the current inpatient programs offered through Pine Rest and

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this led to issues such as safety concerns, frustration with unit policies and procedures, and barriers to

bonding with their babies.

Pine Rest pulls from the greater West Michigan region (at least 1.5 to 2 hours away in all directions) for

participants in this program. However transportation is a significant barrier for local mothers to attend

the program. The nearest bus stop is several blocks away and in inclement weather, it is not ideal to

bring a baby to treatment let alone walk a great distance with baby gear in tow. In order for the program

to meet its targeted margin contribution, the program needs to stay at an average daily census of 4.5.

For the last year it has been averaging a census of 2.5-3.5, this is not sustainable. There have been

several months where the program has not covered its cost causing the rest of the organization to

subsidize. This is not uncommon in many organizations, especially healthcare, as patient census ebbs

and flows throughout the fiscal year. It is the strategic goal of the organization to break even as a non-

profit organization and that each program minimally cover their costs. The program is two years old and

has had several promising months, however has not been able to maintain a consistent census despite

the three other PHP programs within the organization have.

MANAGERIAL CLIMATE

Recently the program has had three different psychiatrists, two different managers and inconsistent

general medicine coverage. This has been problematic for the program to maintain consistency among

the treatment team and has resulted in a lack of strong leadership. The newest manager is also new to

partial hospitalization program rules and regulations which are very different from other inpatient

programs. The PHP did recently contract with a leading psychiatrist within the field of post-partum from

the University of Michigan for several hours a week for consultation through telemedicine technology.

The program has had overwhelming support from within the organization and the community. Several

events have taken place to help promote the program but also to position Pine Rest as a leader within

the field of perinatal mood disorders, they include:

Two perinatal mood disorders conferences (2012 & 2013) on Pine Rest campus featuring Dr.

Musik from the University of Michigan and leader in PMD treatment.

A baby-shower event to promote the service, gain community and staff involvement in the

startup of the program

Sponsorships by several local businesses including Walgreens that has had several diaper drives

for our patients

Two rounds of billboards in the Grand Rapids area referring people to the website when it is

more than the baby blues

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Pine Rest has sponsored a couple events through Moms Bloom and Through the Blue, two area

groups promoting PMD awareness and support

A strong presence on blogs supporting PMD work

MARKET DEMAND

The Primary User that is in demand for a Mother-Baby PHP is mothers who are suffering from some

form of depression and/or anxiety. Many women in this situation are not seeking necessary care despite

significant levels of depression, anxiety and impaired functioning. Others find that outpatient care

through their OB/Family Practice physician or a clinic setting are insufficient, and thus seek care in

emergency departments in crisis. Some women are admitted to area partial hospitalization programs or

inpatient adult programs that do not cater well to treatment of women who are pregnant or caring for

an infant. The selective demand for the Pine Rest PHP will be women who have not realized that they

are in need of a PHP program and are not seeking for the care to solve their problems. This program

meets not only womens needs but also meets a stated community need.

CURRENT MARKET SHARE

The number of births regionally is a key statistic used to predict number of pregnant and new mothers

potentially in need this service. The Birth data used to determine the Pine Rest predictions come from

the recorded and collected from the hospitals that serve the Grand Rapids area. Results from the two

most recent years available for this data have been dictated in the chart below:

Saint Mary's Spectrum Metro Mercy Total

Births

FY 2013 2,024 7,443 1,936 2,059 11,403

FY 2014 1,967 7,461 1,929 1,977 11,357

Variance -57 18 -7 -82 -46

Change FY13-FY14 -2.8% 0.2% -0.4% -4.0% -0.4%

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From these results the Pine Rest PHP has indicated the market share from these mothers that partook in

the offered services.

Market Share:

Births Admissions Rate

FY 2013 11,403 189 1.66%

FY 2014 11,357 284 2.50%

MARKETING STRENGTHS

The sustainable competitive advantage for this program is the location of the center, providing good

quality service by specialists, and offering this service to West Michigan. The Mother-Baby PHP is

located within Hospital Based Services of Pine Rest. Renovation of the space to ensure safety and

privacy for women receiving treatment is critical.

The first most important marketing

strength, in addition to safety, the

atmosphere is homelike and

comfortable. It should be noted

that seven rooms are needed in

this area for the program. These

rooms are currently utilized by

medical records, transcription, and

utilization review staff. Second,

women will benefit from treatment

provided by specialists.

Psychiatrists and clinicians are

specifically trained in PMD. Clinical

staff trained in PMD will be able to better help women with pharmacologic and non-pharmacologic

treatment options while considering physical needs such as pregnancy and lactation. Third, as identified

by the community, the two most urgent and problematic gaps identified are lack of psychiatric care and

any specific treatment programs for PMD anywhere in the Midwest Michigan. By offering this service,

Pine Rest will fill these identified community needs and respond to partnering community organizations

that look to Pine Rest for behavioral health programs. After executing this program, Pine Rest would be

one of only three similar programs nationwide that are designed for women with PMD. Programs in

Rhode Island and California have received national recognition for their services as a result of their help

to families. However, in Michigan, no other health centers have this program to take care of new

mothers and their babies.

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Strategically, it is very important for Pine Rest to partner with other health care systems. This new

program would closely tie Pine Rest to the OB, family practice, PMD therapist and pediatric community

throughout West Michigan.

EXTERNAL SITUATION ANALYSIS__________________________________________________________

EXTERNAL COMPETITION

The original business plan for the PHP indicates that program does not have any direct competitors in

the State of Michigan. However, such establishments as the Postpartum Support International and the

Spectrum Health Postpartum Emotional Support Program1 offer similarly operated and funded partial

and inpatient hospitalization programs aimed at treating and raising awareness of a multitude of

perinatal mood disorders including, but not limited to, postnatal depression, postpartum anxiety and

perinatal exhaustion.

The PHP belongs to a strategic group of programs that focus on the profound clinical management as

well as service science research and application for PMD. The primary goal of this group is an

identification and implementation of useful approaches for the proper management, clinical and

marketing control. Moreover, the program seeks to investigate the link between implemented strategies

and performances that allow for a detailed appraisal of and comparison with other available

similar/identical operations within an industry. For example, the Postpartum Support Internationals

Program of Prevention and Treatment of Childbearing Causes2 also classifies and maps strategic

developments in terms of planning and implementing intensive inpatient and partial hospitalization

treatment programs for postpartum depression and other perinatal mood disorders.

Both the Postpartum Support International and the Spectrum Health Postpartum Emotional Support

Program hold extensive market and industry ranking shares as they both incorporate healthcare-specific

marketing planning aimed at facilitating interaction with and providing intermediate assistance to new

mothers. Specifically, the Postpartum Support Internationals Program of Prevention and Treatment of

Childbearing Causes is a widely recognized organization operating in more than thirty six other countries

with headquarters located in Portland, Oregon3. In contrast, Pine Rest CMHSs health center providers

are primarily located in Michigan and Iowa.

In addition to the these child and mother care programs, the Postpartum Support Internationals

program also offers comprehensive preventative diagnoses and treatments for pregnant and new

mothers suffering from postpartum depression and other severe psychotic abnormalities. Moreover, the

program offers postpartum mental care for mothers of older as well as mentally and/or physically

disabled children. The Spectrum Health Postpartum Emotional Support Program provides emergency

services, education, and resources for postpartum psychosis and other perinatal mental health causes.

The medical market of both pre- and perinatal mental and psychiatric health is not an easily entered or

dominated field of practice. Due to the delicate nature, epidemiology, risk factors as well as social

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stigma of this market, healthcare and wellness providers often take gradual steps in identifying,

pursuing and advocating for resources and information relevant to the postpartum condition and its

treatment. As the market depends on a great number of legislative, financial, and volunteer support,

healthcare providers spend a tremendous amount of time on identifying their primary and secondary

audiences before disseminating information and resources to them. Therefore, the PHP program has a

strong emphasis on creating trustworthy and beneficial relationships with new mothers.

The PHP program has a concrete financial foundation as well as comprehensive strategic and marketing

planning. Specifically, despite certain monetary losses at the immediate release of the program, it has

per annum potential of financial gains exceeding $180,000 per patient. The program aims to add a

number of outpatient treatment facilities, support groups, and consultative services providing

exceptional care and clinical experiences to mothers in need. Also, the current program is heavily based

on the paid participation of highly regarded pre- and perinatal professionals licensed to practice in the

behavioral and science health care.

In contrast, the PHPs two geographic competitors, the Postpartum Support International Program and

the Spectrum Health Postpartum Emotional Support Program often operate at a long term loss due to

the heavy reliance on outdated medical facilities, practices and volunteer labor and knowledge

committed to other full time causes and performances4.

The PHPs original business plan describes the detailed development and design of the partial

hospitalization and nursery programs. The business plan positions the proposed and already

implemented elements of the programs well while it characterizes an exceptional product value and

marketing resources benefiting both the target groups and their families. In addition to the print and

general media information resources, the PHP is also actively engages and relies on word of mouth,

social media and support group marketing. Such extensive marketability can aid the program in

obtaining long term results in reducing the prevalence of postpartum depression and other perinatal

mood disorders among new mothers from both financially established and impoverished populations. In

this regard, the PHP has a great opportunity in creating wider public awareness of the motherly issues,

generating alternative care options and reducing system barriers to emergency and periodic quality

healthcare.

Many of the primary users for this specific medical field suffer from a multitude of severe mental and

physical ailments such as sadness, irritability and insomnia, they often fail to provide an adequate care

for their children and families. To combat this phenomenon, the PHPs competitor, the Postpartum

Support Internationals Program of Prevention and Treatment of Childbearing Causes is actively involved

in the medical research, training, and treatment of paternal depression and child development. Due to

the existing underestimation of the importance of a fathers mental and physical health at the early child

development period, the program hopes to provide adequate tools to offset paternal depression and its

repercussions on both the fathers and childs health and well-being. While it is not a substitute medical

tool for eliminating postpartum depression and other perinatal causes in mothers, it can certainly lead

to more direct and quality care for the child and proper marital satisfaction.

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INTERNAL COMPETITION

The PHPs secondary competitive strategic groups are a number of Pine Rest CMHSs own psychiatric

drug addiction, adolescent, senior care and other programs and services requiring an allocation of the

organizations scarce monetary and human resources. Moreover, the Network 180 also offers a number

of enhanced mental health, referral and counseling services aimed at identifying risk factors and

providing support for new mothers who may or do experience postpartum depression as well as

ensuring that the mothers have an around-the-clock access to on and off site care.

QUALITY OF THE MEDICAL STAFF/ SUPPLIERS

Due to the sensitive nature of

the pre- and perinatal medical

field, the pharmaceutical

companies, mental health

practitioners, maternal and

newborn health practitioners

and other health care and

information suppliers tend to

possess a great reservoir of

outstanding and, at times,

honorary scientific and medical

knowledge and skills aimed at

improving and supporting

maternal parenting, quality of

life, and mental/physical health.

Thus, the involved medical professionals are highly regarded individuals who are committed to guide

and strengthen new mothers mental and physical needs.

INDUSTRY ANALYSIS

The PHP program does not possess the product life cycle as the need for pre- and perinatal psychiatric

and mental health services always exists. Moreover, the industry of neonatal psychopathic, psychiatric

and other behavioral health treatment does not go through the typical marketing phases as it lacks the

so-called lifespan that many commercial and consumer products and services do. In response to this

finding, the PHP program is constantly evolving and adapting to a multitude of innovative and complex

mental health professional data, mental health legal body, pre-/perinatal medical practices and, most

importantly, curative advances in neonatal care. Therefore, the PHP program mainly responds to and

analyzes marketing challenges in terms of investigating the availability of new neonatal data,

determining the target market for it, and seeking socioeconomic means for producing and distributing

engaging awareness activities (advertisements and other promotions). Conclusively, the program

http://youtu.be/boKDfk7kjSM

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encompasses all of the most critical product and service development processes as it greatly impacts the

lives of newborns and their mothers.

The economic structure of the psychiatric hospital and behavioral health care treatment in the United

States is evaluated to be at approximately $1.5 trillion per annum. Maggie Mahar, an author of the

Money Driven Medicine book, wrote that the medical field of pre- and perinatal psychology and care

alone comprises up to 20% of the aggregate psychiatric healthcare industry5. Despite the complexity and

intricacies of the market, it is estimated that there are only about two hundred medical facilities

nationally whose primary purpose is the development and provision of a variety of curative and

preventative interventions for the unborn children, newborns, infants and adults who are adversely

affected by early prenatal and perinatal socioeconomic, psychiatric, psychological and other severe

dysfunctions and traumas. For example, Pine Rest, whos main facility is located in Grand Rapids, MI,

also offers twenty other outpatient locations throughout West Michigan and two in Iowa. Considering

the PHPs operational, capital, and location specifications and support services, it is well positioned to

provide premier mental health services to the growing targeted population and ever-changing

community needs.

The industry's large size and the sub-industry of pre- and perinatal psychology and care are attractive

targets for a multitude of pharmaceutical, biotechnology, life science and other health care companies

designing and distributing a multitude of medical equipment and medical products and services. Pine

Rest capitalized on this notion by strengthening professional development and network opportunities

with Network 180, the primary community mental health authority for Kent County, Pfizer, an American

multinational pharmaceutical corporation and manufacturer of antidepressant Zoloft, and they were

able to successfully create and implement targeted sales and marketing planning for both the product

and the company. Despite the perceived unethical conduct of this business practice, Pfizer was able to

eliminate industry and image barriers by providing educational and social support trainings to Network

180s medical personnel and educators. Instances like this demonstrate how psychiatric equipment and

medicine manufacturers can establish, nurture and financially benefit from the positive relationships

with service providers. Moreover, by utilizing opportunities of direct and prompt communication with

the industrys ultimate end-users, profit-seeking entities can successfully engage in mutually beneficial

activities.

EXTERNAL ENVIRONMENT ANALYSIS

The potential emerging new technologies that can greatly affect the PHP program include medical

device technologies like biochemical oxygen medication, psychoactive cannabinol (cannabis) herbal

remedies, neurological translational research and even endovascular implants6. Specifically, while the

biochemical oxygen medication is expected to dissolve harmful oxygenated organisms in a new mothers

body in order to generate new progenitor cells for a positive cognitive behavior, the psychoactive

cannabinol herbal remedies are presumed to generate psychological and physiological effects on the

mothers body in order to heighten her euphoric and relaxation reuptake inhibitors. In this regard, while

the neurological translational research aids in transforming a new mothers autonomic nervous system

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and neurophysiology in terms of improving sleeping, eating, sadness and fatigue patterns, the

endovascular implants are the most innovative approach in affecting the mothers behavioral

engagement and positive reframing mechanisms by embedding non-active surgical implants in their

synovial membranes. As these new technologies demonstrate, the PHP program may in the foreseeable

future develop and incorporate new technological platforms for decreasing and/or eliminating the

effects and prevalence of the postpartum psychotic behavior.

Fortunately, the medical area of the neonatal psychiatric hospital and behavioral health care and

treatment in the United States is positively impacted and protected by the applicable government laws

and regulations. For example, the Newborns' & Mothers' Protections Act stipulates that both newborns

and their mothers are entitled to the prompt medical assistance and hospital stay if found in any

immediate pediatric, physical, mental and other pertinent need to either a newborn child or his/her

mother. This medical field has a widespread government and community support in order to provide the

utmost emergency, residential and inpatient/outpatient psychiatric care to new mothers suffering from

postnatal depression, anxiety and irritability. Therefore, despite the PHPs struggle to successfully

implement the partial hospitalization program, it enjoys an extensive municipal and community support

tasked with improving the quality of new mothers lives via a multitude of maternal mental care,

emergency, and newborn healthcare programs and services.

The effects of such socioeconomic changes as inflation, recession, unemployment, credit and currency

exchange are quite detrimental for the PHP and its primary users and beneficiaries due to the fact that

such factors substantially decrease the purchasing power and the amount of the programs services that

potential and existing new mother patients can acquire. The fact many of the programs patients come

from the impoverished, food insecure and/or low income households, can further exacerbate the

already underlying destabilized inter-family relationships and lead to an unfortunate increase of new

parents postpartum depression, anxiety, obsessive-compulsive disorder and even child abuse. In this

regard, such positive factors as the increase in real gross domestic product and the market value of the

goods and services produced can eliminate the distorting effects of the economic decline and

costly/inaccessible medical coverage.

The future composition of the PHPs served population will likely continue to be women made up of

young adult and early middle age women in the fertile and childbearing years. As previously mentioned,

many of the women tend to be of low socioeconomic status and lack the financial, social, and

educational support necessary for an adequate family life and for a child's development. Due to the fact

that the women can often suffer from low self-esteem, childcare stress, poor marital/intimate

relationships and infant temperament problems, they may have inadequate skills and limited access to

available mental health resources that can positively affect their decisions regarding their young

children's development and learning. As a result, children of such mothers are at greater risk of suffering

from social withdrawal, inability to be comforted or controlled, as well as sleep and eating disturbances.

There is a multitude of both positive and negative social or cultural trends that can further impact the

livelihood and daily activities of both the Pine Rest CMHC and the PHP program. For example, the

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growing socio-cultural acceptance and social science research of the postpartum depression will

continue to result in a greater clinical and social psycho-educational literature and services available for

both the scientific community and general publics review and understanding. In this regard, new

medical models for the prevention of this psychotic condition will be established and integrated with a

variety of comprehensive healthcare support and service systems. As the PHP program demonstrates,

the interplay of a number of individual and contextual factors in terms of community mental health and

family support are of utmost importance. In other words, despite significant family and community

challenges posed by the neonatal postpartum depression, a positive convergence of such etiological

factors as cultural, social, psychological and biological levels can tremendously improve new mothers

perceptions of the birth and parenting experiences.

SWOT SUMMARY

Major internal strengths and weaknesses:

Some of the major strengths of the PHP program are:

The availability of the prompt and critical partial hospitalization and inpatient care and

services.

The presence of a strong organizational structure, IT protection, convenient location,

adequately trained psychiatrist, support, nursing and therapy staff.

The continuing flow of third-party donations, subsidy and volunteer capital and work.

An excellent provision and monitoring of customer service and administrative staff.

Well identified marketing planning, organizational growth strategies and community need.

Some of the major weaknesses of the PHP program are:

The above services physically separate mothers from their children for the treatment period

of the mothers psychotic and depressive episodes.

The PHP program is only open during working hours five days a week from Monday to Friday.

The long period of breakeven point, including long term proformas of revenue and expenses.

The continuing risk of the program discontinuation due to the ever-changing clinical

programming, referral and quality criteria.

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External opportunities and threats :

The opportunity to identify and localize the most up-to-date psychiatric education and clinical

resources at provider facility.

The opportunity to create and implement a number of additional programs aiming at procuring

more competent clinical knowledge in terms of patients' cultural diversity, substance abuse and

addiction care.

The opportunity to act as a pioneer PHP project for future regional facilities and programs

created for the suffering new mothers, their children and families.

The opening of a better functioning competing program operating on the regional and local

levels.

The lack of referrals from partnering medical providers and/or payers.

The decrease of community and regional demand for acute and latent neonatal psychotic

services.

The census predictors can compromise the validity of and the necessity for the PHP's market.

Internal Communications: Announce program launch in The Source and provide updates via

Management Memo and post updates on Pine Rest.

ROOT PROBLEMS______________________________________________________________________

RETENTION OF STAFF AND PATIENTS

Pine Rest is the first healthcare center to run a PHP in Michigan. There is no direct competition for this

program in the area that is a copycat service. As a market leader, there are some strategies that Pine

Rest used in the development and implementation of the PHP. In 2010, Pine Rest defined three strategic

challenges that drive its activities. The Mother and Baby PHP helps Pine Rest meet these challenges in

the following ways:

1. Exceptional Care Experience: The inclusion of a nursery in the proposed PHP keeps mothers and

babies together and removes a barrier to treatment. The PHP will be comfortable, caring, and

welcoming in contrast to other treatment options which are not conducive for a new mother

suffering from PMD.

2. Superior Clinical Outcomes: A main reason the PHP for women with PMD is being pursued is to

improve outcomes compared to alternatives. Research for this program has included dialogue

about how other niche PMD programs measure clinical outcomes and patient satisfaction. The

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new program will measure clinical outcomes to assess if women being cared for at the PHP are

exceeding established benchmarks and customer expectations. This program must show clear

value over other alternatives.

3. Great Place to Work: Each day, the clinical and hospital staff sees patients that could be helped

more successfully with these services. It is important to value the interests of clinicians working

with women with PMD by effectively providing services and increase the training in niche areas

of interest that also match organizational and community needs. Doing so provides employees

with the right tools and training while helping them know their work is valued and essential to

the mission of Pine Rest. Responding to patient needs in new ways helps Pine Rest attract and

retain excellent clinicians

CONSIDERATION OF ALTERNATIVE STRATEGIES

The PHP has thus far failed to capture an adequate amount of the potential market. The percentage of

participants for the program was half of the initial expectation. These patients are seeking treatment

elsewhere, but when they go to their outpatient therapist, psychiatrist, adult inpatient or general adult

partial hospital psychiatric care they do not receive adequate care. Those services are indirect

competition because they are user alternatives. The alternative strategies that we can consider as

following:

1. Expand the healthcare area: Pine Rest is actively engaging area health systems to integrate and

coordinate care and to be partners in the health of the whole person. A focused PMD program is

a great example of meeting the interests of the health system partners. Furthermore, using

West Michigan as a foundation to pilot the program and then expand the healthcare service

outside of Michigan state such as Indiana, Illinois and so on.

2. Referral Development: A well-established, strong partnership among Coalition members offers a

logical starting point for cultivating referrals and support for the new program. The intent is to

build and nurture positive relationships with key referral sources by: (1) Developing a targeted

sales/marketing call program. (2) Developing program-specific marketing materials. (3)

Providing professional development opportunities through seminars and training.

3. Payer Communications: Work with payers to ensure adequate and prompt payment for services.

For example, document and present quality and outcome reports and implement targeted

sales/marketing call program (distribute program marketing materials).

4. Media relations: Use media to share program news with the larger community and educate

consumers about perinatal mood disorders and treatment options. For instance, announce

program launch, link clinical experts to preferred media outlets for stories about PMD and

treatment options available at Pine Rest, and submit case study to professional journals and

regional media.

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5. Marketing Communications and collateral: (1) Develop service line brochures for referral

sources and patients. (2) Plan and create direct mail series to announce opening. (3) Update

pinerest.org and internal web sites with program/service information. (4) Develop video, DVD or

PowerPoint presentations for use with community groups, referral sources, referral

coordinators.

6. Promotions and Special Events: Schedule educational presentation for providers and clinical

community around program launch.

7. Internal Communications: Announce program launch in The Source and provide updates via

Management Memo and post updates on PineNet.

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PART 2- TACTICAL MARKETING MIX IMPLEMENTATION_______________________________________

SERVICES_____________________________________________________________________________

SERVICE/ PRODUCT LINES

It is recommended that the Mother-Baby Partial Hospital Program offer two different levels for the

client to choose from, the first will be the full version of the program including all sessions and pre-

planned activities that the original program has been built around. The second level of the program will

be on a smaller scale and the client will have an option of attending the program three days a week,

with a smaller selection of activities. This is a way to cater to those that are interested in the program

but are holding back due to either time commitments or monetary commitments.

The core product is the short-term intensive treatment program designed with the core benefit to help

new mothers cope with postpartum depression. Further, more-in-depth benefits to patients is the

flexibility the program provides compared to other programs in the country; mothers will be able to

bring their babies with they while receiving treatment. Another benefit the program provides is the

specificity of the activities. The program has been tailored to the needs of women who are pregnant and

post-partum, as opposed to just women with depression. The medical doctors, psychiatrists, and other

staff have been clinically trained to support this certain for or depression, making the treatments much

more effective for long-lasting improvement.

UNIQUE FEATURES

What sets the Pine Rest program apart from others offered in the country are the family amenities.

Husbands and/or fathers are able to come and stay with the mothers, the nursery is available to

mothers that need to bring the child with them, and the staff is part of a niche program that they have

been highly trained to create a superior program. Another way to augment the program is though the

aesthetics. Pine Rest can create an environment that is comfortable and home-like, while avoiding a

sterile, hospital feel. These women are in a deep depression, often with symptoms leading them to

avoid leaving the house. By creating an environment that so closely reflects a home atmosphere, the

patients will be more willing to come into the clinic to receive their daily treatment.

The product development process will include primary research done from women who have

participated in the program already, women that have previously shown interested in a program like

this, and women that are pregnant that may potentially benefit from this type of program. A focus

group of these women will be identified through the medical doctors that work with these groups of

women and with Pine Rest. From there, the program will be developed around the needs and wants

these participants have described. Top management should review these wants from the customer to

decide if there are any more markets the program is missing. The easiest way to do this would be to look

within their current market and find if there is a different way to capture this audience.

The name of the program will go under the brand name of Pine Rest Christian Mental health Services.

However, the Pine Rest name can be somewhat off-putting to someone that does not have a mental

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illness, or at least a mental illness beyond their postpartum depression. Because of this, the program

name will be a stand-alone entity with support from the parent brand. Any advertising and promotion

will refer to the program as the Mother-Baby PHP. Pine rest may also be present within the marketing,

but in a smaller sponsorship way that does not infringe on the main name of the program.

As the Mother-Baby PHP is a service and not a program the packaging will consist of tangible

advertisement, as well as the structure of the program. Tangible advertisements include the brochures

and literature given to the mothers or expectant mothers from their OB-GYN, psychiatrist, or primary

care doctor. They should include what the benefits of the program are as well as the expected personal

outcome for the woman along with her baby. The graphics and photographs should accurately represent

the appealing layout of the facility as well as successful patient profiles.

The services will be packaged into a structured itinerary for patients over a certain period of time. There

will be the two options of the daily package, and the three times weekly package. These will both be

detailed in the brochures, including detailed information about each of the activities that are offered or

required.

AWARENESS

The Mother-Baby PHP is an innovative program within the United States as there are a limited number

of facilities throughout the United States including the Mother-Baby program in California and the

Women and Infant program in Providence, RI. Because of the limited amount of options for this program

it is a relatively new concept to many people. As a way to bolster the reputation it should be thoroughly

explained to product leaders in the womens care health field. It is through these doctors and medical

professionals that the program will gain the most support and be promoted to the women in need of

the benefits.

BENEFITS

There are two programs available. The more intensive full-time program will offer a higher quality

program strictly due to more exposure to treatment. The half-time program that is three days a week,

but for the same amount of weeks will may be seen as a lower quality service at a reduced cost because

the program will offer fewer opportunities for interaction with the doctors and other professionals. The

amount of meeting sessions and activities will be the only differentiator of the experiences between

participants.

The benefits of this program such as the father/ husband participation, the nursery, and the home-like

environment need to be exploited in all advertisements and communications to really set this program

apart from other programs and to properly show the benefits to potential participants that may not be

considering participating in any of the programs throughout the country.

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PROMOTIONAL OBJECTIVES______________________________________________________________

(established prior to program launch) 1) Full knowledge of program value, ideal patient match and referral procedures known by target

referral sources.

2) General public awareness of new program by target patient and their families, who may aid in referring.

3) Current care alternatives to PHP are abandoned / lessened in use.

Our recommendations will focus on achieving objectives 1 and 2, as accomplishing these will naturally lead to the fulfillment of objective 3. Marketing messaging is intended to reach the following targeted audience: Insight capable, pregnant or postpartum women with moderate to severe nonpsychotic depression, PHP insurance reimbursement and adequate transportation. Additionally and just as important, is reaching, educating and persuading the multitude of key referral sources throughout the community that are absolutely vital to increasing census from a subpar average of 3 to 5-6, ensuring the ongoing viability of the PHP. INTEGRATED MARKETING COMMUNICATIONS CAMPAIGN Since its inception in August 2012, the PHP has utilized press releases, billboards, referral mailings, prospective patient mailings, TV commercials, Web and Social Media spots, News Coverage and Sponsorships. Interviews revealed that to date, public transportation (i.e. signs on bus exterior) and TV commercials have been cited most frequently by patients as generating program awareness. It is important to note that the current strategy has resulted in half the census needed for the program to remain viable. Consistently low census was identified as possible criteria for program discontinuation. However, the history of positive patient outcomes and feedback suggests that only a few minor strategical/tactical adjustments are likely required to reach viable census of 5-6 and achieve consistent margin over direct costs. Some of the problematic issues, which our recommendations intend to rectify, are listed as follows:

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50% of referrals dont follow through and initiate the call

Inadequate transportation

Pine Rest Brand Mental Health stigma

Lack of constant connection with referral sources

Not top of mind with all HCPs SALES While all previous means of advertising will continue to be utilized, albeit in a strategically, modified way, we believe it is essential to hire one full-time, dedicated Educational Salesperson to make face-to-face calls on high potential referral accounts, including, but not limited to:

Spectrum Health

St. Marys

Metro Health

CMH Sites

Network 180

MomsBloom

Arbor Circle Target Groups: Obstetricians, Family Practice, Pediatricians, Emergency/Psychiatric Providers, Outpatient Therapists, Birthing/OB Hospital Staff, Emergency Departments, Inpatient Psychiatric Programs and PMD Support Groups. The sales territory would be primarily located in and around the greater Grand Rapids area initially and focus on the 20% of providers and other support organizations that would naturally account for 80% of the PMD referrals. This would effectively address two of the identified problematic issues: 1) Lack of constant connection with referral sources. 2) Program Top-of-Mindedness with HCPs. Training and salary dollars have already been budgeted to attract and retain highly skilled staff. This would be a highly educational/consultative role intended to help providers identify current and potential MB PHP candidates and then follow through on the referral. A base salary of $50,000 plus commission based on number of qualified referrals generated from targeted accounts would be required.

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ADVERTISING Here is the current Fall/Early Winter 2014 campaign:

Budget Type Audience Item Responsibility Notes

$15,000 TV Public 30 Second Commercial

Marketing Oct-Dec

$5000 Direct Mail Referral Sources

OB/GYN and Pediatrics

Letters Brochures Screening

Tool Hopeline

Card

Marketing Write letter with MBP input, print & mail

$5000 Outdoor Public Promote HOPEline

Bus Advertising The Rapid

Marketing Design and Place

Oct-Dec

$3500 Radio Public Promote HOPEline

WCSG

100 Spots

Marketing Develop and Place

Oct-Dec M-F Prime Rotator

$1550 Radio Public Promote HOPEline

WGVU/NPR

100 Spots

Marketing Develop and Place

Oct-Dec 50 M-F Rotator 50 M-F Evening

$500 Web Pregnant Women + New Moms

Promote HOPEline Facebook + Google Ads

Marketing Develop and Place

Oct-Dec

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Budget Type Audience Item Responsibility Notes

$0 Relationship Development

Referral Sources

Contact with Existing Physician Partners

Phone Calls

Emails

Site Visits

MBP Staff & Referral Specialist

Assign list segments to staff/specialist

Check to see how things are going

Find out whats needed Provide additional

training Report to

MBP/Marketing

$0 Relationship Development

Referral Sources Contact with Other Existing Partners (Moms Groups, Social Workers, Doulas)

Phone Calls Emails Site Visits

MBP Staff & Referral Specialist

Assign list segments to staff/specialist

Check to see how things are going

Find out whats needed Provide additional

training Report to

MBP/Marketing

$0 TV Moms Maranda 1 Interview Marketing Dec Child Focused

$0 Direct Mail Referral Sources

Wave 2: OB/GYN + Pediatrics

MBP Staff & Referral Specialist

Follow-up call within 3 weeks

Book site visits

Provide on-site education; how to code for screenings

Intelligence gathering/obstacles

Report to MBP/Marketing

Book Site Visits Thru Jan 15

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We recommend that the PHP continue this campaign into winter and early spring. Two slight modifications are recommended for all future marketing:

1. Diversify the women featured on the Pine Rest online site and TV ads; reflecting the variety of faces impacted by PMD. Due to various circumstances, Medicaid mothers tend to be overrepresented in the PMD diagnosis, yet most women featured in ads appear middle-class and Caucasian.

2. Place heavier emphasis on the distinctiveness of the Mother-Baby brand extension and less emphasis on the Pine Rest parent brand. This will help lessen the mental health/Pine Rest stigma and highlight one of the needs identified by mothers who have been dissatisfied with competitive alternatives which blended them in with other patients and failed to address their unique PMD concerns, including safety.

SPONSORSHIPS Continued partnership with MomsBloom, Spectrum Health Healthier Communities Seminars and all area PMD Support Groups is essential. For example, on January 9th, 2015, Spectrum Health will be hosting a PMD seminar for a range of providers. The PHP should staff an informational table at this and all similar events. LEVERAGE CLIENT EXPERIENCE TO GAIN REFERRALS Overwhelmingly, the Customer Satisfaction Surveys of program participants have been very positive: This was great, just what I needed! It felt warm Ive got my life back. It felt just like home Each program graduate should be given five referral cards complete with MB PHP contact information (1-844-MOM-HOPE) and referral protocol. The satisfied participants should be simply encouraged to share the card with any woman they believe may be suffering similar symptoms. The standard follow-up phone calls should include a reiteration of the referral cards and encouraged dissemination. ADDITIONAL SOLUTIONS/RECOMMENDATIONS Problematic Issue #1 50% of referrals do not follow through and initiate the call:

The MB Program has recognized this as a barrier and is currently setting up provider offices with the Pine Rest Release of Information Forms, so patients can fill them out in office; allowing PR staff to initiate the call directly to the patient to set up services.

Problematic Issue #2 Inadequate mother transportation:

Driver volunteers should be solicited via church bulletins and ministry websites, similar to Meals-on-Wheels.

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Existing Pine-Rest shuttles can be utilized to pick-up/drop-off mothers from the bus stop several blocks away.

PRO-FORMA MARKETING BUDGET________________________________________________________

The program will require $99,450 in estimated capital dollars to start. In the beginning, the program

utilized 3.625 FTEs[1] of additional staff, including chaplain, utilization management (UM)[2] and

Contact Center (CC)[3] staff (3.525 without UM, CC, and chaplain). In addition, there is a need for about

eight psychiatry and four general medicine visits per week in the first year. With an expectation of a first

year average census of 3.0 (Census of 3.0 means that for 255 business days of the year (that is all PHP is

open; Monday Friday 8:00 am-4:30 pm) there needs to be an average of 3 patients in the program at

all time. Some days there may be 5 and other days 2, but that will average out to be 3 a day, and

including psychiatry, general medical and program capital depreciation costs, the new program will

provide a projected $13,000 operating loss in year one and pre-JOA sharing margins of $105,000 and

$180,000 margins in years two and three. These margin projections also include $25,000 in marketing

costs in years one and two and 15 hours of managerial time to assist in marketing. Census expectations

in years two and three are 4.5 and 6.0 respectively. The actual financial condition as following:

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Mother Baby PHP Three-Year Financial Statement

[1] FTE stands for full time equivalent and represents the amount of labor needed. For example

a person who works 40 hours week = 1.0 FTE. Therefore, here are 3.625 FTEs in the program

means that the number of people working collectively makes up 3.625 FTE or 146 hours a week.

[2] UM is the department that does clinical review of the cases and reports back to insurances to

maintain authorization for services. In this program there is a third party vendor that needs

authorization or approval that a patient meets psychiatric criteria to continue to receive benefits

paid for insurance for such services. It is different from other general hospitals that are paid by

codes (DRGs), so that means if a patient went in for an appendicitis, the hospital is contracted

with an insurance company to pay a set amount for that code, there can be modifiers added to

the code to indicate the level of complexity of the case yielding a higher or lower reimbursement.

[3] Contact center is the triage center. All patients must be screened through this department in

order to be placed appropriately into inpatient or partial hospitalization or referred to outpatient.

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Bibliography

1: The Spectrum Health Postpartum Emotional Support Program

(http://www.spectrumhealth.org/postpartumdepression)

2. The Postpartum Support Internationals Program of Prevention and Treatment of

Childbearing Causes (http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-

global-maternal-newborn-and-child-health/)

3. UN. The Millennium Development Goals Report 2012, 2012; The Millennium Development

Goals Report 2013, 2013 (pages 12-26); and The Millennium Development Goals Report 2013,

2011.

4. USAID. Working Toward the Goal of Reducing Maternal and Child Mortality: USAID

Programming and Response to FY08 Appropriations (Report to Congress), July 2012 (pages

30-35).

5. Mahar, M. et al., The Money-Driven Medicine: The Real Reason Health Care Costs So Much,

HarperCollins Publishers, no. 9730, 2006 (pages 17-22).

6. USAID, The Family Planning & Reproductive Health Programs - Saving Lives, Protecting the

Environment, Advancing U.S. Interests, December 2014 (pages 31-36).

http://www.spectrumhealth.org/postpartumdepressionhttp://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-maternal-newborn-and-child-health/http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-maternal-newborn-and-child-health/