Case studyHealthcare strategy

Improved HCHHA’s overall financial performance

Three problems and one missing certification. The hospice gap explains a good deal of the financial and reputational picture, which makes it the place to start.

Editorial process

Last reviewed · August 25, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

One missing certification, three presenting problems

The board presents three separate requests and the first one is doing more work than it appears to. Without a Medicare-certified hospice, a patient reaching the end of life has to be discharged from the agency and admitted somewhere else, which breaks continuity at the worst possible moment, sends the family to a competitor, and generates exactly the negative publicity described. It also loses revenue the agency has effectively created, since it found and cared for that patient and then hands them to another organisation for the hospice benefit. So the certification question is not only a service gap, it is a leak in both reputation and revenue, and treating it as the first recommendation lets the financial and operational sections follow from a single analysis. Putting it first therefore organises the whole submission around one diagnosis rather than three. The board has asked three questions and the honest answer treats them as one problem with three symptoms.

That said, recommend it with its costs rather than as an obvious fix. Medicare certification requires meeting conditions of participation, a survey, staffing including an interdisciplinary team and after-hours availability, and it comes with a per-diem payment structure very different from home health's episodic model, which changes how the organisation has to manage cost per day rather than per visit. Alternatives exist and should be assessed: a partnership or contractual arrangement with an existing hospice, or acquisition, each with a different capital requirement and a different degree of control. For the financial and operational sections, look for the levers a home health agency actually has, in referral source relationships, visit productivity and travel time, documentation accuracy driving payment, readmission performance, and clinical staff turnover, which is usually the most expensive operational problem an agency has. Turnover is usually the most expensive operational problem an agency has, and it is the one most easily left out of a strategy paper.

Likely learning objectives

Connect a service gap to reputational and financial consequences.
Present a certification recommendation with its operating requirements.
Compare build, partner and acquire options for a service line.
Identify the operational levers specific to home health.

Assignment instructions

Read the full question

Review every instruction before using the planning guidance that follows.

Review the Hillsboro County Home Health Agency, Inc. (HCHHA) case study in this week’s Learning Resources. Note: Your Final Project should show effective application of triangulation of content and resources in your conclusion and recommendations. The Assignment HCHHA’s board of directors and executive leadership team have asked for your assistance with addressing some of the major issues that have adversely impacted the organization’s financial and operational performances. They have requested that you advise them on the following: Strategies to help the organization address the absence of a Medicare-certified hospice, which has inconvenienced patients and their family members and has led to negative publicity for the organization Strategies that might improve HCHHA’s overall financial performance Strategies that might improve HCHHA’s operational performance Strategies that might assist HCHHA with effectively addressing the various external factors that may potentially threaten its market share In a 20-page strategic plan, include the following components: Mission statement (provided in the case study) Vision statement Core values SWOT analysis Grand strategies or long-term strategic priorities Operational and tactical plan Key performance and evaluation indicators Change management plan, including the following: The size of the change and its impact on the community and the organization The organization’s readiness for change Change management strategy Team structure and responsibilities Sponsor roles and responsibilities Planning and implementation Communications plan Change management resistance plan Training plan Incentives and celebration of successes Improved HCHHA’s overall financial performance Timeline/schedule of activities Budget for change management The 20-page narrative plan should be written as if it were to be presented to the board of directors. The plan should also include the following pages that will not count toward the 20-page limit: One-page Executive Summary Tables, graphs, and/or charts The plan should include at least 15 current (no older than 4 years) quality resources, with 10 of those resources being from peer-reviewed sources. The American College of Healthcare Executives Competencies Assessment tool is used to assess health care managers and executives in critical areas of health care management. This valuable assessment is designed to help you identify areas of strength and areas you may wish to include in your personal and academic development plan after you graduate from Walden’s MHA program. Also, you can use the assessment score to identify gaps in skills necessary for optimizing performance. For the Final Project in this course, your Instructor will assign you an overall competency level score based on the work submitted in the Final Project. This competency level assessment score is for your information only and is offered in addition to the grade rubrics, grade points, and grade feedback provided by your Instructor. The competency level designations are as follows: Novice = 1 Competent = 2

What the board has asked for

01Advice to HCHHA's board and executive leadership on the major issues affecting financial and operational performance.
02Strategies to address the absence of a Medicare-certified hospice.
03Strategies that might improve overall financial performance.
04Strategies that might improve operational performance.
05Effective triangulation of content and resources in the conclusions and recommendations.