Introduction
A well-known company New City Home Care is looking to grow its services in a nearby community due to the aging populations and retirees, granting the population of 55,000 which is less than the current home health company. “Although”, the elderly population is growing there are no other home health companies in this Midwestern city.  New City Home Care is trying to be the first leader in entering this new market, “however”, for this to be successful, research on the present market is needed. The opening of a satellite agency involves employee staffing for customer service and scheduling of health care specialist.  The demand for services will be based on how the agency is run, office space required and how the company will market its services in this new Midwestern location.  A marketing plan will take into account the current business as well as the new market.
Historical Resident
According to an article by Santilli, J. & Vogenberg, R.F. (2015, Para 1-49) Market changes began to arise after the passage of the Affordable Care Act in 2010, because of the tracking and tracing of the developing trends in the ACA marketplace 2014 led to the identification of many strategic trends that will be important.
There are several trends that will impact participants over the courses of the years into 2018 include

Keeping the client informed in their healthcare
Quality controlled measures
Joining Revenue
 Advancement in Information technology for communication

The old model of healthcare focused on treating the serious illnesses and the new model focus on the client, preventing diseases and the current management of the continuing disease, with the new healthcare market it allows the client to be involved in their care. The use of data allows open communication with the client, their physician, and home health team about their illness and treatment options. A cost estimator can help clients to understand the cost and quality of healthcare. There are many market exchanges that allows clients to choose from a selection of insurance plans and choices. Consumers enrolled in Consumer Directed Healthcare Plan tend to be more cost-conscious about medication prescription and cost, services and treatment.
The growth of quality measures rises and become more structured in a report from several sources stating that more is spent on the United States healthcare system and is no better than any other developing country in the world because the US healthcare system is mainly a fee for service, where the doctor collects compensation for each service that is performed and is given an incentive to deliver more services. The National Quality Strategy was effective as of March 2011 by the federal government to improve the quality of healthcare and to reduced cost. There are several agencies such as Center for Medicare & Medicaid Services, Agency for Healthcare Research and Quality, Joint Commission, and the National Committee for Quality Assurance that use different method for assessing and reporting on the performance of the doctor.  Private sector organizations function at the local, regional and national levels to give information on the doctors or health care insurance performance to the benefactors and clients.

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The increase in cost of healthcare is causing sponsors to consolidate due to the shift in healthcare to the elderly population and the growing occurrence of chronic conditions. People, institutions, and resources are all part of the healthcare system that is responsible for the delivery of healthcare. To meet the demands of the developing market and healthcare delivery, risk are managed through primary care, medical home models and pay for value reimbursement. “When”, the healthcare system merge the demand for fee increases causing clients to be limited in choices when choosing their physician or hospital will keep premiums low but can cause many problems for clients under ACA.
Information technology is changing the way data is recorded and delivered amongst the client and doctor with such devices as smartphones, mobile applications, and an increase of approved medical devices for the clients’ homes and smartphone makes diagnosing and treating the client more appropriate in improving the need for a robust information security system. The use of activity trackers are becoming more popular and are used to track heart rate, sleep patterns, counting calories. Many companies are offering applications for smartphones to manage diseases such as asthma or diabetes and incorporating wellness in the management of illness or disorders are focused areas of growth in the coming years.
HIPAA/HITEC concerns of privacy will lose ground because of accessibility in 2015, with the use of digital tools and services that gather and evaluate healthcare data. There is a risk involved in sharing universal positioning system location and personal data can cause a security breach and protocols will need to be in place to reduce the risk of sharing of information. The applications use for data collection can improve healthcare productivity, although technology offer some return on healthcare more focus is geared toward the implementation of electronic medical records, and the client insurance companies having access to client information in real time. Advancement to the future technology will allow patients and doctors to improve their practice to manage and coordinate healthcare, this will require patient education and transparency.   
Demographic data
Healthcare continues to be the major topic of United States due to the uncertainty surrounding the Affordable Care Act, New City Home Care findings include:

The older population over 65 years, which has the highest spending demographic per person and will double by 2055.
Containing cost continues to drive hospitals to merge and expansion of outpatient services
Medical office space is much greater than the supply and has led to an 8% vacancy rate in the first quarter of 2017.
Healthcare has seen a surge in transaction volume, spending nearly $10 billion for the year ending in the first quarter of 2017

Our overall mission of New City Home Care is to deliver quality service to the aging population in a well-organized, ethical and cost-effective manner and as healthcare continue to change. National Healthcare Midwest. (2018. Para 1-7)
Quality standards
According to the Standard of Home Health Nursing Practice. (U.N. P 31 Para1-4). New City Home Care is obligated to deliver and improve quality of care provided to our clients. Our standards characterize, measure and provide guidance in achieving excellence in home health care. We are accountable for our clients, respecting their rights and being an advocate for them. Acknowledgement of patients’ rights include:

Right to autonomy
Right to make informed decisions
Right to one’s domain, body, life, property and privacy

Marketplace Analysis, Including Competition
Alder, J. (2015, Para 1-41) suggested that new home health care should look for ways to offer home health type services to clients who need additional help by expanding its service to the community and hoping to reach the elderly who may potentially become residents. The aging population is living longer and more fragile than previous generations and would like to get help where they live oppose to moving. “Due”, to the continuous changes in healthcare in- home nursing is becoming a recognized practice with the goal to lower cost by keeping the senior population out of the hospital or nursing facilities.
On October 2014 Kindred Healthcare Inc publicized plans to purchase Gentiva Health Services Inc and is projected to close in the first quarter of 2015 and serving greater than 1 million clients a year thru out 47 states and following that announcement HealthSouth Corp a home health company that operates 107 rehabilitation hospital purchase a privately held Encompass Home Health and Hospice for roughly $750 million, After Brookdale Senior Living gain Emeritus Corp it is the world’s largest seniors housing operating with 1,147 communities on November 2014 calling to increase its ancillary and home health services which is currently underway for a senior citizen who do not live in the Brookdale building.
According to a large Los Angeles research based firm IBIS reported that on September 2014 the home healthcare business which includes medical and caregiver-type services, represents a $75 billion healthcare market with an annual growth rate of about 3.6 percent due to the elderly population, and the push to provide cost-efficient treatment outside of the hospital or nursing home setting. The healthcare business remains split while looking for ways to expand face regulations that vary state to state, also on November the Center for Medicare and Medicaid Services said that it will cut payments to home healthcare providers by 0.3 percent in 2015 to lower home health cost in a four- year period. 
Home health care faces many challenges in expanding the business. There is a difference in running a building and operating a home healthcare agency because they have different enterprises, they require distinctive styles, and emphasize from an experienced healthcare professional. In 2014 the majority of the largest non-profit Continuing Care Retirement Community provided services to senior citizen outside the community and don’t have enough inner volume to produce a lot of income, “However”, CCRCs are committed to offering services to the greater community are likely huge operations with in-depth experience. 
Operating a home health care business is a difficult business in which quality of service is difficult to control, but with the National Quality forum identifying a need on October 2014 that would improve basis to measure the quality of ancillary services.  Big companies must be equipped to manage outside service because senior citizens have the option to choose in house agency or seek services for extra help.  It is suggested that communities be licensed, provide the seniors with a contract and have policies in place to protect the senior citizens and limit the possibility of being liable. One of the greatest advantage of offering Medicare-certified healthcare services is the ability to decrease hospitalizations. The national hospital readmission rate has decrease from 16 percent to 11 percent over 60- day.
Models and Best Practices for Reaching the Target Audience
More than 70 million of Baby Boomers living in the United States were born between 1946 and 1964 and as senior citizens began to retire they will need more healthcare than any other age group before them and by 2030 hospital admission will double. 8.6 million Senior citizens who suffers from a chronic condition will grow to 37 million. A few ideas to help New City Home Healthcare for seniors to be successful include:
Seniors are becoming acquainted with technology such as smartphones and tablets, so we must make sure the website is quick to respond or easily adjusted to ensure they can without difficulty browse and locate information.  Use search engine to ensure that the website ranks highly for words and phrases most related to your hospital or facility. Older adults look up information online in regard to their illnesses, cures, products, and symptoms.  Applying context marketing can give your website added keywords for search engines to improve your companies ranking and making sure your healthcare company ranks when someone searches topic or treatment facility that focus on that topic.    
“Although”, marketing to senior citizens can be difficulty we can focus on ways to handle this my spreading the word about your company organization through a short TV commercial, newspaper, or magazines articles. We can also look beyond marketing to create a long-term relationship though context marketing, we must also be truthful about our products, benefits, and the services we provide and lastly remain benefit focused. Web Fx. (U.N. Para. 21-30)
Recommendations to Ensure Alignment
In an article by Flanigan, D. (2017, Para 1-16). Healthcare organizations should be quick and easy, it just one piece of the pie that relates to healthcare industry and the lives of our clients and the senior population that New City Home Healthcare services. There is no assured success in an organization without alignment. If New city home healthcare want to work with other establishments, we should move pass a business agreement that affects all the parties involved into something that aligns continuous over time with change that’s beneficial to all parties involved.  In the long run strategic alignment is about building a path toward a professional organization, were the same values was shared between everyone involved. 
In order for New City Home Healthcare to establish a successful partnership, we need to focus on these five principles of alignment. The first principle suggest that we should agree on the state of the health business and share the same vision. “Secondly”, the next alignment focus on the role that Health Information Technology will perform, which should be to manage the flow of information and to understand the digital record moving forward. We also need to understand that HIT does not only back organizations strategies but it is a primary strategy relating of itself. The third principle of alignment is assuring that together the business have the capability and intent to do what they said they will do, and the four principle is if the healthcare organization is going to work with each other they need to like each other. 
The last principle, which is called mutually assured destruction failure must be mount up equally between the parties for success is balanced with a must not fail. We tend to equate partnerships around good thing that the business plans but need to be accountable for the bad. To build balance for success and failure in the relationship the key is making sure the scope are balanced for both parties.  “When”, both organizations stay together and form a great partnership they can accomplish great things.
Writing the Plan and Setting Expectations
A well-known company New City Home Healthcare is trying to open a new satellite company in a Midwestern community, LLC.is offering medical care services to elderly, disabled and people of all ages’ physical conditions and cognitive abilities who would like to remain living at home, yet need help with certain daily or weekly activities.  Working closely with a clients and their families we provide personalized assistance in a client’s home, the hospital, long-term assisted living facilities and other places of residence with things like, Physical Therapy.
“As”, our senior citizen base grows we may consider adding additional services that would supplement the existing list of services.We distinguish ourselves by finding and employing the very best caregivers who believe in and perform their work according to the high standards of excellence in quality care set forth by New City Home healthcare.
Our Vision is for New City home healthcare to be the very best home care provider in the Midwest, providing the very best, superb care to senior in our geographical market by employing only proven, hard-working, professional, honest, compassionate and ethical home care providers in the market who are dedicated provide outstanding home care services and improving the quality of senior citizens lives.
Our Mission is to help every senior citizen with improving their quality of life, encouraging independence and allowing them to be comfortable with excellent care in their own homes by providing superb, professional care with respect, dignity, compassion, the highest ethical standards and honor.
New City Home healthcare is entering the Home Care Industry Market and distinguishing itself from competitors by hiring a staff consisting only of superb caregivers, who require special services and the use of technology in every aspect of the business as possible. In the competitive Home Care Industry, we looked at what other companies were doing, what senior citizens most common complaints were of other agencies, and how we plan to do better from the start. Starting with our caregivers, we employ only the very best caregivers.  We do this by:
Mandatory CNA certifications required by every caregiver is necessary to be considered for hire
Conducting several interviews, so we can see how serious the applicant are about taking care of our senior citizens to determine reliability
Perform extensive background checks, fingerprinting, licensing, to meet the state requirements and to maintain Human Resources Legal Compliance
Required training for staff over 10 hours, CNA certification, training including understanding, believing in and following through with our expectations for service to our senior citizen.  
Implementation of technology to manage our seniors and staff, were we can get real time data on when staff arrive and leave a senior citizen home, service that was provided and alert to any issues. ABC Home Health Business Plan Template. (N.D. P 3-5)
Implementing the plan, proven best practices for implementing
According to an article by Kusserow, R. (2012. Para 1-15). Using best practice standards is important to effective healthcare compliances and allow us to enhance and improve efficiency to avoid government auditors. Best practices can be described as a practice or skill, through knowing how and testing can lead to a desired result for New City Home health company success.
Best practices can also can reduce potential for liability or being in violation set by the compliance program. New City Home Health Company will use best practices improving the program success.  Other benefits include:

Gaining shared trust amongst the provider and oversight organizations.
Sharing of a vision by which New City Home Health Company will use to conduct business.
Creating objectives are in line with the company’s mission and vision.
Supporting relations between compliance and New City Healthcare methods of operation. 
Recognizing the benefits of healthcare compliance in terms that are meaningful to employers and stakeholders 

When following the best practices for health care providers we must consider the following:

Reduce cost by learning from other health care organization and applying that knowledge to your practice this can save money.
Knowledge of what other organization have done can keep New City Home Care from making costly mistakes
Adopting new idea
Following best practices from the outside will help raise the bar and set the standards of excellence for New city Home Care to drive forward.
Reduce risk and liability to avoid any potential lawsuits. 

“When”, applying step for best practices New City Home Healthcare will form process improvement committees, create metric to measure improvements, gather data on the success and best practices of other organizations, and adapt best practices for particular culture, environment of New City Home Health Care and lastly implement the process and measure the outcomes       
Tools for evaluating and adapting the plan
Tools are used in a variety of healthcare setting to avoid or compromise care and to make care safe. The United States Department of Health and Human Services Partnership for Patients and valued-based purchasing program says tools also address area of priority.
New City Home Healthcare will use Consumer Assessment of Healthcare Providers and Systems surveys that was established by AHRQ to measure patient’s healthcare experience, communication amongst patient, doctor, and nurses, staff awareness, and other pointers of safe high quality care. Based on the patient perspective is what will be measured.
We will also use Comprehensive Unit-Based safety Program tools for training that address patient safety issues by combining best practices, science of safety and safety culture, the training includes teaching tools and resources such as module, presentations slides, tools, and videos.
“Lastly”, the implementation of Team Strategies and Tools to Enhance Performance and Patient Safety tool are used to train the trainer, a program used to decrease risk to patient’s safety by trainer healthcare team to improve communication skills.  Agency of Healthcare Research and Quality. (2018, Para 1-5)
Conclusion
In my opinion I believe healthcare cost is rising because of the senior population having an improvement in the survival rate of chronic illness, injuries, and other diseases, also our veterans returning from combat with serious injuries, and the advancement of technology causing healthcare to move into the homes, servicing a diversity of people. Healthcare cost varies greatly in it safety measures, effectiveness, and efficiency and cost of quality of care. It is in my recommendations to improve the state of healthcare in the homes is the use of technology and medical devices in the home care environment, caregivers and our senior citizens, healthcare environment and the gap in information requiring additional research and development. Applying these recommendations can make home health care effective and reduce cost.
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