Golden Health System

For this assignment you are assigned to a group.  Your Group is now a consulting firm.

  1. Give your firm a name. Be creative!  Design a semi professional cover of your proposal
  2. After reviewing the individual SWOT analyses the group will create a single final SWOT analysis.  Using
  3. Indicate what your consulting firm has determined are the priorities that Golden Health’s homelessness strategy should address and why. This will help form your gap analysis.

Remember Golden Health System is NOT trying to solve the entire homeless crisis in San Francisco. No single entity can do this well maybe but it is not the Golden Health System.  Do not get lost in that thought.  Think carefully about what is required to make this system compliant with new laws and profitable while providing the highest quality of care for its homeless and other consumers.

Here are some things to note regarding your SWOT Analyses

  • Most individuals were on the right path with the Strengths and Opportunities Great job!
  • Weaknesses are internal factors to the system that can cause failure and economic losses, poor customer satisfaction, poor consumer health outcomes, create competitive disadvantage, etc.  Homelessness in San Francisco is a threat not a weakness. Not having a plan to address uncompensated care, or to reducethe use of emergency department services for primary care are weaknesses of the organization given the number of ambulatory care centers they have in their system.
  • The competitors, the resources they have and their willingness to also become compliant with the laws can be seen as threats or opportunities.  This depends on how you plan to approach the solutions you offer to the Golden Health Board.

Here are some general pointers:

  • Golden Health System is NOT trying to solve the entire homeless crisis in San Francisco. Do not get lost in that thought.
  • As you research the topic, you should discover that there are at least 4 different types of homelessness. You may also discover that there are persons earning more than $50,000/year, some of whom may have health insurance but are homeless in San Francisco.
  • Golden Health System needs to address the homelessness situation as it impacts Golden Health and their consumers who are experiencing homelessness. Who are the persons most likely to be super utilizers of ER services?
  • All persons experiencing any type of homelessness are at severe risk for poor physical health and poor mental health outcomes.
  • Also, think carefully about what is required to make this system compliant with new laws and profitable while providing the highest quality of care for its homeless and other consumers.

All Group SWOT Analyses Work

Strengths- Increase

  • Two hospitals-Golden and Mission hospitals
  • Mission Ambulatory Care Center
  • Two acute care hospitals
  • Two multispecialty ambulatory care centers
  • 3,000 physicians,14,000 employees,600,000 members
  • Mission Hospital- Cardiovascular Institute nationally recognized for its chest pain center and cancer center
  • Golden- State of the art Emergency and trauma departments
  • St. Francis- medical/surgical units, psychiatric beds, and sub acute care. Nationally recognized for maternal and child health
  • Ambulatory care centers offer specialties including PC, cardiology, women’s health, urology, endocrine, PT, behavioral health, ortho, pain management, podiatry, and urgent care.
  • Golden Health PCP group provides convenient access to care for the community
  • FY 2019 operating revenue of $4.2B, operating income

$50.2 M


  • The newly acquired hospitals and outpatient centers still operate in a fee for service model
  • Delays in infrastructure updates
  • Market fluctuations
  • Last year there was a decline in total EBIDA due to rise in uncompensated care from individuals experiencing homelessness, average $1,400 per visit
  • St. Mary’s- older hospital established in 1947, doesn’t have many advancements
Opportunities- Leverage

  • $100 million over the next 3 years toward initiatives
  • Converting newly acquired hospitals and outpatient centers to the Golden Health’s managed care model over the next 3-5 years



  • Rise in uncompensated care
  • Kaiser Permanente launched a $200M Thriving Communities Fund to take on housing instability and homelessness, and will commit $5.2M to the initiative
  • CommonSpirit created a homeless health initiative to support care for hospitalized homeless patients, investing $20M over 6 years


  • High number of members: The system has a high number of current members who are over 600,000 which indicates that it is in a better position to grow
  • History of acquisition: The system has a history of acquiring other facilities like the acute care hospitals which is a growth strategy in the industry of operation
  • The managed care model: the system operates on a managed care model enabling it to focus on value-based care and population health.
  • Four hospitals operating under the system: The system has four hospitals operating under it which use modern technologies and are nationally recognized because of their care services.
  • Four ambulatory care centers: These centers offer a range of specialized services to the target consumers
  • Primary care physician group: These group work under the Golden Health system and play a significant role in provision of convenient access to care services across the regions of operation.
  • Strong financial performance: Golden Health has enjoyed favorable financial performance where the EBIDA margins has been more than 5% for the three years. This however declined in the last two years because of COVID-19.
  • Strategic location: The facilities operating under Golden Health are strategically located in areas of the city that are densely populated. This places them in the best position to provide care to most people.
  • Huge investments: The Golden Health system is investing resources on initiatives that benefit the homelessness and also reduce the medical utilizations costs.
  • The value-based system: By the time the newly acquired facilities adopt the value-based system and forego the use of fee-for-service method, the facility is likely to increase revenues and minimize medical costs.


  • Operating on fee-for-service model: The newly acquired hospitals as well as the outpatient centers to donor use the managed care model instead, they use the fee-for-service model. This may give a negative impression about the company that it pays little attention to quality of care.


  • Further acquisition of new facilities: Golden Health can take advantage of the new facilities in the industry as well as the struggling one and convert them to their managed care model. This will contribute to its growth and expansion.
  • Increasing population: Golden Health’s facilities can take advantage of the ever-increasing population and set up more facilities as the current ones are strategically located in dense areas of the city.
  • Partnering with other health systems that focus on addressing the housing crisis issues like Kaiser Permanente, CommonSpirit Health, and University of California San Francisco (UCSF).
  • Improved technology: Utilizing the most recent technologies to improve delivery of services and quality of services provided. This makes the facility come up with more innovative services.


  • The rise in uncompensated care consumers: The system offers care to the people experiencing homelessness who are part of uncompensated individuals making the facility to incur losses as evidenced by the declining EBIDA margins in the last two years.
  • New entrants to the industry: Similar companies may enter the industry providing same services like those of Golden Health System. This signifies that there is a likelihood of stiff competition in the industry.


  • Golden Health has a long standing and has continued to grow since it was founded in 1964 with only two hospitals at the time. It now has 14,000 employees and over 600,000 members in its managed care program.
  • Golden Health has some capabilities they excel in; these include:
    • Hospitals
      • Mission Hospital features Golden Health Cardiovascular Institute and is nationally recognized for its chest pain center and comprehensive cancer center
      • Golden Hospital includes a state-of-the-art emergency and trauma department
      • St. Francis Hospital has been nationally recognized for it’s maternal and child health
      • St. Mary’s has a long standing in the community, operating for more than 50 years and serving the most vulnerable populations
    • Ambulatory Care Centers
      • Mission Ambulatory Care Center provides a wide variety of care, including behavioral health, primary care, cardiology, women’s health, urology, endocrine, and physical therapy
      • Oracle Ambulatory Care Center is home of the Golden Health Institute for Orthopedic and Spots Medicine. They specialist in orthopedics, physical therapy, pain management, and urgent care
    • Primary Care Physicians Groups
      • 15 locations throughout the region providing accessible care to the entire community
  • Golden Health has $100 million to put towards their initiatives over the next three years


  • Previously operating with a strong financial performance, last year Golden Health did noticed a decline in total ERIDA.
  • There are competitors in the area that do have an advantage, such as include:
    • Kaiser Permanente – they have launched a $200 million fund with similar initiatives and a plan already in place
  • The average cost of a single emergency room visit is stated as $1,233, however at Golden Health it is $1,400
  • Only Lone Mountain Ambulatory Care Center specializes in behavioral health, which be an essential aspect of aiding the homeless community.
  • By improving homelessness, healthcare cost will decrease – those who are homeless tend to require longer care leading to increased cost
  • The locations of the facilities are strategically placed in densely populated areas to allow convenient care. They are also closely located the Silicon Valley, allowing for easy access to new innovative technology as it develops.


  • Golden Health contributes the recent decline in total ERIDA largely due to providing uncompensated care to those experiencing homelessness
    • Estimated by Chief Financial Officer that approximately 10% of all ED visits and inpatient admissions are by patients experiencing homelessness – this averages to about $1,400 per visit at Golden Health
  • Golden Health plans to grow their membership by 30% over the next five years with the planned conversion of its newest facilities and associated patient populations from a fee-for-service model to a managed care model
  • The location of Golden Health provides opportunity, as San Francisco is a large city, with many struggling with homelessness – 882 per 100k in the Bay Area are said to be homeless.
  • City in densely populated areas to allow for convenient care for most of the city’s inhabitants – there is an opportunity to provide care to these who are not being conveniently served
  • California has taken steps to help combat homelessness with the bill SB 1152 aiming reform the way homeless patients are discharged from hospitals
  • The expense report shows that Mission, St. Francis, St. Mary’s, and Golden Hospitals receive an extremely low payout from insurance – by increasing the number of insured individuals, this amount could increase excess revenue over expenses and decrease operating expenses
  • The operating statistics show an average patient length of stay and the emergency department visits and for Golden and St. Mary’s Hospitals – by improving overall health we can decrease these values, ultimately decreasing cost


  • Golden Health’s legacy facilities operate in a managed care model, however newly acquired hospitals and outpatient centers must still operate in a traditional fee-for-service model. This is expected to remain for the next 3-5 years due to infrastructure updates and market fluctuations, but then it will convert to the managed care model
  • Throughout the area of the San Francisco Bay health systems are investing in resources to help benefit populations experiencing homeless to decrease high medical utilization costs
    • Kaiser Permanente
      • Launched a $200 million fund in 2018 to take on housing instability and homeless called the Thriving Communities Fund with three initiatives
        • $100 million loan fund focused on creating and preserving rental homes for low-income individuals
        • $5.2 to allow a 41-unit apartment building to remain affordable in a gentrifying neighborhood
        • Working together with local partners and governments to end homeless for 500 individuals over a 50-year period with at least one chronic condition
    • CommonSpirit Health
      • Recent merger between Catholic Health Initiatives and Dignity Health Systems
        • Merger was allowed by the state of California on the condition that the organizations create a homeless health initiative in the state to support care for hospitalized homeless patients. CommonSpirit Health plans to invest $20 million over six years to support affordable housing and programs to help address homelessness
    • University of California San Francisco
      • Launched the Benioff Homeless and Housing Initiative using a $30 million gift from Marc and Lynee Benioff that will focus on advancing and advocating for evidence-based solutions to homelessness
      • Plan to collaborate with policy makers to help answer questions that they have not had the resources to answer to discover effective policies

  • Location is convenient for patients to get to the facilities
  • Access to medical equipment and technologies
  • Makes profits every year of operation
  • Having primary center services with each medical facility in group.

  • Newly acquired facilities in group are using Fee-For-Service payments instead of managed care model.
  • St. Francis is spending more than they are making.

  • Golden Health is being given a large sum of money to enact initiatives to help the homeless patients with healthcare
  • Kaiser is also putting money into this cause; this could mean a future partnership with Kaiser to help the issue.
  • Looking at CommonSpirit Health and their initiative to address homeless patients and seeing if there is a way to either form a partnership or to support one another’s actions.

  • Homeless population is overutilizing emergency department for health care services.
  • Homeless population is without health insurance and no ability to pay so there is a lot of uncompensated bills for services.