Will Lindsay

Megan Hansen

July 23, 2014

Company
History:
The Department of Veterans Affairs (VA) has historical foundations dating as far back as
1636 during the birth of the country. The original settlers of the Plymouth Colony
established a law that stated any soldier injured in the war with the Pequot Indians would
be cared for by the whole colony. This humble beginning flourished into a rich and more
sophisticated future.
Highlights of the VA timeline are:

The Continental Congress of 1776

o Pensions established as incentive to enlist in the Revolutionary War

1811
o The Federal Government authorizes the first for veterans

World War 1: 1917

o Congress designs the first official set of benefits for soldiers
o Defined the coverage for disability compensation, insurance, and vocational
rehabilitation.

1930
o The Veterans Administration is formed

1930-Up to now:
o 54 hospitals in 1930 to 152 hospitals to present date
o 800 community based outpatient clinics
o 126 nursing home care units
o 35 housing facilities
o 1973 the Veterans Administration assumed under the Veterans
Administration
o 1989 the Department of Veterans Affairs (VA) was established as a Cabinetlevel position

PhilosophyMission:
To fulfill President Lincoln's promise To care for him who shall have borne the battle,
and for his widow, and his orphan by serving and honoring the men and women who are
Americas Veterans
Vision:
The vision of the Recreation Therapy Department within the Salt Lake City VA Medical
Center is that all the veterans served will live a life that is whole, healthy, and happy.
Values:
VAs five core values underscore the obligations inherent in VAs mission:

Integrity

Commitment

Advocacy

Respect

Excellence.

Our values are more than just words they affect outcomes in our daily interactions with
Veterans and eligible beneficiaries and with each other.

Figure 1: VA Core Values

Objectives:

We will be people-centric, results-driven and forward-looking.

That objective is accomplished with these 16 initiatives:
1) Eliminating Veteran homelessness
2) Enabling 21st century benefits delivery and services
3) Automating GI Bill benefits
4) Creating Virtual Lifetime Electronic Record
5) Improving Veterans' mental health
6) Building Veterans Relationship Management capability to enable convenient,
seamless interactions
7) Designing a Veteran-centric health care model to help Veterans navigate the
health care delivery system and receive coordinated care
8) Enhancing the Veteran experience and access to health care
9) Ensuring preparedness to meet emergent national needs
10) Developing capabilities and enabling systems to drive performance and
outcomes.
11) Establishing strong VA management infrastructure and integrated operating
model
12) Transforming human capital management
13) Performing research and development to enhance the long-term health and
well-being of Veterans
14) Optimizing the utilization of VA's Capital portfolio by implementing and
executing the Strategic Capital Investment Planning (SCIP) process
15) Improving the quality of health care while reducing cost
16) Transforming health care delivery through health informatics

Products, Programs, Services, Facilities, Policies/Procedures:

While the VA exists to serve the veteran community in many ways the major benefits
include Veterans' compensation, Veterans' pension, survivors' benefits, rehabilitation and
employment assistance, education assistance, home loan guaranties, and life insurance
coverage.
Recreation Therapy at the Salt Lake VA Medical Center is located in the following buildings:

Inpatient Unit (Acute Psych): Second floor Building 3

o Office hours are Monday through Friday 7:00am 4:30pm most weeks
o Schedules and hours are subject to change, call to schedule an appointment
at extension #xxxxx

Inpatient/Substance Abuse: Ground Level Building 3

o Office hours vary from week to week.
o Call to schedule an appointment at extension #xxxxx

Outpatient Psych: Garden Level Building 16

o Office hours are Monday through Friday 8:00am 5:00pm
o Group times vary based on current program offerings
o Call to schedule an appointment at extension #xxxxx

Outpatient Physical Rehabilitation:

o Office hours are Monday through Friday 8:00am 5:00pm
o Group times vary based on current program offerings
o Call to schedule an appointment at extension #xxxxx

The VA Medical Center provides specific services including:

Medical Health Care and Prevention

o All the major services that any large medical facility provides
Surgery

Nuclear Medicine

Podiatry

Physical Therapy

Radiology

Emergency Services

Primary Care

Internal Medicine

Orthopedics

o Community clinics to serve the rural and distant communities

o Coverage based on service connection levels

Mental Health Counseling:

o Inpatient Services

Acute Crisis care

Substance abuse detoxification

Physical and Emotional stabilization

Support for veterans with Suicidal/Homicidal ideation

Residential Treatment

Substance abuse relapse prevention

Vocational program

Community transition support

o Outpatient Services:

Counseling Support

Group or individual

Open classes and multi session programs

Holistic and broad care plans

o Recreation Therapy

Inpatient Wards and Clinics

Positive Psychology based

Strength based approach

Psycho Educational, Leisure Enhancement, and Diversional

recreation.

Outpatient Clinics

Group therapeutic outings

Scheduled therapeutic groups

Adventure based activities and trips

o Homeless Veterans Resources

Clothing and other resources for homeless veterans

Housing assistance and waivers

Transitional housing facilities

o Elderly Care

Veterans specific long term care facility

Adult Day Programs

Memory care and dementia programs

Organizational structure (chart):

See Appendix A
Financial status & goals
The VA is reporting an increase of $2.0 billion, or 3.0%, over 2014

2015 Budget includes $163.9 billion for VA in 2015.

o $68.3 billion in discretionary resources
o $95.6 billion in mandatory funding.

Historical marketing efforts:

Previous marketing efforts have focused primarily on enlistment and supporting the war
effort. Very little has been done to promote the VA Medical Centers specifically. A handful
of advertisements center around the benefits of joining the military and
promotions/referrals for the VA Medical Centers have historically been done internally.
Currently a light campaign on national television and billboards in the state have begun to
advertise for the VA Medical Centers as well as social media advertising. Some proposed
marketing examples are included in Appendix B and C.
Here is a link to the VA Public Service Announcements Archive page:
http://www.vacareers.va.gov/about-va/commercials.asp

Figure 4: Salt Lake VA Medical Center Billboard

Figure 2: WW 2 Military Benefits

Poster

Figure 5: Michael DeBakey VA Medical Center Billboard

Figure 6: Jesse Brown VA Medical Center Billboard

Climate
Industry Analysis
While the health care industry has seen many changes in recent history the VA medical
centers have largely remained the same. Being a federally funded organization there have
been fluctuations in budgets and services offered/covered but the system and objectives
have stayed the same.
Currently with the Health Care Reform Act passed there is an increasing demand on health
care facilities to meet the need of a growing customer base. While the VA does not
necessarily share this particular influx of customers they are seeing an influx due to
political factors discussed later on in this report.
Also with a nation focused so much on health, more so than in the recent history, more and
more patients are looking for services in the health care field. Whether it is pressure from a
large aging population or a younger population focused on preventative health.
One of the fastest growing trends in the industry is a movement away from the traditional
medical model of treatment and transitioning toward a Recovery Based treatment model.
While not all medical facilities have taken on this paradigm shift it is a culture that is being
developed and implemented throughout the VA Medical Centers. Recovery Model simply
put is an effort to provide more client centered treatment with the client as the deciding
factor. It is more about providing treatment options rather than prescribing specific
treatments. It is a program that takes the patients personhood into consideration and
makes them an active member of the treatment team.

Global Analysis:
Political:
Currently there is a strong political climate surrounding the VA Medical Centers and the VA
system at large. It is on the one hand damaging to the image of the VA and its services but
on the other hand it is being seen as an opportunity by the Salt Lake VA Medical Center as
an opportunity to advocate for resources and policy changes.
Some of the major factors include:

Tax rate increases

Military Action scope and severity

Diplomatic efforts

Partisanship in congress

Economic:
Much of the economic concerns with the VA medical centers are tied deeply to the political
climate.
Some factors that can affect the economic strain on the VA medical center:

Aging veteran population

Rising costs of materials and resources

Urban sprawl and connections to rural communities

Increased number of covered dependents

Social/Cultural:
It is deeply entrenched in our cultural psyche to care for those that served in the name of
their country and as such the VA medical centers receive broad social acceptance.
Factors that negatively affect the services and care at the VA medical centers:

Social disagreement with the current conflict

Political ideological differences within the populous

Negative paradigm of veterans that are perceived to be milking the system

Factors that positively affect the services and care at the VA Medical Centers:

Increased awareness of Veteran specific diagnoses

A current swell in national pride and patriotism

A recent increase in philanthropic behavior from the private sector

Technological:
Just as in any other medical facility the VA medical centers are driven by advancing
technology. Being funded by a federal body carries its advantages and disadvantages in
regards to the latest technological advances.
Some technological factors to consider:

Rising costs of medical technology

An increased reliance on medical technology for best practices

Tele-health technology to connect rural populations becoming more popular

Environmental:
A recent trend in the world is the focus on environmentally focused business practices. It is
important that the VA Medical Centers keep up with this trend and make the necessary
changes.
Issues of concern to the VA Medical Centers include:

Focus on sustainable practices

Sustainable buildings and facilities

A switch to electronic records rather than paper

Legal:
Since the VA medical centers are controlled by Congress the only laws that can change the
scope of services would have to be at the federal level. Although many changes have been
made to regulate private health care, only a select few have applied to the VA medical
centers.
The counterpoint to the above statements however is that being governed by a federal
agency opens the VA medical centers to deep scrutiny if any transgression surfaces. As it
has been seen in a few other VA Medical Centers this kind of scrutiny can be detrimental to
the VA Medical System even if the offenses are contained to one or a few VA Medical
Centers.
It is this kind of scrutiny however that could lead to increased resources from Congress as
it is recognized the amount needed to properly serve our nations veterans and fulfill the
VAs mission.

Competitors
When considering direct competitors to the VA medical center only one comes to light. The
military hospitals on base compete for a portion of the patients seen at the VA medical
center and offer similar services and compensations.
The military hospitals operate only on an active military base and as such only serve
individuals who are either active duty, active reserve, or medically retired service
members. As such most of the veteran community does not have the current security
clearance to access the base facilities and their medical facilities.
Additionally, these facilities only offer medical and psychological services and do not offer
the same care for the veteran in the sense of transition and continuing social success. These
facilities are also only covered for individuals that still carry Tri-Care insurance benefits
and have a high enough service connection to be covered. These military hospitals also
receive less funding typically than the VA system.
Indirect competitors of the VA Medical Centers would include any private or state owned
medical facilities. While these types of facilities are much more varied and readily available,
a veteran would have to carry a private insurance policy and pay premiums along with
associated medical expenses. The VA Medical Centers also specialize in the care of the
veteran community and are not only trained in veterans specific care but are also generally
staffed by other veterans and thus creates a unique community of care for the veterans.

Consumers
Consumers based on service connection:

Active military, naval or air service

Separated under any condition other than dishonorable

Current and former members of the Reserves or National Guard who were called to
active duty

How many are there?

The VA network serves more than 8 million veterans. Locally at the Salt Lake hospital the
number of patients has been steadily on the rise as the Salt Lake City VA medical center
serves the largest catchment area of the whole VA system.
How satisfied are they?
According to a recent satisfaction survey, the health system earned overall satisfaction
indexes of 84% for inpatient care and 82% for outpatient services, while the U.S. hospital
industry earned scores of 80% and 83% in those categories, respectively.
What this means is that the VA Medical Centers are on pace with the private sectors as far
as customer service is concerned. This also shows that there is room for improvement
within the system and further analysis will guide future program development.

SWOT Analysis
By looking at the Strengths, Weaknesses, Opportunities, and Threats to the VA Medical
Center (See Figure 7), it is evident where the opportunities for growth lie.
A few of the strengths identified centered mostly on the unique community of care created
at the VA Medical Centers. Through some of the specific policies and systems in place it
creates a community that is the most conducive to a veterans care.
With that come the opportunities in the community at large that promote health in general
and the support of veterans in need. It is evident that now a big emphasis on holistic health
exists in the community which ties in seamlessly with the Recovery Model the VA Medical
Centers is implementing nationwide.
Weaknesses mostly include items that are related to this current political climate and the
slow transitions to keep up with medical technology. Many of the issues that have recently
come to light in the media have been due to systems that are not able to keep up with the
current demand. Also with the VA Medical Centers being a federal employer it is difficult
for supervisors to manage staff and remove ineffective members of the team.
The threats identified come from many of these weaknesses but also include Health Care
Reform offering some alternatives to the VA Medical Centers and a population that is seeing
a rising mortality rate which decreases the need for services.

Figure 7: SWOT Analysis

Market Segmentation
In order to decide which area of the market to target for promotions and programs the
veteran population was divided using a segmentation tree strategy which created market
segments based on demographic information. The veteran population as a whole was first
divided into Combat Veterans and Non-Combat Veterans. Combat Veterans were chosen as
the first tier to further define into combat eras as defined by the VA benefit classification
system. These eras are defined as Pre-World War 2 until the Korean Conflict, the Vietnam
Conflict until Persian Gulf War 1, and finally Operation Iraq Freedom and Operation
Enduring Freedom through Operation New Dawn and current conflicts.

Figure 8: Segmentation Tree

Target Market Analysis

Choosing a target market from the options described in the above section came down to a
simple analysis based on 4 categories. Overall awareness of the VA Medical Center benefits
and services, total population density and numbers, potential for growth in the target
market, and overall level of service connection for physical, emotional, and mental
deficiencies were all assessed for each market segment. Table 1 shows the areas assessed
and places a check mark in the market segment that meets the criteria the best.

Table 1: Market Segment Targeting Table

It is evident from the table above that the OEF/OIF OND/Present category shows the
most potential for growth and currently the highest population density. This makes them
the best target segment for the VA Medical Center in the long term.
Due to the potential for growth, programs targeted toward this market segment would see
the longest participation term and consistency. It also means that as new veterans come to
the VA Medical Center for treatment they can be a part of the system longer.
Because this market segment is a large portion of the total veteran population it means that
with targeted marketing the VA Medical Center can reach more veterans and thus generate
more customers.

Market Positioning Analysis

To determine if the VA Medical Center is reaching the target market an analysis was
performed to determine where the VA Medical Center compares to the competitors. The
values chosen to compare to the competitors were access to Recreation Therapy Programs,
and Customer Service. In Figure 9 it is clear that the VA Medical Center is positioned
slightly away from the target market and a few of the competitors are closer. Some of the
suggestions to hit the target market will be addressed in a later section.

Figure 9: Positioning Map

The target market prefers a high level of customer service and is fairly neutral to access to
Recreation Therapy Programs. One private hospital, Intermountain Health Care, and one
state owned hospital, the University of Utah Medical Center, are positioned much closer to
the target market. One aspect of this positioning map that would affect the results is the
coverage options within the target market. If a veteran in the target market was service
connected for an injury or mental illness it could affect the choices that veteran makes.
The map does still show however that changes could be made to the overall customer
service practices in order to position the VA Medical Center better.

POSITIONING STATEMENT:
For people who served our country through military service during
Operation Iraq Freedom or Operation Enduring Freedom, the VA
Medical Center provides quality Recreation Therapy for individuals
like you. Thats because we provide programs designed to help you
transition back into civilian life and cope with your unique
challenges.

Marketing Objectives:

Increase awareness of VA Recreation Programming by 10% in the next fiscal year as

measured by the Program Awareness Survey.
Implement 3 VA campus promotional activities annually to provide additional
knowledge of the VA Recreation Therapy Programs.
Recruit 10 veterans for outpatient Recreation Therapy programs by next fiscal year.

Program Recommendation:
Program Type:
Adventure Weekend for OEF/OIF/OND and current military personnel and their families
Program Name:
At Ease!
Program Specifics:
Adventure Based Recreation Therapy Program:
o Includes a Ropes Course Experience the first day
Contracted with outside partner CLAS Ropes
Transportation provided through VA Van Pool
Outcomes Expected:
Increased emotional awareness
Increased ability to identify family support systems
Resilience Training

o White Water Rafting Trip:

Two days total on the water
Transportation provided through VA Van Pool
Outcomes Expected:
Mindfulness and Relaxation
Savoring Experiences
Mood Management
Veterans would sign up at least two weeks in advance in order to ensure logistics are
covered. When a veteran signs up an itinerary would be immediately sent and resources to
topics that will be covered on the trip will be included. The veteran would be encouraged to
review the information with family that plan on attending.
When the veterans arrive they would receive a program t-shirt and a quick frontloading
session would begin. On the ride to the ropes course some ice breaker activities will be
played in the vans and a competition between the vans is established to see which van can
learn the most about each other. A similar challenge would be issued for the ride to the
water.
During the ropes course events and on the water different therapeutic concepts would be
reviewed and group participation is crucial to the therapeutic goals. Therapist directed
activities will be engaged in and time to spend with individual families will also be
encouraged.
After the last day on the water the participants are encouraged to journal about the
experience and a follow up video will be sent to all participants a week after the
experience.
All of this would be provided free of charge to the veterans and their families through VA
funds but any food outside of meals provided would be the responsibility of the veteran.
Also any souvenirs or other items would be the responsibility of the veterans.

Promotional Strategies
In order to reach this new target market for the Salt Lake City VA Medical Center it is the
recommendations of these authors to implement the following promotional strategies:
Billboard space along I-15:
o Billboard ads will be centered on broad based program promotion
o The intent of the billboard ads is to raise awareness of programming
o The design of the billboard ads will be intended to reach the OEF/OIF OND
target market.
Print ads for daily newspapers and social media:
o Designed to reach the target audience in a short amount of time
o Promotes current or upcoming program specifics
o Intent is to drive participation in the programs
Radio spots on local radio stations:
o Allows for immediate broadcast to target market
o Advertising with a radio conglomerate can reach multiple radio stations for one
global price
o Aired on stations that fit the target market which increases penetration potential
My 99.5FM
KBER
92.5 (Hip hop/Rap)
X96
o Intent is to drive participation and raise awareness
Promotional Event:
o In order to promote At Ease program, Recreation Therapy team will put on a
free festival with rock climbing wall, challenge initiatives, and family
entertainment.
o Will reach target market and connect the experience with the VA Medical Center
o Gets target market on the VA Medical Center campus and raises awareness
Presentation at annual Utah Recreation Therapy Conference
o Free promotion to Recreation Therapists across the state
o Connects the VA Medical Center with other Recreation Therapist who could
provide referrals to the programs
o Aimed at generating awareness in the professional community which creates
potential referral sources.
These strategies will not only generate awareness within the target market but will also
drive participation in specific programs which in turn creates new life long customers for
the VA Medical Center.

Figure 10: At Ease Poster

Figure 11: Program Billboard

Marketing Evaluation
In order to evaluate the efficacy of the proposed marketing strategies the researchers will
consider the following strategies:
Total Participant Attendance to Programs
Raise in program attendance from previous years
o Incremental Participation Analysis
o Lift Percent analysis
Marketing Return On Investment Analysis
o Total cost of marketing efforts compared to Incremental Participation
Analysis
Since the VA Medical Center does not charge the veterans for participation in programs the
evaluation of marketing efforts must center on participation rates. It could be determined
from the benefits department according to service connection rates and participation but it
becomes an inexact science at that point
Tracking participation rates according to the demographic information of participants will
allow the researchers to determine if targeted marking efforts have been successful.

Appendices
Appendix A: VA Medical Center Organizational Chart