Business Plan Request Intake Form

Is a Business Plan Required?

  • Start of a New Program, Service, or Business Arrangement (e.g., Joint Venture)
  • Construction of a New Facility or Major Renovation
  • Acquisition of New Facility or Major Equipment (or Replacement w/ Incremental Benefits)
  • Acquisition of an Operating Business/Physician Group
  • Outsourcing a Function/Department

If YES to the above, proceed.

If NO to the above, form not needed.

 

Business Plan Request Intake Form

"*" indicates required fields

Project Submitter - Must be a System of Care Business Lead, Market Leader's Designee, or Senior Executive's Designee:*
Name:
Title:
Email:
Reporting Manager:
Department:
 
Project Lead's Name (if different from submitter):
Name:
Title:
 

Project Sponsors (2 Required) - Requests that do not originate from neither a System of Care or a Market Leader require one Senior Executive Sponsor to proceed:

For example: Requests originating from a System of Care should receive an endorsement (on the project's "concept") from the impacted Market Leader, and vice versa.

Briefly describe the opportunity.
What are we trying to solve for or take advantage of with this request?
What, if any, inherent risks do we have if this request is not pursued?

Evidence of Market Demand:

Strategic Alignment to Enterprise Strategy:*
Which of the following objectives does this project meet to advance our strategic goal of "maximizing healthcare value"?

Resources Required:

Max. file size: 16 MB.

Proposed Source of Funds:*

Project Timeframe:

When do you expect this project to be implemented (estimated date)?
MM slash DD slash YYYY
(e.g., funding opportunities, operational considerations, external factors, etc.)
This field is for validation purposes and should be left unchanged.
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