Identifying Marketing Opportunities in the Health Services Industry

Marketing Plan for Kaiser Permanente
Part A
For nearly three-quarters of a century, Kaiser Permanente (hereinafter alternatively “Kaiser” or “the company”) has provided quality health care to a growing number of customers (About us, 2018). Indeed, today, Kaiser has more than 12 million members and its future appears bright providing the company can capitalize on its core competencies using a marketing plan that focuses on achieving its current and future organizational objectives. The purpose of Part A of this marketing plan is to provide a framework in which the company can achieve its current and future marketing objectives in an increasingly volatile and competitive marketplace based on the assumptions listed below.
Statement of assumptions
The following assumptions apply to this marketing plan:
· The marketing data provided by the company and third-party analysts are accurate and complete;
· Current trends in changing demographics in the U.S. population will create an increased demand for geriatric health care services as the Baby Boomer generation retires in greater numbers and live longer lives compared to just a half century ago;
· The company’s current leadership will continue to oversee Kaiser’s operations in an effective and informed fashion; and,
· There will be no significant downturns in the U.S. economy during the next 10-year period.
The preliminary information needed to formulate an effective marketing plan for Kaiser is provided below.
Initial information
Founded in 1945 and currently headquartered in Pleasanton, California, Kaiser was originally focused on providing industrial health care programs for blue-collar workers in the construction, shipyard, and steel mill trades who were employed by the Kaiser industrial companies during the prosecution of the Second World War (About us, 2018). According to Raube and Upshaw (2014), the company has transformed itself from this original business model to become one of the leading non-profit health services organizations in the country today. To its credit, Kaiser has consistently provided its members with high quality, integrated health care coverage since its inception (Raube & Upshaw, 2014). The company’s chairman and chief executive officer, Bernard J. Tyson, is highly rated as effective and committed to the organization’s stakeholders by the company’s employees and the company has consistently grown under this leadership (Kaiser Permanent overview, 2018).
The company has been a leader in the health care services industry in a number of ways over the years, including being the first organization to introduce: (a) prepaid health plans that distribute costs to members to make them more affordable; (b) physician group practices that facilitate the delivery of health care services; (c) wellness programs designed to keep its members healthy and reduce corresponding medical costs; (d) an integrated delivery system that provides more efficient care at reduced costs for members; and (e) electronic medical records (Raube & Upshaw, 2014).
The company also maintains a loyal social network following, and Kaiser Permanente had nearly a third of a million “fans” on its Facebook site alone by April 2018 (Kaiser Permanente overview, 2018). The company estimated annual revenues are currently $72.7 billion and Kaiser has about 21,275 employees (Kaiser Permanente overview, 2018). The company is comprised of the following entities:
· Kaiser Foundation Hospitals and its subsidiaries;
· Kaiser Foundation Health Plan, Inc.; and,
· The Permanente Medical Groups (Fast facts about Kaiser Permanente, 2018).
These three entities form the focus for the company’s marketing programs (Raube & Upshaw, 2014).
The company’s operations are currently limited to the U.S. market and current total membership in their health care plans by region of the country is set forth in Table 1 below.
Table 1
Health Plan Membership, by Region
Region
Membership
Northern California
4,284,011
Southern California
4,538,427
Colorado
671,254
Georgia
374,000
Hawaii
255,828
Mid-Atlantic States (Va., Md., D.C.)
783,094
Northwest (Ore./Wash.)
606,511
Washington
711,465
Source: Adapted from Fast Facts about Kaiser Permanente, 2018
The company’s annual operating revenues for the past 5 years are set forth in Table 2 below.
Table 2
Kaiser Permanente Operating Revenues: 2013-2017
Year
Revenues
2013
$53.1 billion
2014
$56.4 billion
2015:
$60.7 billion
2016
$64.6 billion
2017
$72.7 billion
Source: Fast facts about Kaiser Permanente, 2018).
As can be readily discerned from the figures set forth in Table 2 above, the company’s annuals revenues have experienced a significant and sustained increase over the past 5 years due in large part to the efficiency of its operations, the high quality of the health care services it delivers, and the effectiveness of its marketing initiatives which are discussed further below in the market audit of the company.
Market audit
A timely market audit can help companies identify the extent to which their marketing department is achieving its assigned marketing activities as well as the extent to which it is contributing to the organization’s overall performance (McDonald & Dunbar, 2016). A market analysis of the health services organization industry in the United States using a PESTLE (political, economic, social, technological, legal and environmental) framework in provided in Table 3 below.
Table 3
Market Audit of the Health Services Organization Industry
PESTLE component
Description
Application
Political
These factors determine the extent to which a government may influence the economy or a certain industry. [For example] a government may impose a new tax or duty due to which entire revenue generating structures of organizations might change. Political factors include tax policies, Fiscal policy, trade tariffs etc. that a government may levy around the fiscal year and it may affect the business environment (economic environment) to a great extent.
Although the process is expensive and frequently onerous, Blank (2015) reports that the political will to facilitate the introduction of new, more effective drugs has had an impact and the FDA's Center for Drug Evaluation and Research formally approved 41 new drugs in 2014, including a number targeted at treating cancer as well as type 2 diabetes, hepatitis C, and other serious diseases. This accelerated approval rate reflects the political will to streamline the health care services industry.
Economic
These factors are determinants of an economy’s performance that directly impacts a company and have resonating long term effects. [For example] a rise in the inflation rate of any economy would affect the way companies’ price their products and services. Adding to that, it would affect the purchasing power of a consumer and change demand/supply models for that economy. Economic factors include inflation rate, interest rates, foreign exchange rates, economic growth patterns etc. It also accounts for the FDI (foreign direct investment) depending on certain specific industries who’re undergoing this analysis.
The current unemployment rate of just 4.4% is among the lowest in years (U.S. economy, 2018), and recent trends suggest that the American economy will remain strong for the foreseeable future unless the tariffs invoked by President Trump cause a global trade war that results in a severe economic downturn. This eventuality, however, is mitigated somewhat by legislation passed in December 2017 (the Tax Cuts and Jobs Act) which reduces individual tax burdens and eliminates the penalty imposed on taxpayers who do not obtain the minimum amount of health insurance required under the Affordable Care Act by 2019 (discussed further below). The individual reductions do not expire until 2025 (U.S. economy, 2018).
Social
These factors scrutinize the social environment of the market, and gauge determinants like cultural trends, demographics, population analytics etc.
Growing numbers of health care services organizations (including Kaiser Permanente) are integrating social media platforms into their marketing mix. Other relevant social trends include an increasingly diverse demographic population as well as a rapidly growing population of elderly health care consumers (U.S. people, 2018) who will undoubtedly require an inordinate amount of age-related health care services for the foreseeable future.
Technological
These factors pertain to innovations in technology that may affect the operations of the industry and the market favorably or unfavorably. This refers to automation, research and development and the amount of technological awareness that a market possesses.
Innovations in health care technologies have transformed this industry in fundamental ways over the past 20 years, and electronic medical records have substantially reduced administrative costs as a result. Indeed, Cutler (2015) emphasizes that Kaiser’s implementation of electronic medical records initially saved the company over half a billion dollars a year when adopted in a single region and this amount has increased of $6.6 billion after its deployment nationwide. These types of technological innovations, however, are subject to the legal issues noted below.
Legal
These factors have both external and internal sides. There are certain laws that affect the business environment in a certain country while there are certain policies that companies maintain for themselves. Legal analysis takes into account both of these angles and then charts out the strategies in light of these legislations. For example, consumer laws, safety standards, labor laws etc.
The health care services industry is characterized by numerous legal requirements and limitations that are frequently burdensome. In this regard, Field (2008) emphasizes that, “The array of regulations that govern health care can seem overwhelming to people who work in the industry. Almost every aspect of the field is overseen by one regulatory body or another, and sometimes by several” (p. 607).
Environmental
These factors include all those that influence or are determined by the surrounding environment. This aspect of the PESTLE is crucial for certain industries. Factors of a business environmental analysis include but are not limited to climate, weather, geographical location, global changes in climate, environmental offsets etc.
There has been a discernible trend in the health care services industry for organizations (including Kaiser Permanente) to adopt so-called “green” practices in their business operations and building designs (Ferenc, 2015). In addition, many organizations (including the company) have found that these initiatives not only help satisfy their corporate social responsibility obligations but can pay a major economic return on these investments. In this regard, Orndorff (2013) emphasizes that, “It's financially smart from a life cycle standpoint, enhances the healing environment for patients and staff, improves the health of the communities served, demonstrates good environmental stewardship and provides structure for including sustainability in the design and construction process” (p. 8).



Source: Description adapted from PESTLE analysis overview, 2018; other entries as indicated
http://pestleanalysis.com/what-is-pestle-analysis/
While the company takes advantage of its Web site to communicate with the general public as well as its membership and employees, Kaiser Permanente currently relies heavily on several social media platforms as an integral part of its marketing strategy as discussed further below.
Determine the marketing strategy and business communication standards to be used
Like many of its competitive, the company currently maintains a presence on several prominent social media platforms, including Facebook, Twitter, LinkedIn, YouTube, and Pinterest (Fact facts about Kaiser Permanente, 2018). This marketing strategy is highly congruent with the actions that have been taken by the company’s major competitors, and Kaiser Permanente has communicated the importance for its physicians to participate in these online forums as a way to improve relationships with existing members while attracting new members in the process. For instance, Dr. Jeffrey Benabio, a dermatologist practicing at Kaiser Permanente in San Diego, emphasizes that, “Social media provides a way for you to engage with your patients and the community, whether you practice in an HMO or privately, No matter what your specialty, the principles of using social media such as blogs, Facebook, and Twitter as tools for improving patient care will apply” (as cited in Moore & McGowan, 2009, p. 299).
By developing professional communities of practices on their social media platforms, Kaiser Permanente can take advantage of existing resources in ways that will help them achieve and sustain a competitive advantage. For example, yet another Kaiser Permanente physician pointed out that, “Online patient communities are an ascendant means for patients to learn about their disease, and seek advice and comfort from [other] patients like them. Physicians can be part of this conversation and contribute to it. Who better to [advise] patients [on] how to live with pain, live with deformity deal with insurance companies, than physicians?" (as cited in Moore & McGowan, 2009, p. 299). Although social media platforms are a highly cost-effective marketing strategy, they are not without their costs as discussed below.
Assess due diligence (any operational, financial, or human resources requirements needed to implement the plan)
Leveraging the company’s existing social media resources to achieve its marketing objectives will require a significant investment in time and effort but a relatively modest economic investment. For instance, Kubetin (2010) perhaps exaggerates somewhat when he counsels that, “It takes no money but lots of time to build online networks” (e.g., the human resources needed to design, maintain and respond to user feedback represents a significant cost), but he does make a good point when he adds that, “Patients are going online to interact with their physicians, and we are not there. Whereas patients always had to come to us to learn about disease and health, now they get most of their information online. Our absence online perpetuates a trend of diminishing importance of our profession” (p. 58).
The company, however, has recognized the importance of its physicians maintaining open communications with members and prospective members using its social media platforms, but these costs of these activities is far greater than the human resource costs of maintaining the platforms. Notwithstanding these additional costs, though, it is becoming increasingly apparent that organizations competing in the health care services industry cannot afford not to invest in these online resources. As Kubertin (2010) concludes, “As with much in life, the secret to being effective online comes down to showing up. A physician becomes a trusted member of the community by being present. Over time, regular blog posts, Facebook updates, and Tweets allow the audience to become familiar with you” (p. 58). Given the significant investments that are involved in designing, administering and responding to user feedback on social media platforms, it is vitally important to set appropriate marketing goals and objectives that are aligned with these resources and these issues are discussed further below.
Set marketing goals and objectives
The key goals and objectives identified by Raube and Upshaw are as follows:
· Identify opportunities to capitalize on the widespread success of its innovative Thrive healthcare marketing programs;
· Determine how could the company’s marketing become even more accountable in terms of generating tangible membership gains;
· Develop an optimal marketing strategy moving forward, given the rise of competition that was mimicking its wellness approach; and,
· Determine how the company’s marketing programs best weather what would likely be a difficult transition period when the controversial Affordable Care Act was fully implemented, beginning in 2014 (p. 1).
Given the recent changes that have affected the Affordable Care Act, it is also important to add two more objectives as follows:
· Ensure that the company’s health care consumers are aware that the Affordable Care Act remains in effect, but,
· Ensure that their health care customers are also aware that the Individual Mandate has been repealed effective in 2019 (Durkheimer, 2018).
Achieving these broad-based and ambitious goals and objectives requires a careful assessment of any benchmarks that are available from the company’s competitors as discussed below.
Describe any benchmarks from other competitors
Kaiser Permanente's main competitors are Ucsf Medical Center, Sutter Health and Blue Shield; these competitors provide some useful benchmarks that should be used to guide the company’s marketing plan in the future as follows:
· Ucsf Medical Center is seen as one of Kaiser Permanente's top competitors. Ucsf Medical Center was founded in null, and is headquartered in San Francisco, California. Ucsf Medical Center operates in the Hospitals industry. Ucsf Medical Center generates $72.7 billion more revenue compared to Kaiser Permanente.
· Sutter Health is a top competitor of Kaiser Permanente. Sutter Health was founded in 1918, and its headquarters is in Sacramento, California. Sutter Health has 33,725 more employees than Kaiser Permanente.
· Blue Shield is Kaiser Permanente's #3 rival. Blue Shield was founded in San Francisco, California} in 1939. Blue Shield is in the NGO/NPO/NFP field. Compared to Kaiser Permanente, Blue Shield generates $70.5 billion more revenue (Kaiser Permanente overview, 2018).
Beyond the foregoing, the company also has benchmarks available for its respective market share in each of the regions in which it competes that can be used to measure the effectiveness of the marketing actions proposed herein (as discussed further below following the prioritization of the marketing objectives). Taken together, it is clear that Kaiser Permanente is faced with some difficult challenges in the years ahead in gaining additional market share in this competitive industry, making the need to carefully prioritize its marketing objectives paramount as discussed further below.
Prioritize marketing objectives
As noted above, the case study by Raube and Upshaw (2014) described several marketing objectives for the company, some of which have become less important and even irrelevant in the intervening years, so it is important to prioritize the above-listed objectives. To this end, a prioritization of the top three most relevant marketing objectives for the company identified by Raube and Upshaw (2014) are as follows:
1. Identify opportunities to capitalize on the widespread success of its innovative Thrive healthcare marketing programs;
2. Determine how could the company’s marketing become even more accountable in terms of generating tangible membership gains; and,
3. Develop an optimal marketing strategy moving forward, given the rise of competition that was mimicking its wellness approach.
Achieving these marketing objectives will require specific marketing actions which are described below.
Specify marketing actions
The marketing actions that are needed to achieve the above-listed top three marketing objectives are described in Table 4 below.
Table 4
Marketing Actions for Top Three Objectives
Objective
Marketing Action
Rationale
Identify opportunities to capitalize on the widespread success of its innovative Thrive healthcare marketing programs
Partner with major sporting goods manufacturers and retailers (i.e., Dick’s Sporting Goods, Bass Pro Shops) to sponsor a series of nationwide programs designed to promote physical fitness through sports among young Americans. These programs should be conducted in all areas of the country, including those in which the company does not currently compete, in order to achieve optimal marketing outcomes including enhanced brand awareness. This marketing action will require the increased participation of the company’s health care providers, including its nationwide cadre of physicians. This marketing action may require training these clinicians concerning effective methods of “blogging” and how best to use the tools available on each of the social media platforms (Livingston, 2011).
This marketing action is highly congruent with the company’s current initiatives and will help raise awareness and improve Kaiser Permanente’s brand in the process. For example, the research shows that Kaiser Permanente has been a long-time advocate for the promotion of healthier lifestyles to reduce obesity related morbidity, especially in school settings. Under its campaign "Thrive," Kaiser Permanente has developed Educational Theatre Programs to educate children and teens on health issues such as nutrition and physical activity through drama, music, and humor. Healthy Eating Active Living (HEAL) is another example of a Kaiser Permanente community-based health promotion program. HEAL focuses on support for low income communities to develop healthy eating and exercise habits (Moore & McGowan, 2009, p. 299). The company could stream these production live (and in a recorded) version as a valuable addition to their existing social media offerings.
Determine how the company’s marketing can become even more accountable in terms of generating tangible [sic] membership gains
(This objective requires some clarification. In this context, “tangible” will be interpreted to mean “substantial” (rather than something that can be touched) and “gains” will be interpreted to mean “increases” in the company’s membership rolls rather than substantial gains in terms of economic savings or improved health for its members.)
Improving the company’s marketing accountability in terms of generating substantial increases in membership can be achieved by closely aligning its marketing actions through its social media platforms with changing trends in consumer preferences with respect to types of wellness program elements and how these can add value to the company’s offerings.
In any context, improving something requires measuring it, so it will be important to establish benchmarks for each of the regions in which the company currently competes and corresponding metrics in order to assess the effectiveness of its social media marketing actions in substantially increasing the company’s market share while concomitantly reducing its competitors’ market share. As noted above, the company has benchmark data concerning its respective market share in each of the regions of the country in which it competes that can be used to evaluate the effectiveness of these marketing actions.
Develop an optimal marketing strategy moving forward, given the rise of competition that was mimicking its wellness approach
This may be the most difficult objective to achieve given the highly fungible nature of the constituent elements of the vast majority of wellness program offerings today. Fortunately, there are some proven strategies available that can help differentiate the company’s Thrive initiative from its major competitors’ wellness program using its existing social media resources. In this regard, Hunt (2013) recommends “gamifying” social media wellness program offerings, including the addition of mobile apps, to make them more engaging and exciting and therefore more effective. Likewise, incorporating “scavenger hunts” wherein social media users collect points by visiting different wellness program offerings and participating in them for prizes will generate enthusiasm and create major media “buzz.”
This strategy has demonstrated effectiveness in making wellness program offerings more attractive to social media users. For example, Hunt (2013) reports that, “Gamification can help provide positive rewards through constant feedback on performance and success” (p. 24). This marketing action can be used in a wide range of ways, including helping users keep track of how far they have walked or jogged using their smartphone and a mobile app, or by providing opportunities to try new exercise regimens using digital avatars so that users can determine which approach best suits their personal needs and preferences. Moreover, the addition of gaming elements into social media wellness program offerings can be achieved in other cost-effective ways including the use of game-like features such as lotteries or raffles for prizes such as gift cards or health-related products such as exercise equipment or sporting goods (Livingston, 2013).
Explain any global marketing issues in the marketing plan
Because the company’s current business operations are limited to selected regions of the United States, there are no corresponding specific global marketing issues involved in the marketing plan.
Specify any limitations to implementing the plan
There are three overarching limitations anticipated for the implementation of the marketing actions described above as follows:
1. As noted above, although it is reasonable to suggest that many of the employees at Kaiser Permanente possess the skill set needed to interface effectively on social media platforms, many of them, including physicians and other health care providers, may require training in order to provide them with the information they need to use these resources to their best effect.
2. In the case of increasing physician participation levels through blogging or involvement with professional communities of practice on its various existing social media platforms, the company is also faced with the need to ensure an ongoing supply of volunteers who are fully committed to leveraging these online resources in the best interests of the company. In the event that sufficient numbers of volunteers are unavailable, the company may be faced with the need to assign physicians to this task on a part- or even full-time basis.
3. Finally, truly effective gamification designs for social media platforms do not just fall out of the sky but are rather the result of extensive research and development that requires time and other scarce organizational resources. Although the company may possess the expertise needed to design, develop and administer its current social media platforms, developing new gaming themes and concepts and evaluating the effectiveness of current offerings may require outsourcing these requirement.
Conclusion
The research showed that unlike many sectors, organizations such as Kaiser Permanente compete in an industry that is essentially guaranteed continued growth in the future due in large part to enhanced awareness of the importance of timely health care among the general public as well as the graying of America and the increased demand for age-related health services this trend will generate for the foreseeable future. The research also showed that this company has succeeded where many others have failed as a result of its ongoing focus on identifying and applying best marketing practices in the regions in which it competes. The sustained increase in revenues is proof positive that the company’s integration of social media platforms into its marketing mix has been effective in helping it gain market share, but the dynamics of the marketplace mean that Kaiser Permanente does not enjoy the luxury of resting on its laurels but is rather faced with the need to remain vigilant in identifying new trends in social media user preferences and how these trends can be used to help the company achieve its marketing objectives.
References
About us. (2018), Kaiser Permanente. Retrieved from https://share.kaiserpermanente.org/article/ history-of-kaiser-permanente/.
Blank, C. (2015, March). More than 40 novel drugs won FDA approval in 2014. Drug Topics, 159(3), 44.
Cutler, D. (2015). The quality cure: How focusing on health care quality can save your life and lower spending too. Berkeley, CA: University of California Press.
Durkheimer, M. (2018, January 29). Does Obamacare still exist? Forbes. Retrieved from https://www.forbes.com/sites/michaeldurkheimer/2018/01/29/does-obamacare-still-exist/.
Fast facts about Kaiser Permanente. (2018). Kaiser Permanente. Retrieved from https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/.
Ferenc, J. (2015, May). Kaiser Permanente commits to increased renewable energy use. Health Facilities Management, 28(5), 7.
Field, R. I. (2008, October). Why is health care regulation so complex? Physical Therapy, 33(10), 607-608.
Hunt, R. (2013, October). Game on! New technologies deliver much-needed excitement to employee wellness initiatives. Communication World, 30(7), 23-26.
Kaiser Permanente overview. (2018). Owler. Retrieved from https://www.owler.com/ company/kaiserpermanente.
Kubertin, K. (2010, November). Marketing your practice? Make social media work for you. Clinical Psychiatry News, 38(11), 58.
Livingston, B. (2011, May). Harnessing blogs for learning. Talent Development, 65(5), 76-79.
McDonald, M. & Dunbar, I. (2012). Market segmentation: How to do it and how to profit from it New York: Wiley.
Orndorff, D. (2013, July). Kaiser Permanente aims to construct only high-performing facilities. Health Facilities Management, 26(7), 8.
Our history. Kaiser Permanente. Retrieved from https://share.kaiserpermanente.org/ article/history-of-kaiser-permanente/.
Moore, K. R. & McGowan, M. K. (2009, September-October). Community resources for promoting youth nutrition and physical activity. American Journal of Health Education, 40(5), 298-302.
Raube, K. & Upshaw, L. (2014, March 10). Thrive or revive? The Kaiser Permanente ‘thrive’ marketing programs. Berkeley-Haas Case Series B5804.
U.S. economy. (2018). CIA World Factbook. Retrieved from https://www.cia.gov/library/ publications/the-world-factbook/geos/us.html.
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Marketing Plan for Kaiser Permanente
Part B
Executive Summary

Statement of assumptions
The following assumptions apply to this marketing plan:
· The marketing data provided by the company and third-party analysts are accurate and complete;
· Current trends in changing demographics in the U.S. population will create an increased demand for geriatric health care services as the Baby Boomer generation retires in greater numbers and live longer lives compared to just a half century ago;
· The company’s current leadership will continue to oversee Kaiser’s operations in an effective and informed fashion; and,
· There will be no significant downturns in the U.S. economy during the next 10-year period.
Marketing strategy and business communication standards to be used
Like many of its competitive, the company currently maintains a presence on several prominent social media platforms, including Facebook, Twitter, LinkedIn, YouTube, and Pinterest (Fact facts about Kaiser Permanente, 2018). This marketing strategy is highly congruent with the actions that have been taken by the company’s major competitors, and Kaiser Permanente has communicated the importance for its physicians to participate in these online forums as a way to improve relationships with existing members while attracting new members in the process.
Prioritization of marketing objectives and proposed strategies
The case study by Raube and Upshaw (2014) described several marketing objectives for the company, some of which have become less important and even irrelevant in the intervening years, so it is important to prioritize the above-listed objectives. To this end, a prioritization of the top three most relevant marketing objectives for the company identified by Raube and Upshaw (2014) and proposed strategies for their achievement are as follows:
1. Identify opportunities to capitalize on the widespread success of its innovative Thrive healthcare marketing programs; Partner with major sporting goods manufacturers and retailers (i.e., Dick’s Sporting Goods, Bass Pro Shops) to sponsor a series of nationwide programs designed to promote physical fitness through sports among young Americans.
2. Determine how the company’s marketing can become even more accountable in terms of generating tangible membership gains: Generating substantial increases in membership can be achieved by closely aligning its marketing actions through its social media platforms with changing trends in consumer preferences with respect to types of wellness program elements and how these can add value to the company’s offerings.
3. Develop an optimal marketing strategy moving forward, given the rise of competition that was mimicking its wellness approach. Develop mobile apps and gamification elements for the company’s existing social media resources. This proposed strategy can be applied in a wide range of ways that promote consumer health by making health services social media offerings more exciting and engaging. This proposed strategy is not cheap, but it has demonstrated effectiveness in promoting wellness initiatives in ways that will differentiate the company’s offerings from its major competitors.