2015

Rebecca Kendall, Founder and CEO

Bloom Women’s Health and Birth Centers

3/4/2015

Bloom Women’s Health and Birth Centers

Bloom Women’s Health and Birth Center Page 1

Executive Summary

Company Bio

Bloom is a not-for-profit midwifery practice and birth center serving California’s North Bay area. Born from our predecessor, the Santa Rosa Birth Center, Bloom offers new and improved birthing options for families of every income level who want to give their babies the best possible start to life.

Problem

What we do stands in stark contrast to the typical birth model in the U.S. Depictions of birth in media and tales of traumatic experiences cause many women to feel terrified of birth. Fear causes their bodies to shut down, and so they end up having more interventions and complications. The U.S. has a staggering 33% caesarian section rate, which experts agree should be closer to 10% (CDC). These interventions and complications incur a higher cost. Childbirth costs more in the U.S. than anywhere else in the world, and costs have tripled in the past 8 years (New York Times).

Solution

Bloom breaks this cycle by providing natural birthing options that are clinically documented to be as safe as birthing in a hospital, and as comfortable as birthing in a home (Journal of Midwifery and Women’s Health). Our additional locations make these options available to more women throughout the North Bay, and our expanded menu of services gives women even more choices for natural birthing and parenting. Given the fact that 85% of pregnant women are perfect candidates to deliver in a birth center, but less than 1% actually do (CDC), we are prepared to expand and increase our client base to accommodate the growing number of women who are and will be interested in birthing centers as an alternative to both hospital and home births.

Economics

Bloom is a low volume, high value business model. With 300 clients per birth center and average per-client revenue of $6,000, we expect each clinic to generate about $2M. Key Revenue Drivers are prenatal and birth services, women’s health services, and donations, and we accept all forms of insurance and private pay.

In our first year, revenue will increase slightly over current rate at $1.2M. We project revenue growth at about 60% each year thereafter. Bloom will achieve break even in year two, with modest profits in year 3-5, and more significant profits in year 6 and 7, once all four clinics are operating at maximum capacity. Surplus revenue will fund additional services, locations, and our endowment.

Proposal

Bloom is seeking a philanthropic investment of $500,000. $250,000 will be used to relocate and renovate, adding more suites, new tubs, and new technology. The rest will provide 18 months operating cash as we expand. The impact of this investment is a better birth for 200 more moms and babies this year, with the opportunity to prevent 40 unnecessary cesareans, minimize maternal infection and other complications, and save the community at least $2,000,000 in birthing costs alone (American Association of Birth Centers). This is an opportunity to change children’s lives and significantly improve our local healthcare system. Please invest in Bloom, because being born is important.

Bloom Women’s Health and Birth Center Page 2

Introduction:

Bloom Women’s Health and Birth Centers is a California-based non-profit provider of pregnancy,

birth, and well-woman care. The flagship center is located at 583 Summerfield Rd. in Santa Rosa.

Bloom’s clinical nurse midwives also attend births at all major hospitals in Sonoma County.

Bloom’s mission is to help women of all backgrounds rediscover pregnancy, birth, and motherhood

as an intuitive, natural, and empowering journey. This is accomplished by providing a homelike

environment for birthing staffed by highly trained and compassionate midwives, as well as skilled

support for prenatal nutrition and health, breastfeeding, infant care, fertility and pregnancy

achievement, and general women’s health services. Additionally, Bloom educates and advocates in

the wider community on the important role that birth centers play in improving the American

healthcare system.

The Problem and the Solution:

The Big Problem

In 2013 there were 3.93 million babies born in the U.S., and there is strong evidence that many of

them were born into a deeply flawed system (CDC). Hospital childbirth costs in the U.S. have

tripled since 1996 (New York Times), and are higher than anywhere else in the world, but outcomes

remain far behind most developed countries (NACPM). Cesarean rates among American women

were a staggering 32.7% in 2013 (CDC). The problem extends beyond just the delivery, too.

Pregnancy is a challenging time that can surface many questions and concerns for expectant

mothers, but the average hospital prenatal appointment is just fifteen minutes, hardly long enough to

get those questions answered (NAMCS).

The Big Solution

Birth centers offer an attractive alternative to the hospital birth model. Across the country, birth

centers boast cesarean rates of just 6%, and the average cost of a birth center birth is just one third

of the cost of a hospital birth (Journal of Midwifery and Women’s Health). Additionally, women

report higher satisfaction rates and better delivery outcomes when they receive prenatal care and

birth assistance from a team of midwives versus a group of doctors and nurses (Medical Journal of

Australia). An informal poll of local birth center clients revealed an average prenatal appointment

length of 40 minutes, leaving them plenty of time to ask questions and establish rapport with their

midwives (Interview with E.Smith, owner of SRWHBC).

The Local Problem

Still, only one in 300 US births occur in a birth center, and many cities and states lack this essential

option for expectant mothers (CDC). In fact, there are only three accredited birth centers in

Northern California, leaving a huge gap for women who desire to birth in a safe, comfortable, out-

of-hospital setting (American Association of Birth Centers). Fortunately, Sonoma County boasts the

Santa Rosa Women’s Health and Birth Center (SRWHBC), an accredited full-spectrum provider of

women’s health services including prenatal care, delivery services and facilities, postpartum support,

and routine women’s health care since 1997 (Commission for the Accreditation of Birth Centers).

Bloom Women’s Health and Birth Center Page 3

Unfortunately, SRWHBC is limited in its ability to accept patients due to the limited number of

exam rooms and birthing rooms. With only two of each, the facility is able to accommodate a

maximum of 150 clients per year. Additionally, past, present, and potential customers report being

turned off by the facility’s dated and worn appearance and the lack of private restroom facilities for

each birthing room. Lapsed clients and potential clients also report frustration with the perceived

high cost of services (E.Smith). Finally, SRWHBC’s lack of a strong marketing effort means that

many of the 5,200+ expectant mothers in Sonoma County in 2014 were simply unaware of the

existence or benefits of utilizing their services and facilities (Sonoma County Dept. of Health

Services). For this reason, just 140 women utilized their services in 2014, 91 of whom ultimately

delivered at their facility (E. Smith).

The Local Solution

Bloom Women’s Health and Birth Centers is born from its predecessor, the Santa Rosa Women’s

Health and Birth Center. The SRWHBC built a strong foundation as the only accredited birth

center in the North Bay, offering patient-centered care, low-cost and low-intervention deliveries,

highly trained and certified nurse midwives, and positive working relationships with local hospitals

(Santa Rosa Women’s Health and Birth Center). Bloom’s leadership builds on this solid foundation,

and addresses the issues that prevent the birth center from serving the widest possible client base by

providing new and improved birthing options for families of every income level who want to give

their babies the best possible start to life. These options include better experiences, greater

accessibility, and expanded services.

Better Experiences

When they first walk in for a tour, Bloom’s potential customers find

themselves in an oasis of peace and comfort, and immediately notice

the contrast between Bloom’s relaxed and inviting environment and

the chaotic and clinical environment of a hospital. Mood lighting,

warm colors, inviting furniture, and clean surroundings make

Bloom’s new location as modern and upgraded as any local hospital

birthing suite. In addition, Bloom’s new location includes four

birthing suites with private birthing tubs and restroom facilities in each, something that no other

local birthing facilities offer. Finally, Bloom offers increased options for natural pain relief including

acupuncture, essential oils, and TENS units, a clinically proven non-pharmaceutical technology that

reduces labor pain (International Journal of Gynecology and Obstetrics).

Greater Accessibility

Bloom’s rebirth includes a strong marketing effort to educate local women about the benefits of

utilizing accredited birth centers, and Bloom in particular. It also encompasses increased advocacy

at local, state, and federal level for increased legislative support for birth centers, comparable

insurance reimbursement rates, and other government support (American Association of Birth

Centers) that allow more families to take advantage of Bloom’s services and facilities. Additional

clinics increase accessibility for women outside the Santa Rosa Area. Bloom’s fundraising activities

also help ensure that these vital services are available for any expecting mother, regardless of her

ability to pay.

Bloom Women’s Health and Birth Center Page 4

Expanded Services

Bloom offers expanded services including prenatal nutrition education, alternative medicine

workshops, and natural fertility counseling, as well as the convenient rental and sale of specialized

natural mother and baby items.

The economics of the business

Revenue Drivers

Bloom’s primary business is to provide prenatal checkups and birth services through a team of

licensed Clinical Nurse Midwives. Secondarily, Bloom provides an out-of-hospital location for

delivering babies for low-risk mothers. Bloom also offers wraparound services like birth control

services, annual women’s health exams, natural fertility counseling, breastfeeding support, and

nutrition counseling, as well as rental and sales of specialized breastfeeding equipment, natural

pregnancy, birth and postpartum supplements and essential oils, and other specialized mother and

baby items. Finally, Bloom’s fundraising department generates significant contributions and grants

that offset the cost of delivery for low-income women who utilize Medi-Cal, private insurance, or

private pay options.

Repayment Options

Bloom accepts most forms of insurance for prenatal care and education as well as birth and

postpartum care. Private pay clients are also welcome. One of the primary challenges that faced

Bloom’s predecessor, Santa Rosa Women’s Health and Birth Center, was the high number of Medi-

Cal clients whose insurance reimbursements cover only 66% of the true costs of providing the

services (E. Smith). Bloom will address this challenge through diversifying its client base and

attracting a higher number of private-pay clients by enhancing the quality of the facilities as well as

public awareness of Bloom’s offerings. Finally, Bloom is able to raise funds from grantors and

individuals to subsidize the cost of delivering services to low-income women and to promote

awareness of the value of birth centers to individuals, communities, and the nation.

Gross and operating margins

Bloom’s gross margins hover around 70%, much higher than the healthcare industry average of 53%

(CSImarket.com). This is primarily due to the fact that services are high-touch, rather than high-tech,

relying very little on drugs and equipment. Bloom’s operating margins are expected to remain

between 20% and 30% in years 5-10, thanks to expansion efforts and economies of scale. This is

on track with the healthcare industry average of 27% (CSImarket.com). Overall, the healthcare

34%

56%

5% 5%

Average Annual Revenue Per

Client Prenatal Care

and Education

Birth and

Postpartum Care

Wraparound

Services

Rentals/Retail

Sales

12%

12%

31% 15%

30%

Revenue Sources

Grants

Contributions

Insurance

Reimbursements

Co-Pays

Cash Pay

Bloom Women’s Health and Birth Center Page 5

industry has shown one of the healthiest net margins of any industry at almost 19.19%, second only

to the technology sector at 21.5% (CSImarket.com).

Trends

Industry Description

Bloom Women’s Health and Birth Centers is a part of the healthcare industry, and specifically the

alternative healthcare industry, although heavily influenced by and enmeshed with conventional

healthcare as well. According to IBISworld.com, the alternative healthcare industry is characterized

by low revenue volatility, low capital intensity, heavy regulations, low technology flux, high

competition, and low barriers to entry. This $12.2B industry is heavily fragmented with no key

players.

Bloom is categorized under “Offices of all other miscellaneous health practitioners,” NAICS code

621399. In 2007, 11,968 “miscellaneous health practitioner” establishments reported a total of

$3.3B in revenue with 38,126 employees (U.S. Census Bureau). Fast forward to 2012, when 16,592

establishments reported a total of $6.5B in revenue with 66,751 employees (U.S. Census Bureau).

Industry Trends

The alternative healthcare industry is in a growth stage, with annual growth at 3.1% from 2009 to

2014, and projected annual growth at 3.8% from 2014 to 2019 (IBISworld.com). Compared with

the U.S. projected GDP growth of 3% in 2015, the alternative healthcare industry is proving to be a

reasonably healthy industry to invest in (Wall Street Journal). As a whole, the healthcare industry is

expected to grow at an annual compounded rate of 6% between 2013 and 2017 (Sikich.com).

Key factors in the alternative and conventional healthcare industry trends include the number of

people with private or government health insurance, per capita disposable income, and government

funding for Medi-cal. The Affordable Care Act and general U.S. healthcare reform has and will

continue to have a significant impact on the healthcare industry, as do rates for malpractice

insurance premiums, as well as the growth in non-insurance practices (Sikich.com).

As a subset of the alternative healthcare and miscellaneous health practitioner industries, Bloom is

uniquely affected by national and local birth rates. According to the U.S. Census Bureau, over four

million U.S. babies will be born in 2015, a rate that represents 15-year historic lows (Aljazeera). The

birth rate in Sonoma County, where most of Bloom’s clinics will be located, is slowly declining as

well, and at 11%, is lower than California’s overall birth rate (Sonoma County Dept. of Human

Services). Projections indicate that about 5,000 babies will be born in 2015 in this county, compared

with about 3,800 in 2012 (CA Dept. of Public Health).

Despite these declines, there is still a growing market for out-of-hospital birth services. The number

of U.S. non-hospital birthing centers has grown by 27% in just the past 3 years (Childbirth

Connection). Although the annual number of U.S. births decreased by 7.3% from 2007-2010, the

annual number of birth center births increased by 21.7% and in 2013 represented .42% of the total

U.S. births (Childbirth Connection), although the percentage is significantly higher in some areas.

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Competition

Thrive Center for Birth, Family, and Wellness

Strengths: Thrive’s facilities opened in 2014, and include high quality birthing suites with private

bathrooms and tubs, education rooms, patient exam spaces, and a laboratory. Their team of three

licensed professional midwives has nine five-star Yelp reviews (Yelp.com). Additionally, Thrive’s

marketing and online presence is effectively reaching their target market of wealthy white moms.

Weaknesses: Thrive’s primary weakness is that none of the midwives are certified nurse midwives,

which means they have less medical training and lack hospital privileges, so they can accompany

their patients to a hospital only in the role of a doula and not to deliver the baby. An additional

weakness is the high cost of services and their cash-only payment system.

Bloom’s Competitive Advantage: Bloom’s renovated facilities will compete on every level with

Thrive’s facilities, and have the added bonus of clinical nurse midwives who can deliver for mothers

who are transferred to the hospital for any reason. In addition, Bloom’s services will be offered at a

lower cost, thanks to donations that subsidize costs for anyone unable to pay full price.

Kaiser, Sutter, and Memorial Hospitals

Strengths: In the United States, almost 99% of births occur within hospitals, with physicians

attending 86% of these births (Journal of Midwifery and Women’s Health). Kaiser’s hospital-based

service providers, as well as the independent obstetricians who work at Sutter and Memorial, are

qualified to attend high and low risk births. As a facility provider, Kaiser Santa Rosa offers all the

expected state-of-the-art hospital equipment for low- and high-risk births, as well as birthing suites

with private showers, birthing beds and balls, iPads, and TENS units (KaiserPermanente.org). Sutter

Santa Rosa’s facilities include ten similar birthing suites, as well as the requisite emergency facilities.

They have the added benefit of being brand-new, as they were completed in 2014 (Press Democrat).

Memorial has a fairly similar, although slightly more dated environment.

Weaknesses: Unfortunately, most hospital-based service providers demonstrate a proclivity toward

unnecessary medical interventions, and are known for offering short prenatal appointments with

long wait times (NAMCS). In addition, none of the birthing rooms at any of the hospitals include

birthing tubs or queen-size beds, and all have the propensity to feel clinical to laboring moms and

families. Finally, and most importantly, hospital births are significantly more expensive than birth

center births. The average cost of a vaginal delivery at a birthing center is $1,872, while a cesarean at

a hospital could run as much as $21,495, according to a Wall Street Journal article citing the

American College of Nurse-Midwives.

Bloom’s Competitive Advantage: Bloom’s renovated facilities will match hospital facilities in

terms of cleanliness and visual appeal, and offer greater comfort through use of queen beds,

specialized birthing tubs in each suite, and a much less medicalized appearance. Whether they are

seeking prenatal, birth, or general gynecological services, women will experience more relaxed

appointments, and have the opportunity to develop a trusting relationship their caregivers. Bloom’s

clients can expect reduced instances of medical intervention, cesarean delivery, and other birth

complications (Journal of Midwifery and Women’s Health). Finally, Bloom’s services are naturally

lower in cost due to their decreased reliance on drugs, surgery, and expensive equipment.

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Home Births Attended by Licensed or Clinical Nurse Midwives

Strengths: Home birth rates are on the rise nationwide, albeit modestly (CDC). Anecdotally, many

women report extremely high satisfaction rates with homebirths, in particular because they are not

forced to relocate in the midst of labor, and can feel safe and comfortable in their own familiar

surroundings.

Weaknesses: Homebirths can be attended by licensed or clinical nurse midwives, in the former case

with the same risks highlighted above. Homebirths in general place a higher responsibility on the

birthing family for setup and cleanup of the birth process, which can be inconvenient. Some homes

lack the space or may be too inconveniently located to employ a water tub, which some women find

essential for birthing comfort. Finally, homes that are located more than thirty minutes from a

hospital pose a health risk for mom and baby in the event that complications arise (American

College of Obstetricians and Gynecologists).

Bloom’s Competitive Advantage: Bloom offers most of the benefits of a homebirth, including

reduced medical intervention and a comforting, homelike atmosphere, with the added benefits of

established proximity to a hospital, specialized birthing tubs, and no clean-up responsibility for the

family.

Customers

Demographics

Bloom’s demographic target market includes women ages 18 to 45, whose annual household income

is between $50,000 and $250,000. Most have a high school degree, and many have additional post-

high school education. Nationwide, non-Hispanic white women are most likely to have an out-of-

hospital birth, with one in 90 births occurring in an out-of-hospital setting. The rates are much

lower for non-white women. The demographic target market also includes women with low-risk

pregnancies, and excludes women who have high-risk pregnancies including multiples, previous

cesareans, unfavorable fetal positions at birth, and other medical conditions.

Geographics

Bloom’s geographic target market currently encompasses all of Sonoma County plus some outlying

areas in northern Napa County and Marin County. Customers are much more likely to use Bloom’s

services if they live within 30 minutes of the birth center, as they must return to the center for

prenatal services on a monthly or bi-weekly basis throughout pregnancy. Future expansion is

planned for areas without a birth center that are within 30 minutes’ drive to a hospital in case

complications arise. Potential expansion sites include Sebastopol, Petaluma, Novato, Marin, Napa,

San Francisco, Eureka, and Redding. Expansions will be contingent upon Bloom’s ability to

establish hospital privileges with local hospitals and ob-gyn groups, and the presence of interested

potential clients.

Psychographics

Bloom’s psychographic target market includes women and families who prefer low-intervention

births with natural non-medical pain relief options and a high-touch rather than high-tech pregnancy

and birth experience. Customers likely display a preference for healthy, organic, and sustainable

Bloom Women’s Health and Birth Center Page 8

lifestyles, with an openness to alternative medicine and strong preference for emotional connection

with care providers.

Marketing plan

Marketing Message and Look:

Bloom Women’s health and birth center offers safe, comfortable, and affordable out-of-hospital

birthing experiences and women’s health services. Bloom is ideal for first-time moms who are

apprehensive about hospital births and for experienced moms who want to repeat their experience

at the birth center or have a different experience from their previous birth(s).

Bloom’s marketing features an abundance of images of natural-looking babies and mothers who are

happy, confident, and comfortable in home-like settings. Décor in the facilities is clean and

inviting, with comfortable seating and warm colors. An open health-education kitchen, kid-friendly

play areas and a baby-clothing swap area make the locations feel family-friendly and communal.

Marketing Vehicles:

Customers hear about Bloom primarily through friends and family who have had positive

experiences at the birth center, thanks to refer-a-friend rewards offered to all current and past

clients. Supporting vehicles are primarily web-based, as the target market is heavily internet-oriented.

A quick Google search turns up Bloom as the first listing under birth center, and it maintains an

active social media presence, offering incentives for followers who post about Bloom in mommy

groups and leave positive reviews on Yelp, Facebook, and Google Reviews. Current and past

customers receive a monthly e-newsletter that includes upcoming events, recent birth stories,

answers to pregnancy/parenting FAQ’s, and featured natural birth and baby products.

Offline marketing vehicles include sponsoring the bi-annual local baby fair and running

advertisements in Sonoma County parenting magazines. Direct mail flyers are sent to targeted

mailing lists offering women’s health services, fertility counseling, and tours of our birth center. The

staff attend occasional women’s networking events and participate in public speaking engagements

on women’s health whenever possible.

Sales Tactics:

Potential customers can take a free one-hour tour of the birth center that focuses on our three core

services: comprehensive pregnancy and postpartum care, birth facilities and services, and women’s

health services. The tour includes wholesome snacks as well as a walk-thru of the facilities and our

retail spot for natural mother and baby products. Tour guests hear inspiring client stories at each of

the tour stops, myths and facts about birth and birth centers, and ways to get involved at Bloom.

Tour guests sign in at the beginning of the tour, and a staff person personally follows up with each

attendee within three business days to answer questions and schedule appointments or classes.

Marketing Partnerships:

Bloom partners with local alternative health care providers like doulas, acupuncturists, massage

therapists, chiropractors, and counselors to provide education to expectant and new mothers about

their options for birthing and raising healthy kids the natural way. Each of these providers invites

their network of past, present, and potential clients to attend these sessions, and in return they have

a chance to meet potential clients through Bloom’s existing client base as well as their fellow

practitioners’ clients.

Bloom Women’s Health and Birth Center Page 9

Leadership

Organization Structure:

Bloom Women’s Health and Birth Centers is led by a 12 person board of directors, with Executive

Director Rebecca Kendall at the helm. Rebecca oversees the Clinical Director, Marketing/Sales

Director, Finance Director, and HR Director.

Key Management Personnel:

Rebecca Kendall, MBA, is the Executive Director of Bloom Women’s Health and Birth Centers.

She brings ten years of non-profit experience to this job, both with the San Diego Rescue Mission

and Catholic Charities of the Diocese of Santa Rosa. She has extensive experience with non-profit

marketing and fundraising, having doubled Catholic Charities annual contributions revenue in just

three years. A past birth center client herself, Kendall realized the growth potential of the birth

center model and sought to make safe, comfortable birth experiences available to more women in

Northern California.

Elizabeth Smith-Tyko, CNM, MSN, is Bloom’s Clinical Director. She has practiced full-scope

midwifery in Santa Rosa and Marin County for 17 years, delivering over 1,400 babies during that

time. Most recently, Elizabeth focused her clinical attention to caring for women with infertility,

working in the only comprehensive fertility practice in Sonoma County. Through all of her care,

Elizabeth is dedicated to empowering women through compassion and education.

Deborah Walton is the Marketing and Sales Director at Bloom. She brings over 30 years of

marketing experience to the table, having owned and operated the largest marketing agency in

Sonoma County. A veteran of non-profits, Deborah most recently worked as Communications

Manager at Catholic Charities, while simultaneously running her own farm, Canvas Ranch.

Board of Directors:

Bloom’s board of directors is comprised of noteworthy local philanthropists, as well as veteran

fundraisers and nonprofit experts. Several positions are reserved for individuals with medical

backgrounds, as well as government and policy-making experience. The position of treasurer must

be filled by an individual with strong non-profit finance experience. Other key strategic skills

necessary on the board include technology, business development, legal/regulatory, and human

resources. Board members are all involved with and committed to giving personally, as well as

soliciting their networks for donations and support, in accordance with best practices for board

members (Simone Joyeaux, non-profit board expert).

Supporting Professional Partners:

All of Bloom’s CNM’s have hospital privileges at local hospitals, with the support of a backup M.D.

The clinical director, Elizabeth, works extensively to cultivate good working relationships with local

hospitals. In addition, Bloom partners with local midwifery schools to provide hands-on training for

emerging nurse midwives who frequently join our ranks upon graduation. Many of the

administrative functions are performed by outside agencies, including audits, accreditation, legal

advice, and IT consulting.

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Operations

Facilities and improvements

Bloom’s current location is in an industrial complex located off Summerfield Rd. The front building

contains two complete patient exam rooms, two offices, a reception area, and file storage. The back

building contains an education area, two birthing rooms, a bathroom with a tub, a waiting/reception

area, and a small kitchenette. Ample patient parking is available, as well as a modest outdoor area.

The current facility is a significant limiting factor in providing the number and quality of services

necessary to succeed as an organization, and also limits the visibility and public awareness of the

center.

A much larger facility, still located within 15 minutes of a hospital, would better suit the center’s

needs and allow for expansion and appeal to a more affluent clientele. The ideal location would be

a former nursing home that could be easily and inexpensively converted into a birthing center. New

facility requirements include a minimum of four birthing suites, four patient exam rooms, a

waiting/reception area, an education room, three offices, and a laboratory. Birthing suites will be

equipped with private bathrooms and water tubs, queen/king-sized beds, hardwood floors, birthing

balls and stools, and basic medical equipment such as oxygen and fetal heart rate monitors. A major

factor in attracting clients away from local hospitals is ensuring that the facilities feel as clean, safe,

and welcoming as those within the hospitals. Ample and accessible patient parking is a must, as well

as beautifully landscaped outdoor areas.

Additional locations will be appointed in a similar fashion, and can be scaled up or down depending

on the projected number of clientele in that location. Additional location targets include Novato,

Healdsburg, Sebastopol, and Sonoma Valley, as well as regions outside Sonoma County.

Accreditation and Licensure

Bloom is the only accredited birth center in the North Bay, an important distinguishing factor that

elevates our services above our competitors’. “Accreditation is a voluntary program that places the

level of quality desired above that which an individual state requires. (AABC, 2013)” To maintain

accreditation, Bloom must submit to a bi-annual review by the American Association of Birth

Centers in which it documents adherence to best practices established in the Standards for Birth

Centers. In addition to maintaining our voluntary accreditation status, Bloom is required to

maintain licensure as a birth center in the State of California.

Insurance, Legal, and Regulatory

One of Bloom’s most significant expenses is malpractice insurance. Opening additional branches

and locations helps to achieve economies of scale with malpractice insurance, which is one of the

reasons to pursue expansion on a more rapid scale. Being diligent about accepting only low-risk

patients helps to lower Bloom’s risk of lawsuits for unfortunate birth outcomes. Bloom also has an

attorney on retainer in the event that a lawsuit does occur.

Important regulatory issues include patient privacy and HIPPA compliance, patient rights and

responsibilities, timely health screenings and patient compliance, domestic violence and child abuse

screening and mandated reporting status, and toxic waste disposal processes.

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Technology plan

Software Needs

Bloom will need up-to-date software for every aspect of the company’s operations, including

electronic health records (EHRs), appointment scheduling, accounting and billing, human resource

management, donor database, and office operations. Cloud-based software solution developer

Artemis provides a complement of products geared toward birth centers that “improve the quality

of care, eliminate inefficiencies and increase revenues and profitability. (Artemis, 2014)” This

technology, which includes EHRs, mobile patient engagement, and meaningful use options can be

combined with other software providers to meet most of the birth center’s software needs.

Upgrading to the new software system will be a costly but rewarding move that will minimize billing

errors and maximize staff efficiency.

A critical component of Bloom’s technology plan is its efforts to improve meaningful use. All

healthcare providers that receive any kind of government reimbursement are required to use

certified electronic health record (EHR) technology to “improve quality, safety, efficiency, and

reduce health disparities; engage patients and families in their health care; improve care coordination;

improve population and public health; all the while maintaining privacy and security” (Centers for

Medicare and Medicaid Services).

One of the most important components of this mandate is the creation of the patient portal, which

can be accomplished using Artemis’ mobile patient engagement system. Accessible from virtually

any mobile device, Bloom’s patient portal will allow patients to schedule appointments, track their

health progress, find answers to frequently asked questions, and communicate directly via email or

chat with a midwife.

Hardware and Telecommunications needs

Compared to a hospital, Bloom has significantly reduced hardware needs. Still, the flagship clinic

and each additional location must maintain a minimum amount of necessary technology to ensure

maternal and infant health. Hardware technology needs include an ultrasound at each clinic,

Dopplers and fetal heart rate monitors, neonatal pulse oximeters, microscopes, autoclaves, blood

and urine testing equipment, scales, oxygen tanks and tubes, equipment for administering

intravenous fluids and medications, and hospital grade breast pumps and equipment.

With at least three on-call staff at all times, mobile phones are an essential component of Bloom’s

telecommunications needs. An office-wide telephone system and internet access will also be

essential. Other basic hardware needs include desktop and laptop computers, servers, printers,

payment processing equipment, and other basic office equipment. The education center requires

overhead projection equipment and other audiovisual equipment.

Personnel Needs

A critical component of our technology plan is ensuring that our midwives, nurses, and staff are

fully trained in utilizing our electronic health records and practice management system. Customized

training programs are offered through software providers, and are a prerequisite for maintaining

employment at Bloom. Additional specialized staff include an IT consultant and a database manager,

who tracks stakeholder activity and generates action plans for our sales staff and nurses.

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Critical Success Factors, Challenges, and Risks

Bloom’s business model has several critical success factors, challenges, and risks. Two significant

challenges include our ability to establish positive working relationships with local hospitals, as well

as our ability to achieve preferred provider status with insurance companies. In an interview with

Elizabeth Smith, owner of the Santa Rosa Birth Center, it was revealed that one of the primary

challenges facing birth center expansion throughout the U.S. is the birth center’s ability to form

strong partnerships with local hospitals (E.Smith).

According to a recent CNN article on U.S. birth costs, hospital refusal to provide backup to birth

centers and their staff is a pervasive problem, along with restrictive state licensing laws and denial of

insurance coverage (Declercq, 2013), which is largely based on the economic incentive hospitals

have to encourage higher-cost births. “Consider who loses money if birthing centers become

popular: Large hospitals, pharmaceutical companies, obstetricians and anesthesiologists -- all

powerful groups who believe deeply that the use of their products and services is not only a source

of income, but the safest option for mothers and babies (Declercq, 2013).”

Bloom’s strategy for mitigating this challenge is to create mutually beneficial partnerships with select

hospitals, in which the hospital provides backup to Bloom’s midwives in exchange for Bloom’s

commitment to refer any hospital transfers to that hospital, whether they arise in the course of the

prenatal appointments or during labor.

Negotiating with insurance companies is an additional challenge that could impact Bloom’s success.

Historically, many states did not allow government reimbursement for birth center births.

Fortunately, the new Patient Protection and Affordable Care Act (PPACA) mandates insurance

coverage for birth centers across the U.S., although reports from the American Association of Birth

Centers indicate that many states have not yet implemented appropriate birth center facility

reimbursement (Journal of Midwifery and Women’s Health).

Even as states get on board with PPACA, a remaining challenge is the fact that reimbursement rates

for birth centers and midwives have historically been lower than the rates for hospitals, even for

identical procedures. “The Medicare facility reimbursement for care of mother and newborn for an

uncomplicated vaginal birth in a hospital in 2011 was $3998, compared with $1907 in a birth center

(Journal of Midwifery and Women’s Health).” This trend is similar to trends among private

insurance companies, according to an interview with Elizabeth Smith. Additionally, private

insurance companies often delay and complicate reimbursements for patients who qualify for

coverage.

Bloom’s strategy for mitigating this challenge is to use our increased service area and client base to

negotiate with specific providers to achieve preferred reimbursement rates and processes in

exchange for overall cost savings due to lower interventions.

Other present or potential hurdles include our ability to successfully re-brand our birthing centers to

appeal to a higher-income customer base, the potential of a catastrophic and well-publicized

complication or data breach at one of our centers, employee attrition to a higher-paying employer,

and the potential loss of brand identity and group cohesion as we expand from one clinic to four.

These potential issues will be mitigated in part by creating and following rigorous hiring and training

practices and by continually testing for and reinforcing a healthy and cohesive agency culture.

Bloom Women’s Health and Birth Center Page 13

Milestones

Year 1

In its first year, Bloom will deliver 171 babies, 40 more than were delivered at the Santa Rosa

Women’s Health and Birth Center in 2014 (E. Smith, 2014). 131 of those women will deliver at the

center, and 40 will deliver at a local hospital attended by one of Bloom’s certified nurse midwives.

Over 300 pregnant moms and their birth companions will attend Bloom’s new standalone prenatal

education classes, whether they plan to utilize Bloom’s other services or not. Women’s

gynecological services will generate significant revenue for the birth center as well, with almost 200

women utilizing this service. In its first year, Bloom will generate about $1.2M in revenue, a 30%

increase over Santa Rosa Women’s Health and Birth Center’s 2014 total revenue (E.Smith, 2014),

with a net $200,000 loss for the year after COGS and SG&A.

Year 2

In year two Bloom’s midwives will deliver 291 babies, 224 of them at the birth center. Classes will

continue to attract current and potential patients, as well as families who plan to birth in local

hospitals. Women will continue to take advantage of Bloom’s friendly and comfortable

gynecological services. Behind the scenes, Bloom’s leadership will be preparing to expand to a

second location in year three, with a majority of the focus on selecting an ideal location in close

proximity to a friendly hospital, screening additional clinical nurse midwives and registered nurses,

and preparing to expand the leadership team. Revenue will increase to over $2M, and will exceed

expenses by about $170,000, leading to our first breakeven year.

Year 3

Bloom will see a significant spike in babies delivered in year three, thanks to the grand opening of a

new clinic. 455 women will choose to have one of Bloom’s midwives deliver their babies, 345 of

whom will be born at one of the birth centers. Bloom’s advocacy and marketing efforts will be

boosted by the hiring of additional marketing staff, which will lay the groundwork for significant

expansion in year four and five. Revenue in year three will increase dramatically to over $3.1M,

thanks to the increased visibility; however, annual surplus will be a modest $18,000 as we ramp up

our client base at the second location.

Year 4

Over 614 babies will be delivered by the experienced hands of Bloom’s midwives in year four.

Thanks to increased public awareness and education about the benefits of birth centers, as well as

effective preventative care and patient education, 460 of these moms will choose to deliver at one of

our birth centers. Bloom’s leadership will be focusing again on expansion this year, preparing to

open two additional locations in year five. Revenue will jump to about $3.8M in year four, again

thanks to the increased capacity afforded by our second clinic, with annual surplus increasing to

$53,000.

Year 5

Two additional locations will open in year five, increasing Bloom’s visibility and capacity such that

about 864 women will utilize Bloom’s midwifery services, 631 of whom will birth in one of our

centers. Over 1,000 women will access our gynecology services and educational services. Revenue

in year five will exceed $6M with annual surplus at about $90,000.

Bloom Women’s Health and Birth Center Page 14

Financials

Revenue

The primary revenue driver for Bloom will be birth and postpartum care, closely followed by

prenatal care and education, as well as donations and grants. Revenue growth will remain consistent

with existing trends from Santa Rosa Women’s Health and Birth Center for the first six months as

marketing generates new leads. Beginning in month seven, revenue will grow approximately 5% per

month, with little to no seasonality, leading to average revenue growth of 60% each year thereafter.

Total revenue in year five will exceed $5M.

Expenses

Bloom’s COGS remains fairly low, thanks to a “high touch” rather than “high tech” business model.

The highest costs are contracted R.N. and doula services for birthing mothers, as well as

medications and medical supplies for prenatal, birth, postnatal, and well-woman care.

SG&A comprises the bulk of Bloom’s expenses, with salaries, rent, and insurance rounding out the

top three costs of running the business. Malpractice insurance will become a proportionately lower

cost of business as the number of clinics expands.

EBITDA

Due to an aggressive growth schedule and significant capital and staffing expenditures to enable

expansion, Bloom will generate modest surpluses in year 2-5, with significant surpluses in year six

and seven. Each of Bloom’s birth centers will be profitable once it attracts approximately 300

birthing clients and 300 well-woman clients per year, roughly double what the current SRWHBC

practice serves. Once all four Bloom centers are fully operational and serving the maximum

capacity of clients, profits should level off at over $300,000 per year, which will be reinvested into

the endowment or funneled toward increasing expansion, public advocacy efforts, and reducing

client fees.

Bloom Women’s Health and Birth Center Page 15

Proposal

Total Desired Financing

Transforming the existing Santa Rosa Women’s Health and Birth Center into Bloom Women’s

Health and Birth Centers will require an initial investment of $750,000.

Success to Date

Of the $750,000 needed to launch this project, $100,000 has already been committed by board

member Natalie Cilurzo of the Russian River Brewing Company, a passionate advocate for women’s

health in Sonoma County, and another $100,000 by the combined efforts of the remaining board

members. An additional $50,000 loan has been secured by co-founders Rebecca Kendall and

Elizabeth Smith. Together, these visionary leaders have raised $250,000 to fund better births in the

North Bay. Donations and loans already committed will be used to form the base of an operating

reserve to support Bloom through the ups and downs of fundraising and expansion.

Additional Funding Needed

Bloom is seeking additional philanthropic investments totaling $500,000 to match existing

donations. Philanthropists interested in women’s health and better healthcare outcomes in the

United States will find this social investment richly rewarding. Our desire is to engage three to five

business-oriented philanthropists in supporting not only our expansion but our ongoing success as

well, through an initial financial contribution as well as ongoing participation in an advisory capacity.

Donations of $100,000 and above will receive naming rights to one of the four birthing suites

planned for our new location, and gifts of $300,000 or more will secure naming rights to an entire

wing of the new facility.

Use of Funds

Approximately $250,000 of the $500,000 investment will provide necessary capital for relocation of

existing services and renovation of the new location. Renovations will include top-quality surfaces,

furnishings and natural birthing equipment, as well as updated office technology for leadership and

support staff.

The remainder of the $500,000 investment will fund the first 18 months of operations as the newly

opened Bloom birth center attracts a client and donor base that will soon enable the center to

maintain sustainable self-sufficiency. The bulk of the operating cash will be spent on staffing costs

and rent at the new location.

Social Impact

The impact of this investment will be a better birth for 200 more moms and babies in Sonoma

County per year for each clinic that we open. For every 300 clients we serve we’ll eliminate about 40

unnecessary cesareans, and save the community at least $2M in birthing costs alone (American

Association of Birth Centers). We will reduce rates of maternal infection, tearing, and other

complications (Journal of Perinatal Education). Most importantly, we will break the fear-

complications-cost cycle that is plaguing the U.S. birth industry and set our community and our

country on a happier, healthier path.