Eleven Thousand Eligible, Thirteen Hundred Screened: Mapping the Service Area, Competitors and Outmigration for a Community Hospital's Lung Cancer Screening Program
Student Name
American College of Education
HLTH5673: Marketing for Healthcare Professionals
Module 1 Assignment
Instructor Name
July 3, 2028
The Service and Why It Needs Marketing
The composite 180-bed community hospital in this course opened a low-dose CT lung cancer screening program three years ago. National guidance now calls for a yearly scan for anyone between 50 and 80 with a smoking history of at least 20 pack-years who still smokes or stopped less than fifteen years ago (US Preventive Services Task Force et al., 2021). The evidence for screening is strong: the National Lung Screening Trial found a 20 percent relative reduction in lung cancer mortality with low-dose CT compared with chest radiography (National Lung Screening Trial Research Team, 2011). Yet the program performed only 610 screenings last year, and hospital leaders want to know whether that reflects low demand, competition or something else.
Uptake is low nationally. Using a national screening registry, Fedewa et al. (2021) estimated that only 5.0 percent of eligible adults were screened in 2018, with wide variation among states, from under 4 percent in several high-burden southern states to more than 12 percent in parts of the Northeast. A service with a strong recommendation and a low uptake is not a service without demand; it is a service whose demand has not been reached.
Defining the Service Area
The service area is defined from patient origin data rather than from county lines. Using the hospital's outpatient imaging records for the past three years, the analysis ranked residential ZIP codes by volume and identified the primary service area as the 14 ZIP codes that account for 75 percent of the hospital's outpatient imaging patients, and the secondary service area as the next 9 ZIP codes, which account for a further 15 percent. The primary service area covers most of two counties, including the county seat where the hospital is located, several small towns and a rural area to the east with limited public transportation.
The primary service area has about 94,000 adults aged 50 to 80. Applying an estimated 12 percent eligibility rate under the current criteria, drawn from state survey data on smoking history for adults in that age range and adjusted for the area's higher-than-average smoking prevalence, gives about 11,300 residents who meet the screening criteria. This estimate is approximate, because pack-year history is not directly measured in population surveys, but it is the best available starting point for sizing the market.
The market is also growing. The 2021 recommendation lowered the starting age from 55 to 50 and the smoking threshold from 30 to 20 pack-years, which widened eligibility, and the task force noted that the broader criteria would include more women and more Black adults, groups who tend to smoke fewer cigarettes per day and were more often excluded under the older criteria (US Preventive Services Task Force et al., 2021). Many residents who became eligible in 2021 may not know it, and some primary care clinicians still apply the older thresholds from habit. The service area's payer mix matters too: about 55 percent of eligible residents are 65 or older and covered by Medicare, which covers annual screening with no cost sharing when criteria and the shared decision-making requirement are met; most of the rest have commercial insurance or Medicaid, which generally cover a recommended preventive service without cost sharing. Cost is therefore a smaller barrier than knowledge, access and trust.
Who Screens the Residents Today
Claims data purchased from the state's all-payer database, combined with the hospital's own records, identified 1,340 low-dose CT screenings performed on residents of the primary service area last year. The hospital performed 610, or 46 percent. An academic medical center 38 miles away performed 420, or 31 percent. A regional chain of freestanding imaging centers, with one location in the county seat, performed 250, or 19 percent. Other providers, mainly in a neighboring metropolitan area, performed 60, or 4 percent.
The screening rate among eligible residents is therefore about 11.9 percent, more than double the national rate Fedewa et al. (2021) reported for 2018, but still far below what the recommendation intends. About 9,960 eligible residents, 88 percent, were not screened by anyone. That number dwarfs the volume held by any competitor. If the hospital captured every screening now performed by the academic center, it would add 420; if it raised the screening rate among eligible residents by five percentage points, it would add about 565 even without taking a single patient from anyone else.
Comparing the Competitors
The three providers differ on the attributes that influence where patients go. The academic medical center has the strongest reputation, a dedicated nurse navigator who contacts every patient with a positive finding and on-site thoracic surgery, pulmonology and oncology, so patients with suspicious nodules move through workup in one place. Its disadvantages are distance, parking and scheduling waits of about three weeks. The imaging chain competes on convenience: evening and Saturday hours, online scheduling and a single visit. It has no navigator and refers positive findings back to the patient's primary care clinician.
The hospital is closest for most residents and is where most of their primary care physicians have privileges. However, it requires a separate shared decision-making visit with the primary care clinician before scheduling, which Medicare requires for coverage but which some competitors handle within their own programs, and it has no navigator. Its follow-up for positive findings depends on the ordering physician. In short, the academic center sells confidence, the imaging chain sells convenience and the hospital has not yet decided what it sells.
Why Residents Travel
The 480 residents screened outside the county, at the academic center or in the neighboring metropolitan area, are the population already going elsewhere. A review of referral patterns found that 70 percent of them were referred by physicians in two primary care practices affiliated with the academic center's network. The remainder appear to be self-referred or referred by specialists, particularly pulmonologists who practice at the academic center. Interviews with six primary care physicians in the service area suggested two reasons for referring out: confidence in the academic center's follow-up of positive findings and frustration with the hospital's requirement for a separate visit before scheduling.
Some outmigration is appropriate. Patients who already receive specialty care at the academic center reasonably screen there. But for the majority, the reasons are features of the hospital's program that could be changed: the lack of navigation after a positive result and the extra step before scheduling.
Conclusion: Which Market to Pursue
The analysis points to a clear priority. The largest opportunity is the roughly 9,960 eligible residents who are not screened by anyone, not the 730 screened by competitors. Winning back some of the 480 residents who travel is worthwhile, and the two program changes that would do so, a navigator and simpler scheduling, would also help reach the unscreened. The next module should segment the unscreened eligible population by need, insurance coverage and how they reach care, since a strategy aimed at the whole group will fit none of it well.
References
Fedewa, S. A., Kazerooni, E. A., Studts, J. L., Smith, R. A., Bandi, P., Sauer, A. G., Cotter, M., Sineshaw, H. M., Jemal, A., & Silvestri, G. A. (2021). State variation in low-dose computed tomography scanning for lung cancer screening in the United States. Journal of the National Cancer Institute, 113(8), 1044-1052. https://doi.org/10.1093/jnci/djaa170
National Lung Screening Trial Research Team. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine, 365(5), 395-409. https://doi.org/10.1056/NEJMoa1102873
US Preventive Services Task Force, Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Kubik, M., Landefeld, C. S., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(10), 962-970. https://doi.org/10.1001/jama.2021.1117
How this HLTH 5673 Module 1 example is structured
HLTH 5673 Module 1 often maps the service area, its competitors and the population already going elsewhere; your classroom's instructions decide the service and the data sources. This example defines the service area from patient origin data, estimates the eligible population from national criteria, then accounts for every screening performed on residents by provider. The competitor section compares providers on the attributes that drive choice, and a section on outmigration asks why residents travel. The conclusion identifies the market the hospital should pursue first.
HLTH5673 Module 1 questions, answered
What does HLTH5673 Module 1 usually ask for?
HLTH5673 Module 1 often asks students to analyze the market for a health care service: the service area, the population, competitors and patients who go elsewhere for care. Your classroom's instructions decide the service, the organization and whether real or supplied data are used.
How do I define a hospital's service area?
Use patient origin data. Rank ZIP codes by patient volume and define the primary service area as those producing about 75 percent of patients and the secondary area as the next 15 percent or so. This reflects where patients actually come from rather than political boundaries.
Should I count people who use no provider as part of the market?
Yes. For preventive services with low uptake, the largest opportunity is often people who are eligible but not using the service anywhere. Quantifying them alongside competitors' volumes shows whether growth should come from winning share or expanding the market.
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