MHA 599 Week 2 Intrapreneurship and Innovation Design Example

Building a Venture Inside the System: Designing a Pharmacist-Led Home Blood Pressure Program as an Intrapreneurial Innovation

[Student Name]

University of Phoenix

MHA/599: Capstone: Leading the Organization Through Change

Week 2 Assignment

[Instructor Name]

[Date]

The health system, its program design, volumes and revenue estimates are composites written for a model paper; payment rules and research findings come from the sources cited.

When the director of population health at the composite Billings, Montana, health system presented her idea for a home blood pressure program to the chief financial officer, he listened and then asked one question: who pays for this? The question was fair. This paper develops the program as an intrapreneurial venture, with a design, a business model and a plan to test its riskiest assumptions.

Intrapreneurship

Intrapreneurship means building a new venture inside an existing organization. The intrapreneur, like an entrepreneur, must define value, find customers, test assumptions and secure resources, but can draw on the organization's patients, staff, systems and reputation. The approach suits a program that is new to the system but builds on what it already does.

The Core Design From Evidence

The design follows the evidence on what works. In a clinic-randomized trial, patients with uncontrolled hypertension in intervention clinics measured their blood pressure at home with devices that sent the numbers straight to pharmacists, who then tuned prescriptions between appointments; roughly twice as many reached and held control over a year as in comparison clinics, and the benefit persisted after the program ended (Margolis et al., 2013). The trial's lesson for the design is that someone must act on every reading that matters.

The Program in Practice

Patients with uncontrolled hypertension at participating clinics receive a cellular blood pressure cuff that needs no smartphone or internet. Readings go to a central platform. Clinical pharmacists, working under collaborative practice protocols agreed with each clinic's physicians, review readings weekly, call patients and adjust medicines. Clinicians see a summary in the electronic record and are alerted only when a patient needs a visit.

Value for Patients

Patients avoid long drives for blood pressure checks, get medicines adjusted in weeks rather than months and have a pharmacist they can call.

Value for Clinicians

Clinicians gain a partner who manages medication adjustments between visits under protocols they approve, without more readings landing in their inboxes.

Value for the Organization

The system gains better control rates, fewer strokes and heart attacks over time, better performance in its shared savings arrangement and new revenue from monitoring services.

The Business Model Canvas

The venture's canvas summarizes the model. Value proposition: blood pressure control at home, managed by pharmacists. Customers: patients with uncontrolled hypertension, their clinicians and payers. Channels: clinic enrollment at visits and outreach to patients identified from the record. Relationships: a named pharmacist for each patient. Key activities: enrollment, device setup, weekly review and medication management. Key resources: pharmacists, devices, the monitoring platform and protocols. Partners: the device vendor, tribal health programs and payers. Revenue: Medicare and commercial remote monitoring payments and shared savings. Costs: pharmacist time, devices, platform fees and training.

What the Pharmacists Need

The system's clinical pharmacists were enthusiastic but raised practical needs: collaborative practice agreements approved by the medical staff, access to the full record, a way to reach patients by phone during evenings and a clear escalation path when readings are dangerously high. Each became part of the design before the pilot began.

Protocols Physicians Can Trust

The chief medical officer convened primary care physicians to write the medication protocols with pharmacists. The protocols specify starting doses, steps for adjustment, laboratory monitoring and when to refer back to the clinician. Physicians who helped write them were more willing to let pharmacists act on them.

Payment Rules

Payment shapes feasibility. Medicare pays for remote physiologic monitoring through codes for device supply and for treatment management time. For 2026, Medicare's physician fee schedule adopted new codes to describe monitoring with fewer than 16 days of data transmission in a 30-day period and treatment management of less than 20 minutes a month, alongside the existing codes (Centers for Medicare & Medicaid Services, 2025). These codes allow billing for patients who transmit readings less often, which matters for rural patients with intermittent coverage.

Revenue Assumptions

The finance team estimated monthly revenue per enrolled Medicare patient from device supply and management codes, recognizing that billing requires documented days of data and management time. Commercial payers vary; Medicaid coverage in Montana was being confirmed. Shared savings would come later and are uncertain.

Costs

Pharmacist time is the largest cost. At a caseload of about 200 active patients per full-time pharmacist, the four-clinic pilot with 800 patients requires four pharmacists, plus devices, platform fees, a program coordinator and training.

Competing Models Considered

The team considered two other designs: nurse-led monitoring, which would draw on the clinics' scarce nurses, and a vendor-run monitoring service, which would outsource management to a company outside the region. The pharmacist model was chosen because it matched the trial evidence, used staff who could adjust medicines under protocols and kept relationships local.

The Riskiest Assumptions

The founder's discipline is to name what could be wrong. Will rural patients use the devices regularly? Will cellular coverage suffice? Will clinicians accept pharmacist adjustments? Will revenue cover pharmacist costs? Each assumption will be tested in the pilot.

A Small First Version

Rather than launching in all 14 clinics, the program begins with a small first version: 100 patients at one clinic for three months, testing device use, transmission, pharmacist workflows and billing, before expanding to four clinics.

Designing for Adoption

Greenhalgh and colleagues' review of the spread of new ways of working in health care organizations concluded that people adopt changes more readily when the change is plainly better than current practice, fits their values and routines, is easy to understand, can be piloted before full commitment and shows visible results (Greenhalgh et al., 2004). The program builds each of these in: clinicians see better control, the protocols fit their practice, patients need no smartphone, one clinic tries it first and results are reported to every clinic monthly.

Partnering With Tribal Health Programs

For patients on the reservations, the program will be designed with tribal health programs, with community health representatives helping patients set up devices and a pharmacist who visits the clinic monthly to build relationships.

Measuring the Pilot

The first version will track the share of enrolled patients transmitting readings at least 16 days a month, the share reaching control at three months, pharmacist time per patient, clinician satisfaction and billed revenue against costs. These measures test each risky assumption directly and will decide whether the program expands.

Answering the Chief Financial Officer

Who pays? Medicare and some commercial payers pay for monitoring services, the system benefits from shared savings as control improves and the pilot will test whether revenue covers pharmacist costs before the system commits to scale.

Conclusion

Designing the home blood pressure program as an intrapreneurial venture forced the questions that ideas alone avoid. Trial evidence shaped the core design, a business model canvas defined value and revenue, 2026 payment rules informed billing and a small first version will test the riskiest assumptions. Features that help innovations spread are built in from the start.

References

Centers for Medicare & Medicaid Services. (2025). Medicare and Medicaid programs; CY 2026 payment policies under the physician fee schedule and other changes to Part B payment and coverage policies. Federal Register, 90, 49266. https://www.federalregister.gov/d/2025-19787

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., O'Connor, P. J., Pritchard, R. A., Sekenski, J. L., Sperl-Hillen, J. M., & Trower, N. K. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56. https://doi.org/10.1001/jama.2013.6549