BA 7012: MBA Capstone

Leah Nguyen

4/7/2015

Nguyen, LeahMBA Capstone

Table of Contents

Executive Summary & Recommendation …………………………………………… 2Financial Analysis ……………………………………………………………………... 3 Industry Analysis ……………………………………………………………………… 7Competitive Analysis …………………………………………………………………. 12Future Prospects ……………………………………………………………………… 14Appendix ……………………………………………………………………………… 17 References …………………………………………………………………………….. 21

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Executive Summary & Recommendation

CVS Health Corporation is an international company that works in the

Pharmacy Benefit Management and retail pharmacy industry. They are one of the leaders

in Pharmacy Services, filling over 750 million prescriptions annually. For a full

description, see Exhibit 1.

Financially, CVS Health is a competent organization that exhibits strong

growth and a record net revenue of $139.4 billion. They are well-diversified with

multiple lines of business. However, they risk placing too much reliance on certain lines,

such as high-priced specialty drugs, for revenue. Opportunities for CVS Health’s

financial growth lie in expansion in size, services, and the aging population.

The industry overall is in a positive, yet pivotal point. Healthcare reform has

brought many changes to the industry. These changes have affected many players and

aspects of healthcare delivery, such as the move towards value-based care. As companies

grow through mergers and acquisitions, negotiating power with drug companies grows

due to the large economies of scale. Further reform and federal regulations threaten the

success of these companies. They must be prepared to accommodate these changes in

order to continue serving their markets.

As mentioned above, CVS Health is a leader in its industry. Competition is

extremely fierce for share of the growing market and it has taken steps to ensure its

sustained presence and growth through population health initiatives such as its tobacco

cessation program and its proprietary technology system for drug quality and safety.

These indicate CVS Health’s commitment to the public’s well-being where many others

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cannot say quite so solidly. However, they are threatened by firms who can offer greater

discounts due to economies of scale and convenience.

CVS Health is poised to continue this success in the future. They are planning

to introduce new programs and grow their services to improve public health and

accommodate the changing healthcare system and consumer. Collaboration with major

medical centers support a tighter coordination of care. Finally, they are exploring new

advances and innovations in healthcare delivery to improve care and efficiency.

Based on the following analyses, it is recommended that investment should be

made in CVS Health. They are a market leader, conscious of the changing industry

landscape, and focused on improving the well-being of their consumers and the

population. Their past and current position indicate a positive future for continued growth

and success.

Financial Analysis

CVS Health has done very well in the last few years. Executives also project this

success to continue. With the changes from the Patient Protection and Affordable Care

Act (ACA), new innovations and new drugs, and the aging population, CVS Health is

positioned to remain a major player in the Pharmacy Services sector.

Two of CVS Health’s main competitors, UnitedHealth Group Inc. and Express

Scripts Holding Corporation, are involved with Pharmacy Benefits Management (PBM).

Both of these companies also have other lines of business, like CVS Health.

UnitedHealth is heavily involved with the management of health plans and Express

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Scripts works with drug and equipment distribution, consulting, and case management. A

brief comparison of the three companies can be seen in Exhibit 2.

CVS Health has many financial strengths. They are a well-diversified company

with four different business lines: CVS/minute clinic, CVS/pharmacy, CVS/caremark,

and CVS/specialty. Each of these provides a separate function while working cohesively

to achieve improved patient and consumer well-being. For example, certain specialty

drugs are no longer being processed through the pharmacy store but instead through their

mail order capacity. While this lowered basis points for the pharmacy, it increased overall

revenues compared to prescription volumes due to the high price of specialty drugs

(“CVS Health Reports Strong Profits,” 2015). These high-priced specialty drugs are

growing in demand. In the last quarter, revenues for these drugs increased nearly 22

percent to $23.9 billion (Associated Press, 2015). CVS Health also benefitted from the

increase in patient access due to the ACA, as more patients were being treated and filling

prescriptions. UnitedHealth and Express Scripts also saw this increase, and this increase

in value was translated into stock price. Exhibits 3a and 3b show the difference in rate of

stock price increase before and after the ACA of CVS Health, Express Scripts, and

UnitedHealth. As illustrated, the rate nearly doubles after implementation of the ACA.

In the last quarter, earnings rose 4 percent despite the “anticipated blow” from the

termination of sales from tobacco products (Associated Press, 2015). For the total year of

2014, net revenues increased 9.9 percent to a record $139.4 billion [Exhibit 4] and CVS

Health generated free cash flow of $6.5 billion and cash flow from operations of $8.1

billion (“CVS Health Reports Strong Profits,” 2015). This cash flow “exceeded” CVS

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Executive expectations and supports their goal of solid, sustainable growth (“CVS Health

Reports Strong Profits,” 2015).

Despite this success, CVS Health does have weaknesses. Eliminating tobacco

products resulted in expected loss, but it also brought with it less traffic to their front

store sales. Customers who may have shopped for other goods while they purchased their

tobacco products are coming in less frequently for those goods, and instead purchasing

them elsewhere (i.e. with their groceries, at gas stations, etc.). With the loss that

accompanied tobacco sales comes a greater pressure on other departments, such as the

pharmacy. The pharmacy also earns less revenue from generics unless it can be made up

in volume. Therefore, CVS Health must rely more on the higher-priced specialty drugs to

help make up this deficit.

CVS Health, along with one of its competitors, Rite-Aid, is not accepting Apple

Pay. This is a weakness as it obviously excludes those consumers who are making the

switch to digital forms of payment. CVS Health is a member of MCX, Merchant

Customer Exchange, and part of this contract requires companies to work exclusively

with MCX (Tweedie & Kovach, 2014). MCX is developing its own system of digital

payment called CurrenC but it is far from being released. Breaking the contract, to offer

Apple Pay for example, results in steep fines (Tweedie & Kovach, 2014). As more

services become automated through mobile apps and online platforms that can be

accessed from the consumer’s smartphone, the appeal of paying for these services with

their smartphones increase. By not being open to new innovations is detrimental to CVS

Health and their competitors’ revenues and reputations.

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There are several opportunities for CVS Health to take advantage. As has

happened throughout the industry, mergers and acquisitions of other PBMs and pharmacy

services companies is common. When UnitedHealth acquired Catamaran Corporation, it

became the third-largest pharmacy benefit manager with a market share of 20 percent

(“What the UnitedHealth-Catamaran Deal Means,” 2015). Before this, CVS Health and

Express Scripts controlled about 50 percent of the PBM market, with Express Scripts

filling over one billion prescriptions annually. The acquisition of Catamaran brings

UnitedHealth’s estimated fulfillment of prescriptions to mirror that of Express Scripts at a

billion. CVS Health has acquired several smaller companies in the past, such as Coram in

2013, a specialty infusion services unit, and Long Drug Stores in 2008 (Townsend,

2013). To maintain its market share, CVS Health should continue exploring these

opportunities to expand their expertise and services to provide lower-cost and more

accessible care.

A final opportunity for CVS Health is to improve their stock price. Despite the

recent financial successes, CVS Health is not as strong as UnitedHealth. They are doing

much better than Express Scripts, but there is always opportunity for improvement

[Exhibit 5]. This could be achieved through increasing the value of the company to

increase demand for shares as well as buy back some of their shares to reduce the supply

of shares available.

Being a player in the healthcare system does not come without risks or threats.

CVS Health, UnitedHealth, and Express Scripts are threatened by litigation. As these

companies grow larger through acquisitions, the competition is effectively consolidated

into a few major players that have the potential for anti-trust law violations. Settlements

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and any sort of litigation are costly. Between 2004 and 2008, players in the PBM market

were accused of “fraud; misrepresentation to plan sponsors, patients and providers; unjust

enrichment through secret kick-back schemes; and failure to meet ethical and safety

standards” (Balto, 2010). Such cases have resulted in over $371.9 million in damages to

states, plans and patients – and half of these were paid by Caremark and its parent

company AdvancePCS (Balto, 2010). Caremark was since acquired by CVS Health. It is

important for these companies to be aware of their actions and ensure their behavior

doesn't compromise the company in any way.

Industry Analysis

The healthcare industry as a whole is at a pivotal point. The United States has the

most expensive healthcare system in the world but falls significantly below in outcomes

in comparison to countries that spend similarly. The government, providers, payers,

pharmaceuticals, ancillary/retail services, and patients are acutely aware of the issues that

are facing the system. Fortunately, they are all making significant strides to improve the

healthcare system and are inherently connected in these decisions.

The pharmacy services segment maintains several strengths. CVS Health, as a

pharmacy benefits manager and a retail pharmacy, like other PBM players, is in direct

coordination with health plans, employers, unions, government employee groups, and

other sponsors of health benefit plans throughout the U.S. (“CVS Caremark,” n.d.). CVS

Health fills over 750 million prescriptions for beneficiaries of these clients and its retail

pharmacy customers. Because of this extensive reach, PBM players have significant

negotiating powers with drug companies. They are able to negotiate lower prices for

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drugs, which is increasingly important as the costs of both specialty and generic drugs are

rising. Drug companies are making increasingly complex and sophisticated drugs that

require more complex administration (i.e. intravenously) and specific maintenance (i.e.

temperature controlled), which results in costs of over $3,000 per month to the patient.

Examples of these expensive drugs include cancer drugs, fertility drugs, and a cure for

Hepatitis C, which recently was released and cost over $1,000 a day, or $84,000-$94,000

for the whole round of treatment (Heitz, 2014). Because of the large scale PBM

companies have, they are able to negotiate these prices down.

Another strength of the industry is the positioning PBM players have. The

healthcare system is evolving, with the growth of patient-centered medical homes

(PCMHs) becoming the prominent model for care delivery. As a part of this, patients are

actively involved, more educated and empowered in their care. Instead of turning to

emergency rooms and hospitals, primary care physicians, pharmacists, and clinics are the

first line of access for minor acute conditions. Patients are shopping around and looking

for the best value. Because of the positioning of PBMs and retail pharmacies like CVS

Health, they are able to provide for this kind of care and the necessary products. Often,

pharmacists are the first and most easily-accessible healthcare professional for patients to

reach.

While the negotiating power is a strength for this industry, the high cost of drugs

continues to plague them, among other weaknesses. This weakness means that PBM

companies are constantly spending money and time dealing with these high costs that are

inevitably set by drug companies. However, PBMs are limited in their negotiations to an

extent. Many drugs are under patent which prevents other companies from developing

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generics. These drugs remain expensive because the pharmaceutical companies only have

a short window to see a return on their multi-billion-dollar investments. However, one

opportunity that comes with patenting drugs is when their patents expire. Over the next

three years, $15 billion in products are expected to come off patents. These drugs will be

able to be produced generically, increasing access and affordability. Another weakness is

the overall lack of cost control throughout the industry. Eighteen percent of the U.S. GDP

is attributed to healthcare spending – and drug spending has increased 13.1 percent

(“What the UnitedHealth-Catamaran Deal Means for CVS Health and the General

Public,” 2015).

As mentioned above, the healthcare system is at a pivotal point. The

implementation of the Affordable Care Act brought many changes that present

opportunities for the healthcare industry and the PBM and retail pharmacy markets,

specifically. The goals of the ACA are to improve quality and affordability of care,

increase accessibility of care by expanding private and public insurance coverage, and

reduce costs of healthcare for individuals and the government (“Key Features of the

Affordable Care Act,” n.d.). At the end of the 2014 open enrollment period, fifteen

million people who were uninsured prior to the ACA’s implementation in 2010 were now

covered (“Obamacare Enrollment Numbers,” n.d.). That means that fifteen million more

people are able to receive care and fill prescriptions, and that the cost of this care is more

affordable. The opportunity associated with this expansion is significant and is not

something PBMs like CVS Health are going to overlook. In order to be more accessible,

CVS Health has a goal of placing a store within 3 miles of every person. Similarly,

Walgreens has a goal of store accessibility within 5 miles.

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Another opportunity associated with the ACA is the push towards value-based

care and less fee-for-service. The Obama administration set a goal of 50 percent of

payments from the Centers for Medicare & Medicaid Services (CMS) to medical care

providers would be value-based by 2018 (Japsen, 2014). The government, providers, and

payers have recognized the value of performance and health outcomes instead of volume

as a measure of reimbursement. The PBM and retail pharmacy industry is included in

these efforts for value-based care. More and more, retail chains and pharmacies are

affiliating with major medical centers and accountable care organizations. CVS Health,

for example, has fifty affiliations across the country (Japsen, 2014). This supports tighter

coordination between pharmacists and providers to improve care. Retailers also have the

ability to collect and analyze the massive amount of patient data. Because of this,

providers will be better able to understand population health. Patient-specific information

will be able to be passed directly from the pharmacist to the provider and into the

patient’s electronic health record (EHR).

The demographics of the population pose a major opportunity for the PBM and

retail pharmacy industry. By 2030, one in five Americans will be aged 65 or older and

eligible for Medicaid (Matthews, 2013). Two-thirds of the aging population have

multiple chronic conditions that require ongoing treatment and medication. This care can

include as many as 15 medications or more daily. People are also living longer – life

expectancy has increased 30 years over the last century. Thus, people are dealing with

complex medical issues for much longer than they used to.

Adding to this issue is the lack of providers specializing in geriatrics and number

of at-home or nursing care providers available. There are currently only one-fourth of the

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necessary providers available – by 2030, it is estimated the need for geriatric physicians

to increase to 30,000 from 7,500 (Matthews, 2013). This encourages more and more

people to turn to their pharmacists and clinics for care and guidance. The population is

also seeing an increase in public health efforts, such as programs for obesity, tobacco

cessation, drug abuse, and flu prevention. Similar to the aging population, people will

turn to the retail pharmacies for information. PBMs and retailers must be able to serve an

increasing market who demands an expansion of low-cost, high-quality services.

The major threat to the PBM industry is from federal regulations. As a plan

sponsor and participant in the Medicare Part D program, CVS Health and its peers are

subject to changes mandated by CMS. In 2011, CMS updated its regulations regarding

the Prescription Drug Benefits Program. The revisions, posted in the Federal Register,

required companies like CVS Health to update their prescription drug pricing standard

more frequently and also advised on coverage, payment processes in the Part D program,

and requirements governing the marketing of Part C and Part D plans (2011). If

organizations that participate in Medicare do not follow these regulations, they risk being

removed from the program and thus losing a substantial portion of patients and

reimbursements.

Competitive Analysis

The Pharmacy Services/PBM industry is extremely competitive. While there

are as many as 100 different providers, the market is ruled by a select few. Besides CVS

Health, these include UnitedHealth, Express Scripts, Walgreens, and Wal-Mart [see

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Exhibit 6 for an overall comparison – note that Catamaran and OptumRx are now part of

UnitedHealth].

In the face of these competitors, CVS Health has many strengths. By

eliminating tobacco products from their stores, they created a very strong marketing tool.

This well publicized action gave CVS Health a platform to further prove their

commitment to health and well-being. CVS Health’s Eileen Boone explained that

“cigarettes simply have no place in a setting where health care is delivered” and that

many conditions that pharmacies help manage are made worse by smoking (Kanani,

2014). In conjunction with this, they introduced a tobacco cessation program for their

customers that combined medication and coaching from the pharmacy staff. They also

rebranded from CVS Caremark to CVS Health in 2014 to emphasize their dedication to

health. CVS Health also has a separate Corporate Social Responsibility department that

operates several philanthropic efforts under the platform “Prescription for a Better

World.” These efforts prove to the public that CVS Health is committed to their mission

and may convince consumers to use their services instead.

Another strength of CVS Health’s is their proprietary technology. One use of

this technology is in the retail pharmacy. It is able to perform safety checks, interaction

screening, and substitutions for generic and brand drugs (“CVS Health,” n.d.). Their

technology also has the ability to deliver patient-specific information directly to EHRs to

the patients’ providers, integrating even more into the PCMH model. This improves

quality of care and safety for their patients.

The major weakness of CVS Health is the significant power that comes with

major acquisitions, like those of their competitors. As mentioned in the financial analysis,

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UnitedHealth recently acquired Catamaran Corporation for $12.8 billion (Gelles, 2015).

Other examples include Rite Aid purchasing Envision Pharmaceutical Services for $2

billion and Express Scripts purchasing Medco Health Solutions for $29.1 billion

(“UnitedHealth Pays $12.8 Bil to Double Prescription Clients,” 2015). These mergers

create significant competition and gain greater portions of the market share. In 2014,

CVS Health and Express Scripts controlled nearly half of the PBM market, a total size of

$263 billion (“CVS Might Have Tougher Times Ahead,” 2015). With these additional

acquisitions, CVS Health’s share is reduced. It is difficult for CVS Health to sustain its

growth when the major players continue to consolidate market share and grow larger.

With competition and the spread of market share increasing, CVS Health still

has the opportunity to maintain an industry leader. To do so, they need to leverage their

unique position as a PBM and retail pharmacy. Because CVS Health has access to a vast

amount of customer data from their retail pharmacies, they are better able to forecast drug

supply needs. It can more accurately predict supply and demand, resulting in better

procurement from drug manufacturers (“What the UnitedHealth-Catamaran Deal Means

for CVS Health and the General Public,” 2015).

The threats that face CVS Health in the competitive PBM market are the

possibility of competitive advantage and market share loss. While CVS Health is

currently the only company to stop selling tobacco products, if other companies like

Walgreens and Rite Aid follow suit they may lose that competitive advantage.

Consumers who switched to CVS may return to their previous pharmacies, and new

customers may choose a competitor instead. Market share is threatened not only by major

companies, but the growth of smaller firms as well. Grocery stores and other discounters

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have started in-house pharmacies and clinics. These would be a convenient option for

many consumers to combine trips and have prescriptions filled while they do their

weekly grocery shopping.

Future Prospects

CVS Health’s future looks bright. They are one of the leaders in the

Pharmacy Services market and have positioned themselves to continue to succeed. The

efforts CVS Health has made and will make should allow them to see growth for at least

the next ten years.

In the short-medium term, CVS Health’s Research Institute is looking to

implement various health programs. Like their tobacco cessation program, from which

they should expect to see an increase of cessation product purchasing (“CVS Health

Announces Data From Smoking Cessation,” 2015), they are implementing two other

programs by 2017 (“Committed to Health,” n.d.). These include a medical adherence

program to increase adherence by 5 percent up to 15 percent and a pharmacy

synchronization program. Medication non-adherence causes an estimated $300 billion in

avoidable costs in the U.S. healthcare system (“CVS Health Chief Medical Officer to

Address National Business Group,” 2015). The pharmacy synchronization program will

allow patients with multiple prescriptions to pick up their drugs all at once and

elimination inconvenience and confusion (“Committed to Health,” n.d.).

CVS Health is also looking to grow its physical presence. By 2017, CVS

Health plans to have 1,500 Minute Clinics in 35 states and that 50 percent of Americans

will have access to a Minute Clinic within 10 miles. This means that they are opening

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nearly 3 new clinics a week to keep up with this demand (“Committed to Health,” n.d.).

Along with Minute Clinic growth, CVS Health is planning to expand its specialty

pharmacy services and the role of its pharmacists. There is a shortage of primary care

physicians and a growing population of people that have access to care. Patients are more

educated, empowered, and invested in their health care options and are making more

informed choices. The pharmacy will become the “go-to” for primary care and to a

degree, function as a healthcare concierge.

To ensure its sustainable growth, CVS Health also has plans for the long

term. The Affordable Care Act will continue to create waves in the healthcare industry

for years to come and CVS Health must be able to anticipate and adapt to the changes.

Part of the healthcare reform is to increase efforts for population health. This includes

more emphasis and support for preventative care and screenings, much of which can be

conducted by pharmacists and pharmacy staff. Collaboration with medical centers allows

increased coordination of care and greater collaboration between providers, pharmacies,

payers, and patients. CVS Health’s affiliations with two medical centers and fifty other

hospitals are an example of that. This collaboration will expand as it becomes

incentivized from all sides (government, payer, retailer, patient, etc.). This relationship

results in lower costs, increased operational efficiencies, better care, and improved health

outcomes.

CVS Health also understands the increased value in technology. Beyond their

current system, telemedicine and innovations that provide care (i.e. devices, drug-

administration equipment, web-based applications and platforms, etc.) are going to be the

future of healthcare. Healthcare costs are extremely high, and investing in technologies

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that will not only expand care but improve the way it is delivered will enable long-term

cost reductions and sustainability.

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APPENDIX

Exhibit 1Description of Business

CVS Health Corporation, formerly CVS Caremark Corporation, is a pharmacy healthcare provider in the United States. CVS Health has four business lines: CVS/Minute Clinic, CVS/Pharmacy, CVS/Caremark, and CVS/Specialty. CVS/Minute Clinic provides easy and affordable care for minor acute conditions. CVS/Pharmacy provides retail pharmacy services. CVS/Caremark provides pharmacy benefit management (PBM) services, including plan design and administration, formulary management, discounted drug purchase arrangements, Medicare Part D services, mail order, specialty pharmacy and infusion services, retail pharmacy network management services, prescription management systems, clinical services, disease management services and medical spend management. The Pharmacy Services business operates under the Caremark, CarePlus CVS/pharmacy, CVS/caremarkTM, CVS/specialtyTM, RxAmerica, Accordant, SilverScript, Novologix and Coram names. CVS/Specialty provides specialty drug services, such as fertility and cancer drugs. As of September 30, 2014, CVS Health included 7,779 retail drugstores, online retail pharmacy websites, CVS.com and Onofre.com.br, and 17 onsite pharmacy stores and retail healthcare clinics.

Source: “CVS Health.” N.d. Trefis. Retrieved from http://www.trefis.com/stock/cvs/model/trefis?freeAccessToken=PROVIDER_a9f031452ab39f17bca8f48fe987e4daa8cfdc4e

Exhibit 2Financial Competitor Overview

CVS ESRX UNHMarket Cap 117.09B 61.48B 111.93BEmployees 137,800 29,500 170,000

Revenue (ttm) 139.37B 100.89B 130.47BGross Margin (ttm) 0.18 0.08 0.29

EBITDA (ttm) 10.72B 6.69B 11.33BOperating Margin

(ttm) 0.06 0.05 0.08Net Income (ttm) 4.63B 2.01B 5.62B

EPS (ttm) 3.96 2.64 5.7P/E (ttm) 25.94 32.04 20.59

PEG (5 yr expected) 1.35 1.21 1.96P/S (ttm) 0.84 0.61 0.86

CVS = CVS Health Co.; ESRX = Express Scripts Holding Co., UNH = UnitedHealth Group Inc. Data obtained from Yahoo Finance

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Exhibit 3aStock Prices Pre-ACA Implementation

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f(x) = 0.0168306417095693 x − 643.952113042797

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ESRXCVSLinear (CVS)UNH

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Data obtained from Yahoo Finance

Exhibit 3bStock Prices Post-ACA Implementation

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f(x) = 0.0257358191611165 x − 1011.1966149388

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Data obtained from Yahoo Finance

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Exhibit 4CVS Health Segment Profit Breakdown

In millions

Pharmacy Services Segment

Retail Pharmacy Segment

Corporate Segment

Intersegment Eliminations

Consolidated Totals

Three Months Ended31-Dec-14

Net revenues $ 23,874.00 $ 17,698.00 $ - $ (4,517.00) $ 37,055.00Gross profit $ 1,238.00 $ 5,558.00 $ - $ (163.00) $ 6,633.00Operating profit (loss) $ 909.00 $ 1,780.00 $ (205.00) $ (163.00) $ 2,321.00

31-Dec-13Net revenues $ 19,615.00 $ 17,192.00 $ - $ (3,977.00) $ 32,830.00Gross profit $ 1,211.00 $ 5,284.00 $ - $ (157.00) $ 6,338.00Operating profit (loss) $ 901.00 $ 1,671.00 $ (198.00) $ (157.00) $ 2,217.00

Year Ended31-Dec-14

Net revenues $ 88,440.00 $ 67,798.00 $ - $ (16,871.00) $ 139,367.00Gross profit $ 4,771.00 $ 21,277.00 $ - $ (681.00) $ 25,367.00Operating profit (loss) $ 3,514.00 $ 6,762.00 $ (796.00) $ (681.00) $ 8,799.00

31-Dec-13Net revenues $ 76,208.00 $ 65,618.00 $ - $ (15,065.00) $ 126,761.00Gross profit $ 4,237.00 $ 20,112.00 $ - $ (566.00) $ 23,783.00Operating profit (loss) $ 3,086.00 $ 6,268.00 $ (751.00) $ (566.00) $ 8,037.00

Source: “CVS Health reports strong profit growth for full year 2014; fourth quarter adjusted EPS at high end of company’s expectations.” 2015. Yahoo Finance. Retrieved from http://finance.yahoo.com/news/cvs-health-reports-strong-profit-120000835.html

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Exhibit 5Historical Stock Prices

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Historical Prices: 01/01/13 - 03/01/15

CVSESRXUNH

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Exhibit 6Comparison of Competition

Source: http://www.healthstrategies.com/blog/strengths-weaknesses-leading-pbms

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References

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Nguyen, LeahMBA Capstone

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