Industry Cluster Profile: Healthcare and Life Sciences Industry Overview The healthcare and life sciences cluster includes a large and diverse group of companies that encompass healthcare services, medical equipment and supplies, medical devices and diagnostics, and hospital and medical service plans. More specifically, the cluster includes companies that provide preventive, curative, and rehabilitative services offered by healthcare providers, medical and specialty hospitals, kidney dialysis centers, other healthcare organizations, and centers focused on family planning, outpatient mental health and substance abuse, diagnostic imaging, and emergency care. Additionally, companies that provide nursing care, assisted living, and long-term care services for individuals, families, and the elderly are also included. Companies in the healthcare and life sciences cluster also engineer, research, design, and manufacture medical equipment used in the healthcare industry. Further, companies that provide hospital, medical, and other health service insurance plans to enrollees or members are also included. The healthcare and life sciences cluster has proven to be resilient to economic cycles, which continues to drive job growth as a result of several key trends. Colorado’s health insurance landscape is undergoing rapid change with an estimated 500,000 Coloradans expected to gain insurance through the Affordable Care Act, which will drive further collaboration and cooperation among various healthcare and life sciences organizations across the region for specialized services, research, workforce, and facilities. Another contributing factor is the aging population, which is increased demand for services. Further, the digital healthcare infrastructure, created by electronic health records and software solutions, has greatly improved the way patient care is delivered and compensated. The Denver South region offers an emerging digital health community. Founded in July 2012 by the Denver South Economic Development Partnership and Innovation Pavilion, PrIME Health Collaborative is a growing statewide community of 800+ health care executives, physicians, technologists, academics, entrepreneurs, and investors dedicated to improving health and lowering healthcare costs through the commercialization of digital health technologies. PrIME Health is a resource ecosystem for digital health—the convergence of the digital and genetics revolutions with bioscience, healthcare and wellness, and information technology-software. In 2014, PrIME Health held a number of important events showcasing the Digital Health Corridor, including a first-of-its kind $150,000 Digital Health Challenge. More information is available at www.primehealthco.com. The Denver South region1 is home to a growing cluster of innovative healthcare and life sciences companies that are changing the industry, with support from leading research institutions, scientific talent, and unique assets. The region’s aggregation of scientific and entrepreneurial talent, life science-focused professional services, and investment capital supports thriving healthcare and life sciences companies. With nearly 17,370 healthcare and life sciences workers in approximately 1,650 companies across the Denver South region, the healthcare and life sciences cluster offers numerous opportunities in both academic and clinical discovery and is one of the fastest growing industry clusters in the region. In fact, employment growth in the region’s healthcare and life sciences cluster averaged 10.9 percent per year over the past five years, compared with a 3.2 percent and a 1.4 percent increase in the nine-county Metro Denver and Northern Colorado region2 and nationwide, respectively. 2014 Industry Highlights Key Company Announcements The Denver South region is a key location for healthcare and life sciences companies to grow and expand. Notable company announcements in 2014 included: Sky Ridge Medical Center celebrated the redevelopment of the Women’s Hospital, which now spans two floors in a world-class facility. The new facility has 62 post-partum rooms, four C-section suites, eight high-risk antepartum rooms, six private amenity suites, and a six bay triage area with private rooms. The hospital has additional service expansions slated for completion in mid-2015. 1 The Denver South region consists of zip codes 80111, 80112, 80124, 80126, 80129, 80130, 80134, and 80237. The nine-county Metro Denver and Northern Colorado region consists of Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer, and Weld Counties. 2 April 2015 | Page 1 Industry Cluster Profile: Healthcare and Life Sciences Sky Ridge Medical Center opened its new Advanced Wound Care Center, which includes a suite with two hyperbaric oxygen chambers. The Center will expedite recovery for patients suffering from painful, otherwise slow-to-heal wounds. Between the two chambers, Sky Ridge can treat about eight patients daily. Children’s Hospital Colorado’s South Campus celebrated its one-year anniversary in December 2014. The 180,000-square-foot facility is the only pediatric urgent care center in South Metro Denver and provided more than 41,550 outpatient specialty visits over the last year for services ranging from pulmonary and neurology to orthopedics and gastroenterology. MorningStar Senior Living broke ground on a five-acre senior residence complex in Lone Tree. The $55 million project includes 190 units, which are designed for independent living and assisted living/memory care. The facility will include private theaters, bistros, fine dining, activities programs, transportation, concierge service, pool, exercise facility, and a courtyard. Wind Crest plans to expand its Highlands Ranch retirement community. The $60 million expansion will include three new residential buildings, with the first opened in December 2014 and the second opening in the spring of 2015. Allosource donated bone allografts to surgeons from Cincinnati Children’s Hospital Medical Center who traveled to India to perform free surgeries for children afflicted with spine and upper extremity deformities. The donated bone grafts were used in the operation of six children with complex spine deformities. The FDA approved Centennial-based Cochlear Americas’ one-of-a-kind Aqua+ accessory, the only waterproof behind-the-ear solution for cochlear implant recipients. The device allows recipients to swim underwater for up to two hours. Baxter International Inc. acquired SuppreMol GmbH for $225 million. SuppreMol is a privately held biopharmaceutical company based in Germany developing treatment options for autoimmune and allergic diseases. The acquisition will give Baxter access to SuppreMol’s early-stage development portfolio of novel biologic immunoregulatory therapeutics. Cross-Cluster Convergence The Denver South region is characterized by its network of collaboration and innovation centers that lead to cross-cluster convergence. The healthcare and life sciences cluster combines these regional assets to strengthen partnerships and enhance growth opportunities across industries such as digital health, IT-software, and aerospace. Centennial-based Thinklabs designed a new digital stethoscope, which is compatible with iPhone and iPad technology. The Thinklabs One stethoscope is Bluetooth compatible for wireless transmission, has an earphone jack that is compatible with different headphone models, and has volume control to enhance the sound up to 100 times louder than the traditional model. Centennial-based AlloSource signed a Space Act Agreement with the National Aeronautics and Space Administration (NASA) and the Jet Propulsion Laboratory (JPL) to collaborate on microbial research. AlloSource will leverage technologies developed by NASA/JPL for assembly and launch operations of various Mars missions, including rapid molecular microbial burden measurement and genetic inventory cataloging to advance microbial research in tissue processing. Healthcare and Life Sciences Economic Profile The healthcare and life sciences cluster includes offices of physicians, dentists, chiropractors, optometrists, mental health practitioners, physical and speech therapists, podiatrists, and other health practitioners. The cluster includes hospitals ranging from general medical, surgical, and psychiatric to substance abuse and specialty care, and includes centers focused on family planning, outpatient mental health and substance abuse, kidney dialysis, April 2015 | Page 2 Industry Cluster Profile: Healthcare and Life Sciences diagnostic imaging, and emergency care. Companies focused on nursing care, assisted living, and long-term care and businesses that manufacture ophthalmic goods and medical equipment rental services are also included. Companies in the healthcare and life sciences cluster also engineer, research, design, and manufacture medical equipment used in the healthcare industry. Further, companies that provide hospital, medical, and other health service insurance plans to enrollees or members are also included. The healthcare and life sciences cluster consists of 41, six-digit North American Industry Classification System (NAICS) codes. Healthcare and Life Sciences Employment and Company Profile, 2014 Denver South 17,370 United States 15,942,040 Number of direct companies, 2014 1,650 1,138,010 One-year direct employment growth, 2013-2014 6.4% 1.2% Five-year direct employment growth, 2009-2014 67.6% 7.4% Avg. annual direct employment growth, 2009-2014 10.9% 1.4% 7.5% 11.0% Direct employment, 2014 Direct employment concentration Sources: Dun & Bradstreet, Inc. Marketplace database, July-Sept. 2008-2010; Market Analysis Profile, 2011-2014; Development Research Partners. Healthcare and Life Sciences Employment The Denver South region’s healthcare and life sciences employment (17,370 workers) rose 6.4 percent in 2014, compared with the previous year’s level, adding nearly 1,050 new jobs over the same period. National employment levels increased 1.2 percent over-the-year. Healthcare and life sciences companies employed 7.5 percent of the Denver South region’s total employment base and roughly 12 percent of all healthcare and life sciences employment in the ninecounty region is located in the Denver South region. Healthcare & Life Sciences Number of Employees Growth Rate 16% 14% 12% 10% 8% 6% 4% 2% 0% 2009 2010 2011 Denver South 2012 2013 United States 2014 Avg Annual Growth Approximately 1,650 healthcare and life Source: Dun & Bradstreet, Inc., Marketplace database, July-Sept. 2007-2010; Market Analysis Profile, 2011-2014. sciences companies operated in the Denver South region in 2014. More than 78 percent of the region’s healthcare and life sciences companies employed fewer than 10 people, while 0.7 percent employed 250 or more. April 2015 | Page 3 Industry Cluster Profile: Healthcare and Life Sciences Healthcare & Life Sciences Employment by County, 2014 Denver 4.0% Douglas 41.6% Arapahoe 54.5% Sources: Market Analysis Profile, 2014; Development Research Partners. Healthcare & Life Sciences Employment by Industry Sector, 2014 Surgical & medical instruments mfg. Kidney dialysis & 8.8% home health care services 9.0% Nursing care facilities 8.2% All other health services 5.7% Medical & dental laboratories 1.3% Other medical devices mfg. 1.1% Hospital & medical service plans 10.4% General & medical, surgical, & psychiatric hospitals 18.8% Physician offices & clinics 36.7% Sources: Market Analysis Profile, 2014; Development Research Partners. Major Healthcare and Life Sciences Companies AlloSource www.allosource.org American Medical Response www.amr.net Baxter Corporation www.baxter.com Brookdale Senior Living www.brookdale.com CareFusion (formerly Vital Signs) www.carefusion.com Catholic Health Initiatives www.catholichealthinit.org Centura Health www.centura.org Children’s Hospital Colorado www.childrenscolorado.org Delta Dental of Colorado www.deltadentalco.com HCA-HealthONE LLC www.healthonecares.com Highlands Behavioral Health System www.highlandsbhs.com Kaiser Permanente Colorado www.kaiserpermanente.org Life Care Centers of America http://lcca.com Medtronic Surgical Technologies www.medtronic.com Optum (formerly Connextions) www.optum.com Sandhill Scientific www.sandhillsci.com April 2015 | Page 4 Industry Cluster Profile: Healthcare and Life Sciences Major Healthcare and Life Sciences Companies Cont’d Cochlear Americas www.cochlearamericas.com Colorado Center for Reproductive Medicine www.colocrm.com ConMed Corporation www.conmed.com Correct Care Solutions, LLC www.correctioncare.com DaVita Inc. www.davita.com SteriTec Products Inc. www.steritecproducts.com United Healthcare www.uhc.com Vi at Highlands Ranch www.viliving.com Wind Crest, Erickson Living www.ericksonliving.com Zynex Medical, Inc. www.zynexmed.com Healthcare and Life Sciences Workforce Profile Many companies choose locations because of the available workforce. With nearly half of the nine-county region’s 3.6 million residents under the age of 35, employers can draw from a large, young, highly educated, and productive workforce. Of the region’s adult population, 41.2 percent are college graduates and 90.5 percent have graduated from high school. The state has the nation’s second-most highly educated workforce as measured by the percentage of residents with a bachelor’s degree or higher. The attractiveness of the region draws new residents through migration. The region’s population is expected to grow 53.3 percent from 2010 to 2040, driving a 36.3 percent increase in the region’s labor force over the same period. It is important to note the changing composition of the workforce supply as the baby boomers begin to retire, which will pose implications for businesses whose employee pool includes significant numbers of these workers. Educational Attainment of Metro Denver and Northern Colorado's Population Age 25 and Older 3.9% Less than 9th Grade 5.6% 15.3% 9th to 12th Grade, No Diploma 20.0% High School Graduate (includes equivalency) Some College, No Degree 25.9% Associate Degree Bachelor’s Degree 21.7% 7.7% Graduate or Professional Degree Source: U.S. Census Bureau, 2013 American Community Survey. 3,000,000 Metro Denver and Northern Colorado's Labor Force Projections by Age 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 2010 16-24 25-34 2020 35-44 2030 45-54 55-64 2040 65+ Source: Colorado Division of Local Government, State Demography Office. April 2015 | Page 5 Industry Cluster Profile: Healthcare and Life Sciences The Denver South region’s healthcare and life sciences industry employs nearly 17,370 people and includes a large pool of talented, welleducated, and highly skilled workers. Compared with the age distribution across all industries, the healthcare and life sciences cluster in the nine-county region has a larger share of employees that are between the ages of 25 and 44 years old and also between the ages of 55 and 64 years old. Metro Denver and Northern Colorado's Distribution of Employment by Age 25% 20% 15% 10% 5% The healthcare and life sciences workforce 0% supply consists of four main components: those 16-24 25-34 35-44 45-54 55-64 65+ currently working in the industry; those doing a Healthcare & Life Sciences All Industries similar type of job in some other industry; the Source: Provided by Arapahoe/Douglas Works! QCEW Employees, Non-QCEW Employees, Self Employed, & Extended Proprietors - EMSI 2014.4 Class of Worker. unemployed; and those currently in the education pipeline. The Metro Denver and Northern Colorado Occupation & Salary Profile below includes the 10 largest healthcare and life sciences occupations in the region. For these 10 largest occupations, the chart details the total number of workers employed in that occupation across all industries, the number of available applicants that would like to be working in that occupation, the number of recent graduates that are qualified for that occupation, and the median and sample percentile annual salaries. Wages The 2013 average annual salary for a healthcare and life sciences worker in the nine-county region was $57,590, compared with the national average of $55,550. Total payroll for the healthcare and life sciences cluster in the nine-county region reached nearly $8.1 billion in 2013. Metro Denver and Northern Colorado Healthcare and Life Sciences Occupation & Salary Profile, 2014 10 Largest Healthcare and Life Sciences Occupations in Metro Denver and Northern Colorado 1. Registered nurses 2. Nursing assistants 3. Medical assistants 4. Receptionists & information clerks 5. Home health aides 6. Clinical, counseling, & school psychologists 7. Personal care aides 8. Medical secretaries 9. Dental assistants 10. Secretaries & administrative assistants, except legal, medical, & executive Total Working Number of Across All Available Number of Industries Applicants Graduates (2014) (2014) (2013) 31,699 374 1,938 Median Salary $69,722 10th Percentile Salary $50,523 25th Percentile Salary $58,490 75th 90th Percentile Percentile Salary Salary $83,117 $93,350 12,714 1,076 1,504 $28,163 $22,568 $25,085 $32,469 $36,504 7,127 779 1,365 $34,133 $26,666 $29,765 $38,563 $44,325 16,292 2,349 0 $30,139 $20,571 $25,189 $36,338 $43,618 10,075 477 209 $23,338 $18,117 $20,342 $28,288 $32,760 6,595 17 2,261 $55,744 $41,101 $48,256 $65,770 $72,821 20,769 572 182 $20,592 $17,139 $18,574 $22,714 $24,274 5,762 352 173 $34,278 $24,856 $29,120 $39,936 $46,550 4,554 262 540 $37,794 $26,333 $31,304 $45,718 $54,891 49,442 650 71 $36,005 $23,566 $29,037 $43,992 $51,938 Notes: The number of available applicants is a point-in-time measurement of the number of people who have registered in Colorado’s workforce development system’s statewide database, Connecting Colorado, as being able and available to work in a particular occupation. Results should be interpreted with caution since registration in Connecting Colorado is self-reported. In addition, the skills rubric may assign up to four occupation codes for each registrant. Therefore, the number of available applicants could be inflated. Source: Provided by Arapahoe/Douglas Works!; QCEW Employees, Non-QCEW Employees, Self Employed, & Extended Proprietors - EMSI 2014.4 Class of Worker. April 2015 | Page 6 Industry Cluster Profile: Healthcare and Life Sciences Education & Training Colorado’s higher education system provides an excellent support system for businesses in the region. There are 28 public higher education institutions in Colorado, of which seven four‐year and six two‐year public institutions offering comprehensive curricula are located in the nine‐county region. In addition, there are more than 100 private and religious accredited institutions and nearly 340 private occupational and technical schools offering courses in dozens of program areas throughout the state. Although not exhaustive, a list of the major, accredited educational institutions with the greatest number of graduates for each of the 10 largest healthcare and life sciences occupations in the nine-county region are included below. A directory of all higher education institutions with corresponding websites may be accessed via http://highered.colorado.gov. Aims Community College www.aims.edu Metropolitan State University of Denver www.msudenver.edu University of Colorado Denver www.ucdenver.edu Concorde Career College – Aurora www.concorde.edu Pima Medical Institute – Denver Campus www.pmi.edu University of Northern Colorado www.unco.edu Emily Griffith Technical College www.emilygriffith.edu Regis University www.regis.edu Front Range Community College www.frontrange.edu University of Colorado Boulder www.colorado.edu Key Reasons for Healthcare and Life Sciences Companies to Locate in the Denver South Region and the Surrounding Nine-County Region 1. A robust culture of health Douglas County ranked as the second-healthiest county in Colorado based on a combination of health outcomes including length and quality of life. Douglas County also ranked first in health factors ranging from clinical care and healthy behaviors to social and economic factors and the physical environment. (University of Wisconsin Population Health Institute, 2013) Nearly 30 public and private golf courses are located in the South Metro Corridor and world-class ski resorts are located within 100 miles of the Corridor. (Denver South Economic Development Partnership) Metro Denver ranked as the fourth-fittest metro area in the nation in 2014. Denver’s high percentage of residents participating in physical activity and low obesity and cardiovascular disease rates contributed to its high rank. (American College of Sports Medicine, 2014) Colorado is the leanest state with the nation’s lowest rate of adult obesity (21.3 percent). (Trust for America’s Health, 2014; Robert Wood Johnson Foundation, 2014) Colorado ranked as the sixth-healthiest state for adults ages 65 years and older. Colorado’s seniors have the second-lowest prevalence of obesity, high rates of physical activity, low percentage of hospital deaths, and low premature death rate. (United Health Foundation, 2014) 2. The ability to recruit and retain technical and scientific employees Two of the 10 best places in Colorado for job seekers were in Denver South—Centennial and Parker. The study examined the cost of living, the unemployment rate, and the growth in the number of working-age people in each city. (NerdWallet, 2013) Metro Denver ranked 11th among U.S. life science clusters and received top 10 rankings in life science employment concentration, establishment concentration, and employment growth. (Jones Lang LaSalle, 2014) April 2015 | Page 7 Industry Cluster Profile: Healthcare and Life Sciences Colorado ranked among the second tier of bioscience states and the state ranked among the top tier in bioscience-related venture capital investments since 2009, totaling $1.1 billion. (Battelle Memorial Institute, 2014) Colorado has 10 higher education institutions with bioscience programs. Biological sciences graduate programs at the University of Colorado Boulder (CU-Boulder), Colorado State University (CSU), and the University of Colorado Denver ranked within the nation's top 100 in 2014. (U.S. News & World Report, 2014) Colorado ranked fourth in the number of scientists and engineers as a share of all occupations in 2012. (National Science Foundation, 2014) 3. A regional healthcare and life sciences hub, with exceptional facilities and unique assets Sky Ridge Medical Center received high scores in hospital safety in The Leapfrog Group’s 2014 survey of more than 2,600 U.S. hospitals. Sky Ridge received an “A” grade, which is based on 28 measures of patient safety, including medical errors and infection rates. (The Leapfrog Group, 2014) U.S. News & World Report’s 2014-2015 “Best Hospitals” named Sky Ridge Medical Center to its topranked healthcare facilities list. Sky Ridge Medical Center scored high in patient safety and was ranked in three other high-performing specialties: gastroenterology and GI surgery, geriatrics, and orthopedics. The facility tied Parker Adventist Hospital and Presbyterian-St. Luke’s Medical Center as the seventh-best hospitals in Metro Denver. (U.S. News & World Report, 2014) The Colorado Center for Reproductive Medicine (CCRM) is one of the nation’s leading fertility clinics. Two-thirds of CCRM’s patients travel to Colorado from other states and countries for treatment and it is internationally recognized for success rates and scientific achievements in the field of reproductive endocrinology. Rocky Vista University’s College of Osteopathic Medicine (RVUCOM) in Parker is one of only two medical schools in Colorado. Founded in 2006, RVUCOM has among the highest board scores of any osteopathic medical school in the nation and a 100 percent match rate including some of the nation’s top residency programs. (Rocky Vista University College of Osteopathic Medicine, 2014) Children’s Hospital Colorado (CHC) ranked as the sixth-best children’s hospital in the nation with six of its specialty areas also in the top 10 in their respective categories. CHC was also named to the U.S. News’ Honor Roll and ranked fifth on Parents magazine’s “10 Best Children's Hospitals in America” list. (U.S. News & World Report, 2014; Parents, 2014) 4. A pro-business environment and competitive tax structure Colorado's simplified corporate income tax structure based on single-factor apportionment allows companies to pay taxes based solely on their sales in the state. Along with few regulatory burdens, Colorado's corporate income tax rate of 4.63 percent is one of the lowest and most competitive tax structures in the nation. (State of Colorado; The Tax Foundation) Manufacturing equipment used in clean room operations is exempt from state sales tax. (Exemption clarified in Colorado House Bill 1277 (2007)) Forbes ranked Metro Denver fourth among the “Best Places for Business and Careers” in 2014. Four other Colorado metropolitan areas were included on the list. The Fort Collins metro area ranked fifth overall, Greeley ranked 20th, Boulder ranked 23rd, and Colorado Springs ranked 29th. (Forbes, 2014) Colorado ranked as the No. 8 small-business-friendly state in the nation. Fort Collins (24th) and Denver (28th) ranked among 84 cities in the country. (Thumbtack.com, 2014; Ewing Marion Kauffman Foundation, 2014) 5. An overall better quality of life Centennial ranked among the top 15 in MONEY Magazine’s 2014 list of the “Best Places to Live.” Castle Rock (fourth) and Boulder (23rd) were also named to the list’s top 50. (MONEY Magazine, 2014) April 2015 | Page 8 Industry Cluster Profile: Healthcare and Life Sciences NerdWallet named Highlands Ranch, Lone Tree, and Parker among the top 10 “Best Towns in Colorado for Young Families.” The cities were touted for their quality education, recreational opportunities, creative and innovative energy, and affordable housing. (NerdWallet, 2014) Douglas County ranked among the “10 Best Counties in America” in 2014. The County recorded the lowest poverty rate (2 percent of families) on the list with the highest high school graduation rate (97.2 percent). (Movoto Real Estate, 2014) Douglas County ranked sixth in the nation on a list of counties with the highest median income as a result of high wage jobs in the area. Douglas County had a median income of $99,767 in 2013, compared with the national median income of $52,300. (Sentier Research, 2014) The Denver South region boasts a variety and quality of housing options from expansive apartment complexes to single-family homes surrounded by open spaces. One of the largest and most comprehensive master planned communities in the nation—RidgeGate—is located conveniently along Interstate 25 and Lincoln Avenue in Lone Tree and offers 3,500 acres of mixed-use density including retail, dining, healthcare, recreation, and mass transit. (Denver South Economic Development Partnership, 2014) 6. Access to financial resources to fund research and development The Colorado Digital Health Challenge is a three-month program to curate and vet the best and brightest digital health companies in Colorado. The Challenge is split into two tracks—one to connect applicants with major health systems and health insurance carriers for pilots of new technologies (called the Access Track) and another to connect applicants to potential funders (called the Finance Track.) The Colorado Health Foundation provided $150,000 in awards in 2014 and is the first of its kind in the West catering to early-stage digital health and health information technology companies. Two grant programs were created by the Colorado Legislature to grow and expand the region’s bioscience industry: The Clean Technology Discovery Evaluation Grant Program established a pool of funds to support research and development of new products and technologies, to support early-stage companies, and to develop infrastructure. This program could generate as much as $2 million each year in new seed money for the bioscience industry. The Bioscience Discovery Evaluation Grant Program was created to grow and expand bioscience research and accelerate the development of new products and services. The program has created 45 new Colorado companies resulting in 381 direct jobs, an additional $418 million in grants and investments to further commercialize these bioscience technologies, and awarded a total of 220 grants totaling more than $27 million to research institutions and early-stage bioscience companies. (Colorado Office of Economic Development and International Trade, 2013) Colorado ranked fifth in the nation for funds raised per worker from the Small Business Innovation Research (SBIR) grant program. The state received $25.82 SBIR grants per worker compared with the U.S. average of $11.15. (U.S. Small Business Administration, 2014; U.S. Bureau of Labor Statistics, 2014) For additional information, contact us: Denver South Economic Development Partnership 304 Inverness Way South, Suite 315 Englewood, CO 80112 303-792-9447 www.denversouthedp.org Prepared by Development Research Partners, Inc., www.DevelopmentResearch.net April 2015 | Page 9