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Page 6B— COLORADO REAL ESTATE JOURNAL — March 4-March 17, 2015
T he health care
landscape continues
to shift with the
onset of health care reform,
the empowering of consumers,
and a focus on wellness and
prevention. Wellness and
prevention are part of a strategy to
keep patients out of the hospital,
drive down costs and use the
inpatient environment for the
most critically ill. This also allows
patient care to occur in less costly
environments from operations
to infrastructure. Several trends
have emerged in the ambulatory
marketplace. I’ve outlined
eight trends and described
how they might affect the built
environment.
1. The educated consumer.
Consumers today are empowered
to be active participants in their
health. This change is driven by
the availability of information
related to their care as well as
to provider cost and quality.
This means that their decisions
will be consumer-minded and
the provider must offer a value
proposition that is clear and aligns
with the consumer’s desires. From
a real estate perspective, providers
are looking for locations that are
closer to the consumer to offer
ease of access and convenience
for patients. The focus is no
longer on a centralized location
for services, but rather a dispersed
model in the community.
2. Shifting acute care
environments.As health care
reformmoves into full swing,
incentives for keeping the patient
out of the inpatient environment
accelerate the need for acute
patients to receive care in the
outpatient environment. More
acute-episodic and complex
care is being driven to larger
ambulatory centers. In addition,
while the inpatient environment
may not grow, the level of severity
of patient will rise. Health care
providers are developing larger
ambulatory centers, designed to
support more complex care, that
some defined as almost a hospital
“without beds.”
3.Operation driving design.
More progressive health care
providers have recognized the
need to develop approaches to
clinics based on lean, efficient
operational parameters. Using
historical data, business goals
and operational metrics for
performance, they are building
virtual simulations of space in
order to design the optimal flow
of patients, staff, physicians and
resources that result in intentional
experiences. This approach allows
organizations to develop designs
around how they want to practice
going forward.
4. Nontraditional design
approaches. Outpatient
clinics traditionally have been
organized around a warren of
exam and procedure rooms, a
design concept that can hinder
communication among members
of the care team. As the medical
home model prevails, many
experts are working together
to assure care coordination.
This means clinics need to be
organized differently. Designers
and their clients are taking
cues from the research and
retail worlds, using concepts
for promoting collaboration
among and within the care
coordination teams. Further,
some organizations are beginning
to intentionally organize services
around “neighborhoods” with
individual characteristics or
“storefronts,” especially to help
patients navigate.
5. Genomics as part of the
care continuum. The P3 mode
(prevention, prediction and
participation) continues to
grow within the health care
marketplace, therefore so does
the need for primary care
providers to effectively use the
analysis of information from
“omics” (genome, proteome,
metabalome, microbiome,
etc.), comparative analysis of
approaches and therapies,
information management and the
opportunity to better understand
the mechanisms of disease.
Some clients are developing
novel ways of bringing providers
and researchers together within
one environment designed to
compel collaboration for a more
robust approach to capitalizing
on this type of research. The
approach will create a competitive
advantage to those who can
leverage this knowledge on behalf
of their patients, allowing them to
better inform the continuum of
care on a truly personal level.
6. Rise of the information
manager. The notion of getting
patients engaged in their health
is fundamentally reshaping the
role of providers in outpatient
settings. Providers, especially in
primary care, are transforming
into information managers who
have to proactively anticipate
the clinical needs of patients
and populations in their care.
Providers are becoming the
“interpretive hub,” particularly
in primary care, helping patients
understand clinical complexities
and laying out treatment plans.
This requires that the outpatient
environment be flexible to allow
for team size to grow when
necessary as well as accommodate
the technologies of today and
tomorrow necessary to support
these new information managers.
7. Retail health. Retail health, as
defined by some, is the collection
of retailers in the health care
business – Walgreens, CVS, Target,
Walmart, among others – that are
beginning to constitute the largest
portion of primary care in the
U.S. But an even more important
trend is organizations using retail
business models in developing
a new approach to care delivery.
This means traditional health
care organizations are thinking
nontraditionally, using active
waiting (i.e., Apple Store) and self
check-in (i.e., airline industry).
Providers are increasingly
researching how their customers
make choices and then giving
customers those choices wrapped
in intentional experiences, which
in turn drives satisfaction and
repeat business.
8. Population health. In
order to develop and execute
population management models
and research-driven practices,
community providers and
academic medical centers are
creating affiliations. As a result,
clinical research is making its way
into ambulatory care venues at an
accelerated pace. Multidisciplinary
collaboration spaces often
associated with translational
health sciences are being
accommodated within primary
care clinics to allow for greater
population health research in the
community.
Abigail Clary,
AIA, ACHA
Vice president and regional director,
Healthcare at HDR Architecture,
Chicago