MEDICAL CONSTRUCTION & DESIGN®

T H E S O U R C E F O R C U R R E N T N E W S , T E C H N O L O G Y & M E T H O D S

March/April 2017 | Volume 13, Issue 2 | mcdmag.com

FOCUS: AROUND THE GLOBESPOTLIGHT: BUILDING ENVELOPE+FIRE SAFETY

INSIDE

FLOURISHA PLACE TO

The making of an award-winning Canadian hospital

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Healthcare networks and their facilities are facing multiple pressures including legislation, population health, the rise of consumerism and changing technology. These forces press healthcare institutions to adapt to remain competitive and profitable in a value-based system. Healthcare leaders are evaluating new strategies and design models to build a consumer relationship platform with new types of facilities/sites of care and to improve clinical quality and access.

Bending the cost curve of healthcare is a major goal of health networks, consumers, insurers and legislators, alike. And since 2009, the healthcare law has required networks to adopt pay-for-performance measures, improved patient care and increased access.

Even before the healthcare law, healthcare networks had begun to optimize overall

performance by pursuing each dimension of the Institute for Healthcare Improvement’s Triple Aim (2007):

> Improving the health of populations

> Improving the patient ex-perience of care (including quality and satisfaction)

> Reducing the per capita cost of healthLooking forward, the

Triple Aim needs to consider the importance of place in creating a continuum of care, as no one size fits all.

When considering the Triple Aim, it is important to acknowledge that patient care outcomes are not always synonymous with patient sat-isfaction and loyalty. Beyond legislative changes and pay-for-performance measures, patient outcomes and experi-ence should be the focus.

Some may argue that place is covered within the Triple Aim’s dimension of “improving

population health,” but with today’s expansive continuum of care — from telemedicine to outpatient centers, regional hospitals and major academic medical centers — there is a need to introduce the impor-tance of place as a dimension all its own.

Legislative changesThe healthcare law tightened the reins on reimbursements through value-based pur-chasing, bundled payments and HCAPHS scores, effec-tively determining payments. According to the American Journal of Public Health’s January 2016 analysis, 63 per-cent of healthcare payments are supported by governmen-tal programs.

Any new social contract de-veloped by the new adminis-tration will continue to impact healthcare delivery, and it is unlikely that reimbursements will rise in the future. Many

health networks continue to move forward in a value-based direction and see it as the right way to drive quality and af-fordability.

Population healthPopulation health research attempts to understand the root causes of disease, and ways to mitigate risk factors. According to David Kindig (2014), population health de-terminants are broken down into four categories:

> Health behaviors (30 percent): Includes diet and exercise, along with tobacco and alcohol use

> Clinical care (20 percent): Focused on access and

The fourth dimension in patient care continuum

Aim Aim AND THE

Importance of PlaceAim Quadruple

BY LOUIS A. MEILINK JR. & CHRISTINA GRIMES

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MCDMAG.COM | MARCH/APRIL 2017 | Medical Construction & Design 49

quality of care available > Social & economic factors

(40 percent): Includes education, employment and income

> Physical environment (10 percent): The built environment and environ-mental quality

According to the CDC, chronic diseases are the root cause of two thirds of all deaths and account for three out of every four dollars spent on healthcare. To reduce the cost of chronic care, health networks are developing strategies to increase their access within the communities they serve and effectively meet

patients in the exurbs and suburbs.

An architect’s professional responsibility is to protect the health, safety and welfare of

the public; the profession is actively engaged in creating healthier spaces. Evidence-Based Design has drawn correlations between the built

environment and patient out-comes, and design is a catalyst to encourage movement and activity that promotes healthy living.

Penn Medicine Lancaster General Health, Ann B. Barshinger Cancer Institute improves

access, diagnosis and treatment, and management of chronic disease with the goal

of providing an extraordinary patient and visitor experience every time.

Quadruple AimHealthcare networks should broaden strategies of the IHI Triple Aim to include the evolving quadruple aim: the right care, at the right time, with the right price, in the right place.

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Rise of consumerismPatients have access to in-formation and choice about their care. As high deductible healthcare plans increase, and there is increased transpar-ency in pricing, patients are shopping around for care. When patients shop with their own healthcare dollars, they demand greater value and bet-ter experiences.

This rise in consumer-ism highlights the need for improvement in patient care and experience and the need for facilities that also focus on patient satisfaction. The goal is to improve access to the right facilities in the right place for all patients, while considering consumer preferences.

In order to develop and capitalize on patient loyalty, every visit within the same health system must create a consistently positive experi-ence. Health networks need to build a consumer relationship platform and ensure it trans-lates from facility to facility across the continuum of care.

Changing technologyTechnology is changing faster than ever and its impact on healthcare planning is sig-nificant — partly because so much technology is required in healthcare facilities. With construction budgets con-stantly under cost pressures, it is important to design spaces with flexibility, targeting

those areas most likely to have frequent changes in scope or technology.

It is also important to ac-knowledge the growing inclu-sion of big data and its impact on the hospital facilities of tomorrow. As data continues to become more available, how will it be integrated into health networks and facilities

to assist patient diagnosis and care planning options in real time?

Technology growth is en-couraging the notion of place to expand even further into the community level. As more patients become comfort-able with wearable devices, healthcare networks can track patients across more sites of care, expanding the continu-um of healthcare.

‘Place’ is crucial to successThe inclusion of place is cen-tral to the Triple Aim equation to address population health, improve the patient care qual-ity/experience and reduce cost.

Awareness of the changes brought by the advent of the healthcare law, and the growth of internet access, is leading to the relocation of many of the services to more convenient and cost-effective venues. When place is taken into ac-count, healthcare networks and planners can “curate” every step of the patient

The Reading Health System’s new HealthPlex for Advanced Surgical and

Patient Care is committed to advancing health and transforming

lives. This regional hospital is home to an 88,000-square-foot green roof and healing garden with therapeutic value

for patients, families, staff and the community.

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Navigating Today’s Healthcare Landscape

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interaction, an interaction that begins even before leaving home.

Lower-acuity care remains close to the patients at home; follow-up and primary care is accessible “on demand” and it is only when patients are facing more acute or compli-cated care that they travel to the higher-acuity care options. With various locations for patients to receive the level of care they need — close to home and at a variety of price points — a health network can

behave as an organism coordi-nating all its parts.

Future success will require a different playbook than the one health systems are operat-ing with today and must react to the growing demand for patients to receive great care when they need it, where they need it, for a price they can afford.

The initial 2015 and 2016 Site Neutrality Rulings from the Centers for Medicare and Medicaid Services limit any outpatient facility from

maintaining the technical fees and hospital-based pricing if opened more than 250 yards from a hospital. These rulings appear to run counter to the goal for care closer to patients in their communities. While attempting to provide more low-cost options for patients closer to home, this ruling may create barriers for future construction of care centers within the community.

Navigating today’s health-care landscape, health net-works and architects must act

together with agility and ef-ficiency to put forth a diversity of healthcare facility solutions — collaborating to bend the cost curve by designing for the entire continuum of facilities that deliver the right care, at the right time, with the right price, in the right place.

Louis A. Meilink Jr., AIA, ACHA, ACHE, is a principal at Ballinger. He can be reached at lmeilink@ballinger.com. Christina Grimes, AIA, EDAC, LEED BD+C, is a senior associate at Ballinger. She can be reached at cgrimes@ballinger.com.

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A consumer relationship platform to build patient loyalty

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