How Changes In Healthcare Are Impacting Facility Design And Development

Bisnow’s Healthcare Leadership and Life Sciences Forum last week kicked off with a panel of healthcare facility experts discussing changes in delivery of healthcare, what is driving them, and how changes are affecting healthcare facilities.

Moderator Lance Carlson, an architect and principal/director at Taylor Design, began by asking panelists what changes are affecting their businesses and impacting people who design and build healthcare facilities. The panel included Lance, Matthew Jenusaitis, Chris Ross, Jake Rohe, Scott Mackey, Elizabeth Hawkins and Charlie Adbi. Bisnow's Kyle Nicoles is shown above left introducing the healthcare panel.

UC San Diego Health System chief of staff Matthew Jenusaitis said the Affordable Care Act has brought a lot of new people into the system, and there’s high demand for both wellness and acute care services in all healthcare settings—hospital and community. “Our hospital is packed to the brim and bursting at the seams,” he said. “We have a new hospital we’re opening in six to eight weeks, and we’re projecting that that’s going to fill up quickly too.”

Swinerton Builders project executive Elizabeth Hawkins said, “This trend toward retail-based healthcare, I think, is going to be really big in the future.” She said it will be interesting to see how Millennials impact delivery of healthcare, saying they want everything fast and convenient, which is why there’s movement toward retail-based healthcare like Minute Clinics. “Millennials are more concerned with convenience and ease than with provider relationships,” Elizabeth said.

JLL SVP Chris Ross said one commonality of Baby Boomers and Millennials is they want convenience, including in physician location. “Retailization of healthcare is going to be critical and a hot topic for the next five, 10, 20 years, and we’re going to see some incredible things happen,” he said.

Lionakis principal Scott Mackey predicted the retailization of healthcare and use of technologies to deliver care will be applied mostly to wellness and primary care, family care and general practice. “Specialty care and really the majority of healthcare will involve physically seeing a doctor,” he said. With both Millennials and Baby Boomers wanting a short drive, medical offices buildings will continue to rise in communities, rather than on medical campuses, he said.

Finest City Realty CEO Charlie Abdi said the best place to put MOB's is next to community centers and neighborhood retail services, such as grocers, cleaners and pharmacies. He said healthcare is a very competitive environment and providers are doing different things in hospitals, physician offices and clinics to retain and attract patients, including the addition of technology to improve patient experience by entertaining them and providing health education.

Elizabeth (pictured above with Jake Rohe and Scott Mackey, left, and Charlie Abdi) said along with ACA came a move away from volume-based service to value-based service. She said ACA provided incentives for providers to keep patients healthy. “It’s about outcomes, and reimbursement is tied to patient experience. So patient satisfaction scores actually affect what hospitals are reimbursed for,” Elizabeth said, suggesting this was what spurred interest in designing facilities around patient experience and a holistic care model that includes wellness services.

Scott said both Millennials and Baby Boomers present challenges for providers, because the two groups have completely opposite perspectives on healthcare delivery. “So being nimble and diversified in services alone is an incredible challenge, but also how that is driving facility development is even more challenging, because there’s so many directions, styles and technologies going into this,” he said.

Pacific Medical Buildings SVP of development Jake Rohe said the trend toward consumer-oriented healthcare came on the heels of high-deductible health plans. He said previously healthcare consumers weren’t concerned about what providers charged for their care. Now with more skin in the game, patients are value-shopping for healthcare services and asking for discounts. “The retailization of healthcare to me is consumerism, there’s choice, transparency. We all have access to information in the palm of our hands, so we can make educated choices based on quality of care, outcomes and costs,” Jake said.

“It’s about scale and convenience,” Scott said. Specialized services are splitting off from large medical centers into smaller, more convenient facilities that provide services at a lower cost. “The big medical centers are still there for a reason: there’s a big need, but in order to reach the amount of population you've got to get to, you have to get out into those communities at a smaller scale.”

Millennials want to be looked at as consumers, not patients, Elizabeth said, and are more likely to question the cost of things and ask for a discount.

Matthew said there is consumerization of healthcare and desire for convenient access. But he stressed the importance of the care continuum. “The point of Minute Clinics is access,” he said. “People will enter the healthcare system through a Minute Clinic, virtual medicine and these types of things, but will still need the full breadth of medical care.” Matthew said Millennials will evolve and age and will develop medical issues beyond the scope of Minute Clinics and virtual medicine capabilities and will go to a tertiary-care center.

Jake asked Matthew how convenience-based primary-care services link back to the rest of the healthcare system—acute care, post-acute care, specialty care, population health?

Matthew said the connection point is going to be driven by insurance companies, which are moving to population health management and developing products that encourage providers to take on more risk. He said payers are saying, “We’re going to give you $500/month to take care of Jake and his whole family, and whatever happens, you’re going to take care of it. And if you keep him healthy, you’re still going to get the $500, but if he needs a heart transplant, you’re still going to get $500/month.”

Jake said private insurers are following Medicare's lead in moving to a population health model, but Matthew said that while private insurers do adopt Medicare policies, they’re more aggressive than Medicare in population health management and are leading the way by developing more risk-oriented health plans.

A member of the audience asked about the advancement of personalized medicine and use of genomics in the healthcare environment. Matthew said, “It’s slow, but it’s happening.” Stem-cell therapies used to be considered exploratory, investigative and experimental in the US, but are proving effective and are now popular treatments. But insurance doesn’t cover them, so these procedures are an out-of-pocket expense, he said.

“So what’s driving this is the cost-model component,” Matthew said. “There’s huge benefits to [personalized medicine/genomics], but again, you’re taking a huge tanker on the sea and trying to turn it 180 degrees—it’s going to be awhile.”

One area benefiting from personalized medicine and Big Data analytics is oncology. About half of insurers pay for genetic testing to match treatment protocols with patient genetic profiles, and genomics companies are paying for the rest, because they want to see genomics become a standard practice, Matthew said. He said payers are latching onto some things that are useful and proven to work. Pictured are Lance Carlson, Matthew Jenusaitis, Chris Ross, Jake Rohe and Scott Mackey.

Lance said population health implies a whole range of services and different types of patient experiences, and asked how this is playing into healthcare project development and design.

Elizabeth said population health doesn’t actually affect design of facilities, but there’s more focus today on enhancing the patient experience than ever before.

“It’s about diversifying and finding the right locations to base your services out of,” Scott said. “In designing a facility, you’re just trying to make it comfortable—not a sterile environment or a place you dread going to.”

Healthcare facilities are beginning to look more like lifestyle centers, where people not only go to see a doctor when they have the sniffles, but also for wellness and preventive offerings, such as exercise and nutrition classes, Jake said. He mentioned some Kaiser facilities are even hosting farmers markets.

Matthew talked about the phenomenal level of technology going into all types of healthcare facilities. “We’re way wired, pumping millions of dollars into distributed antennas to make sure everybody can use their devices—have access to WiFi everywhere,” he said. UCSD is stringing CAT 7 cable to provide high-speed data transmission.

Charles said the expansion of technologies and services in healthcare facilities will continue and predicted the introduction of lots of new technologies and services that haven’t even been thought of yet.

Jake recalled visiting a hospital in Seattle that had a tech bar with two employees dedicated to finding patients the right phone apps for whatever it was they wanted to do—counting calories, monitoring diabetes. There was also an insurance education booth that provided patients insurance basics—the difference between a co-pay and a deductible, what in-network means or limits of liability. 

Responding to a question from the audience about where natural light and other design elements proven to speed healing and improve the patient experience are being incorporated into facility design, Scott said there’s a more holistic view of patient care, and providers are cognizant of what patients are looking for.

“There will continue to be a trend toward natural light and things like that, as there’s been Six Sigma studies throughout healthcare, so providers are on the front end, designing facilities around what speaks to a holistic patient center,” Elizabeth said. This includes natural daylighting in patient rooms with a view to the outside or a headboard on patient beds at Kasier facilities that mimics the natural circadian rhythm, going from bright daylight to soft amber as the day progresses. “So the built environment is really impacting patient care and the ability to heal,” she said.

“We’ve got so many changes going on in healthcare, the challenge is how to design a facility around many influences,” Chris said. “We’re working on transactions where the biggest challenge is getting business done, while catering to different needs.” He said the rising cost of construction is another issue.

Scott summed up the bottom line for developers: “It all comes down to working with providers and administrators, taking input from them to create a space that meets medical needs and makes patients happy.”