Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, offered the attendees assembled for ASHE PDC in San Francisco his perspective on where we’ve come from and where we’re going now that the Affordable Care Act (ACA) is a reality. His keynote speech, “Healthcare Reform: Implications and Challenges,” focused on supply (a.k.a. our industry) versus demand (patient needs/wants) in shaping the built environment.

Keckley set the stage with a discussion of how healthcare spending saw a 4 percent increase this year, as it has every year for the past three years, while the GDP has increased just 2 percent year over year during that same period. As a result, “every other industry’s bottom line is less,” he said, and reminded the audience that employers are making more noise about finding a path to economic recovery that will require healthcare spending to slow.

Along with fixing the insurance system, Keckley continued, ACA aims to fix the delivery system as well, and he spelled out the three new changes to effect that: (1) the move toward permanently replacing   fee-for-service incentives with outcome-based models, (2) incentives to reward clinical integration across the delivery system for a more holistic continuum of care, and (3) focus on clinical innovation that reduces unnecessary healthcare procedures and practices. This last one, Keckley said, “is probably the biggest blind spot” for those in our industry, who may not realize that the budgets required to define necessary care is what “used to be spent on bricks and sticks.”

In the meantime, he said, consumer preferences cannot be ignored. He said that polling shows that 70 percent of people under age 45 would like to “chuck the system” we have and move to a single-payer system. In addition, patient preferences are driving more demand for retail health--alternative medicine and healing options--citing the example of post-menopausal pain treatment focused on yoga and tai chi over medication.

What this means for the built environment is fewer beds, “beyond what current medical staffs think are necessary. It’s demand driven, not supply—that is, us—driven.”

And how does this new focus on patient preference drive the design of facilities? People have high expectations for well-designed and “nice” facilities and amenities, Keckley said, especially in ambulatory settings. But the real question, he added, was “how does that set up the retail health options?”