The dual themes of this month's issue-patient room innovation and healthcare reform-highlight the million dollar question on everyone's mind: “What impact will healthcare reform have on facility design and construction?” It's been talked about at almost every meeting I've attended over the past year and the answer is always the same-nobody is really sure how, but everybody knows that it will. In the same way that technology is changing not only how we deliver care but where we deliver it, it's clear that healthcare reform will impact everything from the process of care to the environment of care. We have already seen the impact of reimbursement changes and have had to focus our attention on health outcomes over expediency of care. At its best, reform will highlight innovation in all aspects of healthcare and this will surely include the built environment.

All things inevitably change under pressure. We need only look at most major social reformations over time to see this or at a diamond, created after carbon is exposed to billions of years of intense heat and pressure. Though we don't have billions of years to find appropriate solutions to the issues we are facing in healthcare, there seems to be the possibility of promise on the horizon.

A number of promising and potentially innovative new models of care will be funded and tested through the Patient Protection and Affordable Care Act. Only time will tell what transformational opportunities may come from these new demonstration and pilot projects, but it's obvious that innovation is a priority of the U.S. government, as the words “demonstration” and “pilot” are mentioned 392 times in the newly passed legislation. Many of the projects are far afield of the work we do around the built environment, but more than a handful could yield results that directly impact facilities, especially as they start to look at wellness models and pay-for-performance. They include:

  • healthy aging, living well; evaluation of community-based prevention and wellness programs for Medicare beneficiaries;

  • demonstration project concerning individualized wellness plan;

  • pilot testing pay-for-performance programs for certain Medicare providers;

  • demonstration project to evaluate integrated care around a hospitalization;

  • independence at home demonstration program; and

  • medicare hospice concurrent care demonstration program.

The legislation also establishes the Center for Medicare and Medicaid Innovation (CMI) within CMS. The new CMI may be instrumental in spurring innovation. According to the language in the legislation, “the purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients.” Models that prove successful in the demonstration phase can more easily be expanded nationally. A significant opportunity now exists for us to make the connection on a national stage between the built environment and improved health outcomes and reduced costs.

Another innovative movement growing out of the turmoil of the current environment is the move to create company owned health and wellness centers. These ambulatory care centers are company-owned and run, providing convenient access to care, as well as complimentary and alternative therapies. Cisco's new on-site LifeConnections Health Center is just one example (HEALTHCARE DESIGN, June 2010 issue). Cisco employees and their dependents are able to access a breadth of medical services, in a thoughtfully designed setting, ranging from primary care and physical exams to immunizations, lab work, health coaching, acupuncture, chiropractic care, and physical therapy. Also available is an on-site pharmacy. In addition the health center has childcare and a state-of-the-art fitness facility to encourage a healthy lifestyle. Cisco believes that healthier employees are also more productive employees and the new LifeConnections Health Center allows the company to apply its own technology solutions to create a more holistic and integrated experience for its staff.

As technology advances, we will see even more innovative solutions for the patient room, especially as the patient room moves from mostly acute care hospitals into people's homes. How these environments will interface with the acute care hub, how patients will be monitored over the long run, and what service industries will grow out of the opportunity for certain illnesses to be treated from home has yet to be fully seen, but it's clear that the possibility is on the not too distant horizon.

Reflecting on past economic downturns, it's clear that though economic turmoil is painful and unsettling, it also brings out the entrepreneurial drive that leads to significant innovations. These innovations may one day lead to a healthcare system we may only be able to get a glimpse of today. A system that, in time, could provide safe, efficient, effective care in facilities designed using an evidence-based approach. This would help reduce the economic burden on our society, and create a culture that focuses on prevention and wellness in addition to state-of-the-art effective treatment of illness-all at a cost that can be sustained over time. HD

Healthcare Design 2010 August;10(8):8