In the first two parts of this three-part series (Part 1, Part 2), we explored the constraints and opportunities during the healthcare sector’s transition in the changing regulatory environment. At a global level, we concluded that there are two fundamental strategies that appear to be the key to the success of future accountable care organizations (ACOs): bringing health to the populace and capitalizing on the potentials inherent to active living principles in designing the physical setting of the continuum of care.
While doing so, we built in the assertion that, irrespective of the direction the healthcare sector adopts (ACOs or some other form), the main solution to the current problem is to reduce the cost of care. The focus of Part 2 was on acute care facilities. In this part, we will focus on the pre-acute and post-acute care settings, which are expected to provide a considerable chunk of services to the future population in the quest for reducing healthcare costs. What are the physical design implications? Will there be any necessity for physical design changes in these settings?
Articulating physical design interventions warrants a closer look at the main challenges. Two of the fundamental avenues toward cost reduction are to (a) keep people well through health promotion and (b) provide more care at a lower cost in pre- and post-acute care settings. That includes reducing the impulse of a sizable portion of the current population in treating the emergency department as their primary care setting.
In response, almost every acute care provider organization has embarked upon the task of developing relationships with providers in pre- and post-acute care settings. It is a challenging task that is, nevertheless, acknowledged as the key step in providing cost-efficient care.
These emerging configurations of provider organizations are predicated on one vital assumption/ precondition—that the population at-large (healthy as well as the ill and injured) will maintain an appropriate care regimen depending on their health status, including regular checkups and treatments as necessary. This will ensure maintaining health, preventing illness, and reducing the chance of acute illness, which may require long hospitalization and expensive treatments.
Some contemporary developments already are challenging this premise. For instance, rising out-of-pocket expenses for a clinic visit (originating from deductibles and co-pay rate increases) are a formidable challenge that may act as a disincentive. For many, it is in addition to the problem of physical access to a provider. In this context, if a care environment is perceived as unsafe, stressful, or cold, the combination of financial, cultural, and environmental impediments could almost guarantee non-participation of a section of the population (those who are not critically ill or in immediate need of care) in preventive or timely health care.
The challenge in diverting non-emergent patients away from the emergency department may, in such a case, continue to exist despite the formation of extensive networks of provider organizations.
The physical environment is not a panacea for all problems. However, for a sizable segment of the population, the physical environment of care could prove to be the tipping factor between maintaining and not maintaining a regular health assessment and/or treatment regime. This is especially true for the ones who are not in ill health (and hence needing only preventive care and health maintenance) or those who are able to manage their daily lives despite ill health (procrastinating care until reaching acute conditions).
How could the physical design, in conjunction with other factors, motivate this segment, specifically, and the entire population, generally, to maintain health and prevent (emergence or reemergence of) acute illness?
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