On the afternoon of Nov. 6, healthcare futurist Joe Flower predicted President Obama would see another term, and with that new term healthcare reform would see implementation. As it turned out later that night, he was correct.

This was just one of a several projections Flower made on the future of healthcare in the United States—and how our buildings will need to support this shift—as part of his closing keynote session at the HEALTHCARE DESIGN Conference in Phoenix, “What Will You Build in the Next Healthcare?”

It’s no secret that healthcare costs in the United States are grossly higher than those of other developed countries and that the current system, by most accounts, has been deemed unsustainable. Looking ahead, Flower says the future of healthcare must be focused on managing incentives and risk, meaning hospitals are going to need to be efficient, effective, and easily accessible.

And with a “wild proliferation” of different ways to provide care anticipated, Flower says the healthcare design industry must prepare for what architecture will best support the new atmosphere to come.

“That is the question that has to occupy us,” he says.

With future care delivery models requiring flexibility to best prepare facilities for the uncertainty that prevails, Flower adds that adaptive design will be key: “Get the building out of the way of operations.”

With a new patient population entering the system with healthcare reform, changes in reimbursement models, and chronic diseases linked to obesity on the rise, Flower predicts that five shifts must take place in healthcare to brace for what’s to come.

The first is to explode the fee-for-service business model that exists today, which has commoditized healthcare to the point that consumers can’t shop for value. But replacing it with a value-based model won’t be easy, Flower warns, since revenue sources, business structure, physical environment, workflow, relationships, and so on are all tied together and must, therefore, undergo change together, too.

However, Flower says the push toward value will mean a system created around the patient (or the population in general—such as to focus on prevention of obesity), taking patient-centered care beyond theory.

“We’re getting to a point where it’s more than a buzzword. It’s an operations model,” he says.

Next in the five steps is building on smart primary care by moving upstream and getting closer to patients in ways they’re not used to—for example, in easily accessible retail outlets or through comprehensive treatment provided in medical home models of care.



Third is to “put a crew on it,” or build an effective healthcare environment with a team-based model, driving risk to the operational level.

Normally in a team environment, Flower says, there’s a scoreboard that all players look toward. However, that’s not quite the case in healthcare, where in today’s system each team member may have a different agenda or ways of looking at patients and outcomes.

Flower instead encourages the use of an integrated practice unit, a dedicated group with a range of skills to treat a defined problem and take deep personal interest in doing things that make a patient better.

Next up is preparing for the patients of the future, a customer base that will come with healthcare reform and likely be different from those in the system today. Flower predicts these new patients will be less educated, have lower incomes, and/or bring language barriers.

And to answer this, he says evidence-based design (EBD) will be more important than ever. “Beauty matters for them, but even more so for functional, therapeutic, and financial reasons,” Flower says, adding that an attractive environment will help build trust and, therefore, help establish a place where a long-term, face-to-face relationship can flourish.

Finally, Flower’s fifth shift is to rebuild processes, especially how healthcare facilities look at metrics. And what should be measured? Everything, he says: from patient outcomes and feedback to cost and experience.

“If you don’t measure something, you can’t improve it,” he says, adding that the use of EBD will be critical to generating evidence that can drive business strategy.

And when all of these five pieces come together, Flower says a complex system begins to take shape, but it will be a system that is leaner, smarter, and smaller than what we know today.

Jennifer Kovacs Silvis can be reached jsilvis@vendomegrp.com.