In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Alicia Wachtel is vice president and regional healthcare practice leader for the Los Angeles office of HOK. Here, she shares her thoughts on retail clinics, medical office buildings, and urban healthcare planning.

1. Follow the money

Capital, construction, and operational budgets are silos in most healthcare organizations, yet they all influence outcomes in facility design and construction in a manner that’s apparent when the Public-Private Partnerships (P3) delivery model is implemented. Over the 30- to 50-year life expectancy of a healthcare facility, approximately 9 percent of the cost is attributable to design and construction while the remaining 91 percent is associated with operational costs. Compare the price tag of floor-to-ceiling solid-surface material in high-impact areas of a hospital with the cost of labor to paint the same walls over a 30-year period. Suddenly, the material cost, which appears prohibitive if you look only at design and construction costs, is relatively small when you consider the impact on the operational budget over time.

2. Population health and sustainable urbanism

More than half of the world's population is city dwellers and the World Health Organization estimates that will increase to 70 percent by 2050. As urban planners and designers strive to create sustainable urban environments, the U.S. government struggles to provide affordable health care. Cities offer a concentration of amenities, services, jobs, and opportunities that spur urban growth and, often, unintended sprawl. Meanwhile, the shift to population health seeks to reduce our nation’s share of the world’s 3.2 million annual deaths attributable to physical inactivity and the 1.3 million annual traffic injuries through prevention programs. Consciously adding a layer of population health drivers onto city grids should be part of responsible urban planning.

3. The MOB model

Is there an opportunity for healthcare architects to team with real estate developers to create a new model for old typologies? Architects who understand existing healthcare real estate and its functions—from hospitals and clinics to doctors’ offices—can create a bridge among facility types. A re-envisioned medical office building (MOB) model should be part of a synergistic system of inpatient settings, other outpatient settings, and providers capable of delivering integrated and coordinated care, rather than a series of competitor-based care facilities all chasing for the same patient dollar and recreating options that already exist.

4. The penalties and incentives test

Clients today face potential penalties and incentives based on Medicare's Value-Based Purchasing (VBP) Program, which has a payment structure that’s based on two sets of measures: timely and effective care and patient satisfaction. In 2013, hospitals had the ability to earn up to 1 percent extra for each Medicare patient’s stay or lose as much as 2 percent based on these measures. These percentages are scheduled to grow. For years, the design profession has been promising to deliver positive impacts in the reduction of infection rates, the creation of quieter, less stressful healing environments, the implementation of Lean principles to increase efficiencies, and the avoidance of medical errors and much more—the very attributes measured by the VBP Program. Are we making a difference yet?

5. Have it your retail way

Consumer-driven growth in healthcare services is capitalizing on patient preference by making care accessible in non-traditional environments. One example is the retail-based mini-clinic that’s taking off at such places as CVS, Walgreens, Target, and Walmart. Usually staffed by nurse practitioners or physician’s assistants, the clinics generally stay open evenings and weekends when most doctors’ offices are closed, the pharmacy is right there, and the patients can do other shopping. Another retail clinic model is mammogram screening at Nordstrom. The clinics are located in select department stores and are very successful for the patient, the clinics (operated by local healthcare organizations), and the store. An appointment becomes part of a planned day of shopping for friends or family who often schedule back-to-back appointments.

Alicia Wachtel

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