One of the very first blogs I wrote after joining Healthcare Design in 2010 was on healthcare reform and what it might mean for this industry—a topic that’s remained evergreen over the last few years, to say the least.

From anticipation of a U.S. Supreme Court decision on the Affordable Care Act (ACA) to the ruling upholding reform to implementation of the legislation, those on the planning, design, and construction side of the coin have spent a lot of time in “wait-and-see” mode as clients sorted through their own new realities of care delivery.

And while many providers are still struggling with what the ACA’s reimbursement changes will mean for their bottom lines, and subsequently how that translates to available capital for future construction projects, there’s a lot tied to reform that we do know now.

We know that a value-based model of care will replace one driven by volume and that providers are incentivized to keep patients well. The solution has increasingly become focused on preventive care delivered via new ambulatory care networks built at the community level.

We know that hand-offs between primary care doctors and specialists with little communication between the two is an outdated model being replaced by collaborative approaches like medical home models of care, requiring a new look at existing spaces to encourage teaming among caregivers.

And we know that this focus on wellness will in theory tackle the prevalence of chronic diseases we see today, meaning the flood of existing inpatient beds won’t be needed in the future and existing spaces must be repurposed for other programming, requiring thoughtful master planning.

Translation: We know there’s plenty of opportunity emerging.

That’s what I heard from respondents to Healthcare Design’s 2014 Corporate Rankings Survey. These opportunities, however, come right alongside the threats that still exist in a new reform environment.

While ambulatory projects are flooding design boards, they’re smaller than acute care spaces of old and require volume to match previous years’ billings. These spaces are also less complex, comparatively, allowing new firms to enter into what was once a specialized niche of the A/E/C world. And when projects do get the green light, pressure from clients for short schedules and tight budgets are common challenges.

You’ll see a lot of this reflected in the data captured from healthcare design business in 2013, as the industry continues to take on new shape. And while it’s different than years ago, I think there’s value in knowing what you’re up against. The unknowns are falling away, and there’s plenty of information available today to help plan for the future.  
I’ll be digging into this more deeply in an analysis of the survey results—watch for that and rankings of our top A/E/C firms here online and in the July issue of Healthcare Design