Healthcare Planners on the Affordable Care Act, Part 2

Today two of our leading healthcare planners continue their conversation from earlier this month (Part 1) about the impact of the Affordable Care Act.

Paula brings a unique perspective of clinical operations, having been an ICU nurse and Senior Project Manager at Massachusetts General Hospital and Karen brings over 20 years of healthcare planning and design experience to our team.

What changes do we need to make to how we approach the design of healthcare facilities based on the changes to healthcare delivery as a result of the ACA?
KP: New inpatient facilities, or even all healthcare facilities, will need to be designed to enhance operational efficiency and flexibility.

PB: I think there are 4 major drivers.

1. People will get their care wherever they need it and in many forms: Think about the convenience of your doctor or hospital having a partnership with a CVS minute clinic, where your visit there is included in your EMR at the main hospital. For you the location is convenient, the hours are convenient and the price is ‘right.’ There are over 1700 clinics in stores today, (e.g.  Walgreens Healthcare Clinic, Target Clinic, etc.) And with the expansion of the ACA, more of these clinics will accept Medicaid. With improved smaller accurate diagnostics the scope of services in the retail clinic will be expanded. Think now about the power of the vast amount of data that these corporate giants have about your health – rich pharmacy data. This provides a better understanding of population health, chronic disease management effectiveness, costs and our behavior (Did you renew your BP medicine on time or are you only taking it every other day?).Care will be delivered at home and remotely – telehealth. There is good evidence that engaging patients in their care by sharing information, involving them in making decisions about their care results in better health outcomes and incurs lower costs. You likely have access to your medical records and test results.  It was not too long ago they were secured in the hospital and your doctor’s office. We hope patient engagement leads to better compliance. Jeffrey Brenner MD is a family doctor in Camden New Jersey who has been demonstrating for over 5 years how to deliver high quality care in a vulnerable community – reducing hospitalization, increasing quality and reducing costs. It’s not the demise of the acute hospital but I hope it helps us see the bigger picture and importance of the continuum of care. [A Revolutionary Approach to Improving Health Care Delivery]
    
2. Demographics and population health: We face an aging population in a time with chronic disease management, which leads longer life spans. All this doubles the population of the 65+ set in the next 25 years to about 72 Million (that’s 20% of the US population in 2030). Also, our healthcare systems need to own the entire continuum of care. Outpatient day care programs, geriatric and cognitive impairment care facilities will need investment. The Alzheimer’s Association recently released facts and figures noting that today 1 in 3 senior citizens die with Alzheimer’s or another dementia. By 2050 the number of people age 65 and over living with Alzheimer’s could triple to a projected almost 14 million (13.8M).
    
3. Healthcare Analytics: While not all ‘big data’ is ‘good data,’ we have seen how data is being used to measure quality and value in healthcare. This helps the organization develop systematic approaches to improve network performance and redesign processes.
    
4. Biomedical, Diagnostics and Pharmacological advances: Much smaller devices (nanotechnology) such as ventricular assist devices – 15 years ago this device meant you had to ‘live’ in an intensive care unit, today people are living at home.Lab testing, which, with accuracy can be done at home or provided in a mobile clinic is reducing costs of those LAB tests.

   The advances in molecular biology and nuclear imaging are also really interesting to me – e.g. a new isotope ‘spots’ your cancer months earlier, which enables different treatment options. And while we complain about the costs of ‘big pharma’ these medications are preventing worsening disease and giving people a better quality of life as they live at home.

What are the most interesting opportunities for innovations in healthcare design do you see coming out of the requirements of the ACA?
KP: Hospitals are transitioning from a fee-for-service to actively managing the population’s health, and receive incentives for keeping people healthy. They are now benefitting from reaching out into the communities to deliver care and many have looked to building re-use to get their services closer to their urban patients.  Adaption of abandoned strip malls and other vacant retail space is particularly appealing from a sustainable perspective. Telemedicine will also have a greater impact. Both in terms of clinician-to-clinician and clinician-to-patient, the design of spaces to support the communication in compliance with HIPPA regulations could change our approach to clinician work space as well as the amount of space allocated.

PB: I see the most innovation coming from the drivers of care I mentioned; embedded ubiquitous technology in the home and design that supports multiple levels of physical and neurocognitive disorders. As Dr. Eduardo Salas said, “Healthcare is a team sport” and we need to plan spaces and places that support multidisciplinary teams and more inclusion of other health professionals into every aspect of care.

Are there any drawbacks to the impact that you see the ACA having on how our healthcare clients make decisions related to their facilities or design?
KP: Construction budgets will be tighter and there will be a demand to stretch each dollar. There will be a greater emphasis on efficient, low cost design. Construction cost will likely be the driver of decisions as institutions will have less available funding therefore making the ROE arguments for sustainable design more challenging.

PB: As the continuum of care expands, capital investment decision-making would seem to lead to more holistic planning.  I think there will be less acute hospital centric spending while still maintaining the power of the AMC – quaternary care – upgrading diagnostic equipment, finding ways to get more private rooms out of their existing space.

How do the changes required by the ACA align with other goals within the healthcare design industry (evidence-based design, WELL certification, resiliency, sustainability, etc)?
KP: Hospitals will be looking to maximize acute care operational performance. Any means that facilitates a more cost-efficient, streamlined operation for inpatient care, such as Lean strategies or evidence-based design, will be used more and more.

PB: In the past I think the design community reported evidence based design (EBD) based on the physical environment only. I am encouraged that EBD today includes that other factors including clinical work processes and organizational culture are equal partners in improving care and performance.

I think most major centers are well informed on resiliency but perhaps community hospitals have had less investment over time. I think sustainable strategies will be considered the norm and we will have better data on the operational costs of running facilities to feed back into our design decisions.

Related:
Cultural Shifts Transforming Healthcare Design: An Introduction
Does Remote Health Monitoring Mean the End of the Exam Room?
Adapting Healthcare Design to Accommodate Future Generations
The Future of Flexibility in Healthcare
DMB UNITE: Healthcare Environments
A Challenger to Proton Therapy?
Inpatient Care Units & Wireless Telemetry
Healthcare Trends: Looking Back to Move Forward
Impacts of the Affordable Care Act on Hospital Design
Leveraging Opportunities in Hospital Design for Resiliency
Healthcare Planners on the Affordable Care Act, Part 1