Healthcare Design - May 2017 - 30

CHUCK SICONOLFI

Title: Medical Master Planner, Principal
Firm: Perkins+Will (New York)
Number of employees: 2,284
Healthcare revenue in 2016: $90.1 million

BUSINESS CHALLENGE: SUPPORTING CLIENTS
I N U N C E R TA I N T I M E S

Funding structures for the provision of healthcare services are
changing, yet no one can say how or what the ultimate impact
will be. As the need to control cost persists, healthcare systems
face unprecedented challenges in planning how to serve their
communities. For healthcare design firms, this translates into
the challenge of how to best serve clients. In some cases, new or
renovated facilities will be the answer; for others, new service
models. The solution must be determined by the assessment of
a health facility's physical infrastructure.
Recent attempts to change the way healthcare services are funded have
left many questioning what the future holds. But it's important to look at
what's to come: New technologies will deliver new treatments, the population will continue to age, and the demand for services will be strong. Hospitals and healthcare networks will need to develop new, advanced strategies
to meet those needs and provide quality care, and make facility and real estate decisions that support those strategies. The design community must
support them with these efforts.
W H AT ' S B E H I N D I T

We are, in a sense, in a good position to reinvent the future of healthcare.
Science is progressing every day and delivering more effective treatments
than ever before. This is due to advanced technologies that are providing
new ways to interact with and discover treatment patterns buried in all the
data that patients generate during the receipt of care. Additionally, population health strategies (or value-based strategies) have the potential to realign incentives toward disease prevention. These trends are complementary and will help to control providers' costs.
In the short term, there's concern that a large percentage of those who
gained insurance coverage through the Affordable Care Act -especially
in states that accepted the Medicaid expansion-will lose that coverage as
the federal government curtails or withdraws health insurance subsidies.
When coverage is lost, neither illness nor wellness are managed. People
present at emergency departments with chronic episodes of what would
otherwise be manageable conditions, and they present in a much worse
state. This uncompensated care delivered by providers is associated with
an increase in costs to hospitals, taxpayers, and those with insurance.
Conditions like these make it difficult for healthcare providers to move
forward and plan new healthcare facilities. The immediate challenges for
healthcare providers are to understand new and emerging healthcare
models, the incentives that are created or eliminated, and the programs
that must be supported.

MAY 2017

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THE SOLUTION

Consider the intersection of healthcare and payment models. In markets with a high percentage
of revenue in fee-for-service models, inpatient
days per 100,000 people equates to about 120
days. In markets with a high percentage of valuebased healthcare arrangements, the number of
inpatient days for the same population equates
to about 60 days.
As designers and planners, we must be prepared to understand the effects of these changes
on our clients, to assist in the quantification of
those impacts, to evaluate the suitability of the
physical assets of a health network, and to develop new design solutions. In this, we can offer
solutions to our provider clients that respond
to the changes in their business and healthcare
models. A new building may not always be the
answer, but a combination of health strategy assessment, facilities assessment, and future scenario testing can provide our clients with the
best match between their goals and the tools
they use to deliver them.
To quantify the effects of these changes, utilization studies of key service modalities and
demand studies can be conducted. The latter
often requires close cooperation between the
design team and strategic planners. A facilities
assessment process can inform the client and
the design team about the extent to which current facilities support their evolving mission and
needs.
Considerations today include the need for
more ambulatory care services with greater interventional capabilities and virtual connectivity to be located closer to the communities they
serve. Additionally, inpatient environments will
continue to require replacement because existing facilities don't provide single patient rooms
and high degrees of safety and efficiency. Facilities will also be needed to house staff who manage remotely monitored patients, and these
spaces may also evolve to support the staff who
supervises and renders in-home care.
WORDS OF WISDOM

Designers and strategic planners working in
concert with healthcare providers can answer
the reductive forces of wellness, improved
healthcare models, technology, and value-based
compensation. This is contingent upon the
growth of insured individuals, the overall population, and the aging population. They can also
match that balance to the physical structures in
which a health system operates.

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Healthcare Design - May 2017

Table of Contents for the Digital Edition of Healthcare Design - May 2017