The access to healthcare and the cost of providing it are driving many decisions within your organization today. Capital expenditures are being reframed as “capital investments” in facility meetings across the country. You are being asked to develop ROI statements for every project requiring funding. In the outpatient environment, prevention and choice will continue to drive your facility development strategy.


As illustrated in this chart (part of a Commonwealth Fund report), the healthcare system in the United States ranks last among 11 comparably wealthy nations. I could find 100 similar charts and none of them would surprise you. The health of our population is directly connected to the expense of our health system. To support the focus on wellness care over medical care, your facilities need to change:

  1. Primary care centers will replace small physician-centric practices. From Patient Centered Medical Homes to Accountable Care Organizations, the system is looking for ways to coordinate care and ultimately improve prevention. These practices will be “care team” centric with numerous roles supporting the delivery of care to each patient. This results in larger, flexible work areas, consultation rooms over full-sized exam rooms, and a renewed focus on throughput. In a recent presentation, a futurist physician theorized that providers would be asked to double their annual visits over the next 7 years. To support this, teams may grow from 2 (provider + medical assistant) to include RNs, care coordinators, wellness counselors, and specialists.
  1. Be prepared to compete with (or partner with) employer-provided healthcare delivery models. From physicians to employers, everyone is getting into the mix. The idea of providing care directly are work is hardly new, but the focus has changed. (It) has shifted largely to health promotion, wellness and an array of primary care services, rather than occupational health or convenience care. Indeed, the increased interest in onsite clinics is linked to greater demand for workplace wellness programs—an interest shared by both employers and policy makers. If an employer can provider care directly to its employees, it has the ability to reduce costs by improving wellness and limiting the need for reactive care. More and more, my healthcare clients are developing clinics within company campuses.

Care coordinators are calling patients to ensure they have filled their prescriptions. Employers are offering wellness programs and incentives to lower insurance premiums. The U.S. Department of Labor is clear about the strategy, “Implementing and expanding employer wellness programs may offer our nation the opportunity to not only improve the health of Americans, but also help control health care spending.” Gone are the days of private physician offices; multidisciplinary care teams work collaboratively to ensure the complete health and wellness of your patients (often referred to as clients) in large, flexible clinics.


The trend toward higher deductible insurance plans put the choice (and the responsibility) in the hands of the patient. The focus of the conversation is now shifting toward patient education. Jeff Jones of Huron Consulting Group reflects:

High-deductible plans, because they place greater financial responsibility on consumers, serve as a good way to increase patient engagement. The experience to date shows that patients with high deductible plans tend to reduce utilization across the full range of care from preventive and elective care to more urgent care. Payers and providers should focus on improving patients’ understanding of when and where to access care based on their condition

With this increased engagement and the development of Yelp-like ratings for physicians, the power of choice drives decision-making. Health systems must focused on improving their offerings, improving their processes, and improving their facilities to keep up with the competition.

  1. Develop (or revisit) your primary care real estate strategy. Working closely with the executives in your organization who are recruiting physicians, defining catchment areas, and calculating market share, your real estate and facilities groups need to develop a strategy for supporting the new era of care delivery. What buildings do you lease? What buildings do you own? What property do you want to strategically acquire? The more time you can give your group to ask these questions and generate answers, the more capital flexibility it gives you.
  1. Update your off-campus facility assessments and be prepared to invest in modifications. The new competition is for patients to enter your health system through their primary care provider. Outdated and inefficient facilities are an immediate (and obvious) barrier to choice. How long until your boiler gives out? What expansion capacity does your electrical service have? Can you accommodate a mobile imaging trailer are your locations? By working with your A/E partner to assess the condition of your facilities on a regular basis, you have the information you need to develop a clear plan for keeping your facilities aligned with the strategic objectives of your organization.

I recently had two friends go on recruiting visits. Not to college campuses; to mother-baby units at competing hospitals. It’s logical that health systems have historically spent significant capital dollars on mother-baby units as they are often the “front door” to the health system. Women make 80% of care decisions for their families so receiving impressive care during this major event sets the health system up to serve the family in the future. The primary care network is the new mother-baby unit.

With the advancement of technology, the (required) expansion of the comprehensive electronic health record (EHR), and the trend toward hospital employed physicians, it is clear that health systems see their primary care networks as a key to their survival. Once you are in the network, they want to make it as easy as possible to stay in the network.

So why are we talking about outpatient care so much? Because many believe that building strong primary care and outpatient care networks will close the gap between cost and outcomes in the United States. This means the networks are growing and the current processes (and spaces) will need to adapt to support them. “The United State health care system is the most expensive in the world” and it is clear that one strategy to improving that dialog is a focus on outpatient care.