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Developing (or Updating) Your Primary Care Master Plan
The importance of a health system’s primary care network has become increasingly important, especially when you consider the idea of population health management. Primary care providers can be the most important entry point into your system. Since these physicians typically practice outside the walls of the hospital campus, primary care networks tend to get developed somewhat haphazardly over the years. If this sounds familiar, now may be the right time to assess your primary care master plan.
The primary care master plan is often neglected but might be the single most important facility planning document in your health system today. Primary care is booming. You need to make sure you are building and maintaining practices in the right locations.
Where to begin
The team responsible for the system’s real estate portfolio is key in the development (or updating) of the primary care master plan. This group may live in project planning, in facilities development, or in real estate services. No matter the name, their job is to carefully balance property management, lease contracts and real estate purchases, etc. When the VP of Practice Management walks into your office with the Director of Business Development to discuss the state of the primary network in the organization, what steps do you need to take to be prepared?
Step 1: Assess your market share
First, study the current market. Practice managers should have a good handle on the catchment area of each primary care location and the anticipated (current and growth) market share based on competitive analysis. Overlaying this information onto a map of your locations will show you a clear view of where patients are coming from and what locations they prefer.
Step 2: Assess the condition of your current locations
Next, you need to look at the physical condition of each location. A health system’s primary care real estate is rarely consistent. Typically a portfolio will include both leased locations and owned locations, which have most likely been acquired through the acquisition of provider practices, lease deals and some new construction. Start with the basics to understand the assets you have by performing a Facility Condition Assessment (FCA). These assessments take a methodical look at each property to help you understand not only the current condition, but also the anticipated future maintenance investments. If your assessments are greater than 5 years old, we recommend you update the FCA. Proper assessments of each location will allow you to develop strategies that tie the business goals to your real estate infrastructure.
As part of the FCAs, you may consider having a qualified team assess the locations’ operational efficiency. By looking at the throughput of each practice (patient visits per provider, per month, for example), you can easily benchmark against national standards.
But what are the underlying causes of inefficiency? What is the building doing to help or hinder your staff in providing quality care? A healthcare architect, through observation, interviews, and analysis, can shed light on potential improvement areas.
Step 3: Identify a realignment strategy.
Ask yourself, where do we want to go? Once you have a clear view of your current state (business and real estate assets), the team is ready to develop, or update, the master plan. In the past 5 years, the fabric and demands of primary care has completely changed. You most likely have some locations that are bursting at the seams, some locations that may be underperforming, and others that could benefit from significant operation improvements.
The realignment process should start with a multidisciplinary workshop that includes the business, real estate, and planning team in the same room. You will have all of the resources on hand to brainstorm ideas and make set initial direction. Pull out the overlay map of your current locations and your potential catchment areas. Ask your team:
- Where are your areas of growth?
- Where are your areas of saturation?
- Are there simple realignment moves you can make by developing a new location or moving a practice to a different geographic location?
As you are moving these pieces around, have the FCA information readily available. Questions to cover include:
- What locations are in the best condition?
- What locations work best for the health system’s balance sheet?
What investments make sense?
This information, along with knowledge about real estate in the area, is critical to developing a new (proposed) plan for further investigation.
Step 4: Support your future primary care practice
The operational model of primary care is rapidly changing. Electronic health records are common. IT networks across the country have dramatically improved. Retail stores are offering care services. “E-care” solutions are seeing exponential growth. Right now, the only things we know for sure is that change is happening and flexibility is key.
Using all of the information gathered and analyzed by the team, you can begin to develop comprehensive solutions (through design improvements, acquisitions, sales, operational adjustments, etc.) that set your organization’s primary care network up for success. The result of will be a series of intentional moves that clearly support business objectives. With all of the options on the table, you can begin to outline a plan that fits the urgency and capital appetite of your health system. Some moves may be small (i.e. renovating exam rooms and staff work areas to increase efficiency) while others may be large (i.e. building a new integrated care campus in a growing area of your network).
The key to a successful master plan is providing a road map that identifies high priority initial moves and supports flexibility in the future.
Having the right team to support your organization in this strategic effort is critical. Whether you utilize in-house resources or outside consultants, trusted partnerships will help you navigate the every-changing healthcare real estate market. Architects, engineers, planners, process engineers, etc. who know your organization and its goals should look beyond a single engagement and serve as advisors as you develop new initiatives, find new properties and expand your network.