Decoding the Recipe for Success for Your Ambulatory Strategy

  • November 9, 2018
  • Author: Michael Pukszta

minnesotaWhile the major shift from inpatient to ambulatory care is allowing healthcare systems to remain at the forefront of medicine, it also creates significant challenges with respect to reimbursement, revenue, and patient volume. Exacerbating those challenges, there isn’t a “one size fits all” ambulatory strategy. Just as there is no single type of consumer, there is no single right or highest use of an ambulatory facility. Every patient is unique in how they want to interact with a health institution. And technology, digital solutions, experience, and patient expectations all play a role in their interactions.

In order to build a successful ambulatory strategy, health systems need to approach ambulatory care similar to how a chef approaches a recipe. While you may start with the same ingredients, the different amounts and ways in which they are mixed together will create very different results. It is essential for health systems to identify those ingredients, and then combine them strategically to create the successful recipe that matches their patients’ expectations.

Our ambulatory care team understands the many questions this “recipe” may pose for an organization, which is why our approach recognizes the uniqueness of each health system – targeting our efforts to identify ambulatory marketing opportunities and tailor solutions that correlate with each client’s definition of value.

We recently created a report that outlines the four major categories of ambulatory influencers and defines the building blocks for an ambulatory care site, to guide healthcare systems in tailoring an ambulatory strategy to their own unique brand of healthcare delivery.


Finding Certainty in Uncertainty: What Healthcare Can Expect in 2017

  • April 6, 2017
  • Author: Michael Pukszta

Regardless of one’s political beliefs, everyone can agree 2017 promises to be full of uncertainty regarding healthcare. On President Trump’s first day in the Oval Office, he signed his first executive order aimed at dismantling the Affordable Care Act (ACA). While the proposed American Health Care Act failed to gain enough support to become law in late March, House Speaker Paul Ryan has said that continuing to push for an overhaul of the nation’s healthcare system remains a priority.

Most agree a full-scale replacement will take time, and new legislation wouldn’t have much impact this year as government rules for 2017 have already been incorporated into contracts with insurance companies. Furthermore, since the Trump administration has always positioned any potential replacement as a significant departure from the ACA, it could be many years before anything far-reaching is implemented.

Long story short: there are still a lot of unknowns about what healthcare will look like in the future under President Trump. But even with all this uncertainty, we know there are a few ways the healthcare industry (and capital development within it) will change in the years ahead.

Partnerships and moonshots

This past December, Congress overwhelmingly passed the 21st Century Cures Act, which boosts funding for medical research, eases the development and approval of experimental treatments, and reforms federal policy on mental healthcare. The bill, signed into law by President Obama, provides $4.8 billion in new funding for the National Institutes of Health, with $1.8 billion reserved for the “cancer moonshot” launched by Vice President Biden and another $1.6 billion earmarked for brain diseases. Importantly, the new legislation places a strong emphasis on science and evidence, pushing federal agencies to fund programs that are backed by solid research.

Novartis center for advanced cellular therapies

Center for Advanced Cellular Therapies

As a result, one trend we will certainly see continue this year and beyond is partnership. Specifically, we’ll see silos torn down between biomedical companies and academic medical centers, and alliances emerging. For example, Novartis and Penn Medicine recently came together to launch the Center for Advanced Cellular Therapies — a facility designed for Chimeric Antigen Receptor (CAR) technology, which enables a patient’s own immune cells to be reprogrammed outside of their body and re-infused to hunt for and potentially destroy tumors. The partnership between the two organizations is fueled by their mutual goal of finding more effective treatments for cancer.

Mental healthcare overhaul

Although the U.S. is making advances in the treatment of mental health, we have a ways to go before we bridge the gap between the current state and where we need to be. The relationship between physical health, community health and mental illness is complex, and the challenges that need solved are plentiful — from education and access to costs and stigma.

Thankfully, as part of the 21st Century Cures Act, mental healthcare will also be getting a boost in funding. The Act provides $1 billion in grants to states to support efforts to prevent and treat the consequences of opioid misuse and abuse, as well as funds for a number of additional areas related to mental health promotion and prevention of illness. This, along with the continued insurance payment advances that were stimulated by The Mental Health Parity and Addiction Equity Act (MHPAEA), has turned mental health into a profitable enterprise for many providers.

behavioral healthcare space

Virginia Treatment Center for Children

Looking ahead, mental health providers will seek innovative approaches to destigmatize mental healthcare and normalize the treatment environment. We’ll also see a heightened focus on mental health for children, taking cues from trailblazers like the Virginia Treatment Center for Children — an institution set to open one of the most progressive pediatric behavioral health center’s in the U.S. this fall. Proper utilization will also continue to be a focus; hospitals will look for new ways to make sure non-emergent mental health patients who present at the emergency department can easily be referred to primary or psychiatric care. For example, the new University of Kansas Behavioral Health Hospital features a crisis intervention center designed to encourage appropriate utilization and reduce visits to the university’s emergency department down the street.

Micro health on the rise

Outpatient care in convenient settings, such as in MinuteClinics and urgent care centers, continues to be a successful strategy in providing accessible healthcare. Based on the success of these models and the overall growth of the ambulatory care market, we’re now seeing a rise in the business case for microhospitals. Microhospitals are “micro” due to their number of inpatient beds (typically 8-12) and their overall compact size. In addition to being convenient for patients, they provide healthcare systems with affordable settings to deliver care, and the ability to test demand in new communities or provide enhanced services in established markets without an extensive investment.

Of course, the ability to reduce costs and risk by testing a market before going all in is extremely attractive in the midst of ACA-repeal talks. Although microhospitals usually require more upfront costs than ambulatory care and urgent care centers, they’re significantly more affordable than a full-service hospital and they currently experience a much higher reimbursement than ambulatory care facilities due to their inpatient facility classification. Microhospitals are already being built across the U.S., and with a growing body of research emerging on this new approach to care, we anticipate the number of microhospitals will grow, too.

Continued value

The concept of value-based care is directly tied to the ACA, but even with the impending changes, it’s not likely the focus on value will change: keeping people healthy and out of the hospital will continue to be a wide-spread goal of healthcare providers. While most U.S. healthcare providers still live in a fee-for-service world, there are value-based programs that reward healthcare providers with incentive payments for the quality of care they give to people, as opposed to the quantity.

health and wellness center

Allegheny Health Network, Wexford Health & Wellness Pavilion

One of the hallmarks of value-based care is preventive healthcare. As organizations strive to prevent illness and promote wellness, we’ll see more and more embracing a human-centered approach to medicine where the well-being of patients truly is the center of their universe. A great example is Allegheny Health Network’s new Wexford Health & Wellness Pavilion, an ambulatory care center designed to make health and wellness an ingrained part of every patient interaction. Part of doing this has to do with offering team-based and proactive healthcare, while a bigger part of has to do with community outreach, education and engagement. We’ll also continue to see an increase in healthcare organizations promoting a culture of health, not just healthcare in the traditional sense, and expanding into nontraditional health settings via partnerships with employers, retailers and community organizations (e.g. Kaiser Permanente’s partnership with Target).

Reimagined healthcare education

The rate of healthcare transformation is becoming so rapid that it’s often difficult for established healthcare institutions and physicians to keep pace, let alone universities who are challenged to educate the next generation of health providers. Most experts agree we are looking at a shortage of health providers over the next 20 years as Boomers age and put pressure on the healthcare system. Looking ahead, we’ll see medical schools emphasizing an interprofessional model of health education where physicians, nurses, pharmacists, public health and allied health students will become accustomed to practicing medicine together. This will allow the highest-educated health providers to extend their reach by utilizing lower-educated professions. Additionally, since hiring innovative health professionals is essential to healthcare systems seeking to increase their own levels of innovation, it’s likely we’ll see more providers separating themselves from others by completely reimagining their approaches to education with inventive new pedagogies.

For example, one of the biggest headlines related to healthcare education in 2016 was Kaiser Permanente’s announcement that it will open its first medical school. The school, which will enroll its first students in 2019, will enable Kaiser to influence its physicians literally from the beginning of their professional training — teaching them the Kaiser Permanente “way” from day one. In response to healthcare staffing shortages, we’ll also continue to see an increase in health education degrees provided at the college and community college level. City Colleges of Chicago recently opened Malcolm X Community College in direct response to the projected 84,000 regional healthcare jobs set to come on-line over the next decade. The college was designed with input from local healthcare organizations to ensure the school could funnel students directly into these high-demand jobs.

Patient experience

Orchestrating exceptional patient experiences isn’t a new concept, but with a healthcare marketplace filled with established institutions and startups competing for the same patient population, it’s never been more important. But it’s not always easy to get right; the patient experience encompasses every interaction a patient has with a healthcare system — from parking, check-in and wait times to somewhat subjective feelings about design, the quality of cafeteria food, bedside manners of healthcare staff, and that list goes on. With user review platforms like Yelp increasingly being used by patients to share “real-time” experiences, the pressure to perfect the patient experience will continue to intensify.

UC San Diego Jacobs Medical Center

Jacobs Medical Center

Healthcare organizations will continue to invest in strengthening patient experiences by seeking new links between technology, design and service excellence. With a growing body of evidence-based research about the role design plays in healthcare experiences and outcomes, they’ll not only look to improve and measure the overall patient experience, but also give patients the ability to control their own personal experiences. At the University of San Diego Health’s new Jacobs Medical Center in La Jolla, every patient room is equipped with an iPad that can be operated from the bed. The iPad empowers patient to customize their environment by controlling window shades and temperature, in addition to ordering meals, controlling an in-room Apple TV, and giving patients access to their treatment schedule, medical records and doctor conversations.

The new University of Minnesota Health Clinics and Surgery Center is also enhancing patient experience via technology with a program called CareConnect. Patients are given a badge with a tracker when they arrive at the clinic, and the CareConnect program allows clinic staff to easily find patients and get alerted if they’ve been waiting too long. Coupled with a patient experience modeled after Apple retail stores where concierges greet patients with mobile technology, the clinic has been able to decrease wait times and improve personalization and privacy.

While healthcare re-reform will mark another important moment for U.S. healthcare — and will likely create change that is at this point difficult to exactly predict — all of the aforementioned advancements will continue to shape the future of healthcare capital development, regardless of what that future ends up looking like.

Learn more about our Healthcare Expertise >

MGMA 2015 Recap: Repositioning the Quaternary Academic Ambulatory Hub for the Future

  • October 27, 2015
  • Author: Michael Pukszta

MGMA IMageTwo weeks ago, I had the great opportunity to present alongside Mary Johnson, Chief Operating Officer of the University of Minnesota Physicians, at the MGMA (Medical Group Management Association) 2015 Annual Conference in Nashville. Using the recently completed University of Minnesota Ambulatory Care Center (ACC) as a case study, this session explored how academic medical centers are evolving care-delivery models as they undertake new building or renovation practices, and the underlying culture shift required to be successful in such efforts. The University of Minnesota ACC is a unique facility that pushes several new ideas and will open in Q1 2016. We had a really engaging discussion with a full room of health leaders from across the country, with several referencing other projects where some of these concepts have been successfully implemented – including some of our work with other clients.

I sincerely hope anyone who has an interest is able to see this presentation as we’ll be looking to deliver it at future health conferences. However, I wanted to share five key themes that stand out from the presentation and also guided the conversation at MGMA.

  1. Looking to other industries for innovation. As a recent article by Quartz magazine discusses at length, University of Minnesota Health took cues from consumer industries as related to optimizing patient transactions, streamlining throughput and processes, and creating memorable, favorable experiences.
  2. Building for the future by transforming care processes and experience. Healthcare isn’t the only thing that’s changing — workplace design preferences and the concept of the patient experience are both rapidly evolving. The University of Minnesota ACC creates an environment that supports inter-professional team collaboration, new models of office space for providers, and a smooth patient journey from check-in to check-out.
  3. Leveraging capital investments as opportunities to attract new markets. As health systems increasingly compete for market share and new patients, factors like brand identity and convenience are more important than ever. The new ACC provided University of Minnesota with an opportunity to reinforce both — building upon its image as a top academic institution and offering convenience to consumers at every touchpoint.
  4. Using technology to your advantage. The critical role of technology in healthcare is two-fold when it comes to building a new facility. First, health systems must consider how technological breakthroughs of today and tomorrow may impact capital investments and sizing requirements (e.g., the rising popularity of virtual visits). Second, they must embrace current technologies as they relate to user experience expectations, as the University of Minnesota did by offering a digital component at nearly every point along the patient continuum.
  5. Creating a flexible and adaptable building. Perhaps above all else, flexibility and adaptability are essential when designing a new healthcare space. For the University of Minnesota ACC, replacing private physician offices with 200+ “touchdown” areas helps keep spaces flexible, and adopting modular layouts and universal floors plans will allow the building to meet tomorrow’s needs as well as today’s.

Download Our Latest White Paper on Ambulatory Care >

The Power of Partnership

  • September 18, 2015
  • Author: Michael Pukszta

How New Collaborations are Creating Opportunity for Leading Health Organizations

In July 2015, we hosted a Peer Colloquium Panel Discussion as part of our Health Practice Executive Education Program. Panelists included:

  • Samuel Moskowitz, President at MedStar Franklin Square Medical Center
  • Dennis Murphy, Chief Operating Officer at Indiana University Health System
  • Steven Sonenreich, President and Chief Executive Officer at Mount Sinai Medical Center
  • Peggy Troy, President and Chief Executive Officer Children’s Hospital of Wisconsin

The group covered numerous topics during the discussion and the word “partnerships” came up time and time again. It was interesting to hear how these leaders are leveraging partnerships to support more effective growth strategies.

Partnership in support of population health

Most organization are utilizing partnerships, in part, to help ramp up their efforts in supporting population health goals. In order to achieve super clinically-integrated networks, organizations are looking towards partnerships that will help them more effectively manage populations – whether that be with employers that allow them access to large segments of population or with organizations that provide an aspect of care not currently included in the health system’s current offerings. As Mr. Murphy, the future CEO of Indiana University Health System mentioned,

Skilled nursing facilities and assisted care facilities are business models that we don’t necessarily want to get into, but we can utilize partnerships to create access to the resources we need to better manage chronic or complex patients.

Specialty centers such as children’s hospitals are interested in partners that value the unique services the hospital brings forward, particularly those that allow them to become more involved in lower-level acuity activities, giving them greater access to a larger population.

Streamlining capital investments through strategic partnerships

We also heard how some partnerships are allowing health systems to expand their presence geographically, without having to invest a large amount of capital. Using third party sources to help cover a broader footprint allows capital to be conserved for investing in a denser footprint on main medical campuses. These partnerships can also be an effective entry strategy into a new region, allowing organizations to assess whether it is in their best interest to make a capital investment that would allow for more effective brand integration, or utilize third party facilities in a test market.

The Executive Summary highlights the major themes from the discussion. Download it here >

Interested in taking part in a future panel discussion? Let us know:

Collaborating with Kaiser Permanente Center for Total Health

  • May 20, 2015
  • Author: Michael Pukszta

New opportunities in the era of population health management

One of the highlights of my year thus far came in early February when I represented CannonDesign as we co-hosted an event with Kaiser Permanente Center for Total Health focused on discovering new opportunities to build partnerships and strategically align missions in the era of population health management. The event brought together leaders from real estate, architecture, facilities management, sustainability, community health, academia, and healthcare to discuss the collective challenge of creating healthier people through healthier environments. Hosted at the Kaiser Permanente Center for Total Health in Washington D.C., we enjoyed thought-provoking presentations and an interactive neighborhood walk. Most importantly, we engaged in great conversations that pushed new boundaries – investigating the sometimes surprising intersections between our industries and identifying new opportunities to collaborate and forge partnerships to more holistically address population health.

Health-Centered DesignKaiser Logo425w

The day focused around health-centered design – a strategy leveraging design as a tool to achieve better health at every scale – in buildings, neighborhoods, and regions. To achieve this lofty goal, collaboration across numerous industries is necessary; especially since in order for design to be a meaningful strategy for health, it must be conceived early on in any effort. Throughout the day we discussed great opportunities for cross-disciplinary collaboration in this area:

The Future Patient

It is well understood throughout the healthcare industry that patients are quickly shifting outside of the hospital – with renewed focus on ambulatory and primary care settings. We need to consider how care may shift to other environments closer to home – driven by technological advances and growing patient volumes that demand new ways of engagement.  This provides an opportunity to rethink the care model and how smart investments in real estate may also become smart investments in health infrastructure.

Retail RevolutionCentralKitchen425w

Retail strategy is top of mind for many health systems these days. Still, the question remains of how far are we willing to go in terms of how we think about that retail experience? While many health systems may be strategizing about how they can offer the convenience, accessibility, and amenities of retail – are they willing to think about how the options they offer and the ways they provide them are intrinsic to their goals for a healthier population? What would it take to create a wellness village – where people live, work, play, and receive care – designed with the goal of population health at the heart of it? This is where integrating real estate strategy and design thinking can improve results.

Big Data

Perhaps more than anyone, healthcare leaders recognize the untapped opportunities in big data. During our time together at the event, we specifically looked at examples of how we can start to leverage big data to better understand the communities where we offer care, design buildings, and develop real estate. Big data can be used to understand everything from transportation routes to healthy food access to housing patterns and we need to find the means to harness this knowledge to inform more holistic solutions. This is a big challenge and it demands big minds – it’s not going to happen overnight.

Where Do We Go From Here?

This gathering was not about creating a new committee, working group, initiative or series of meetings. It was about meeting, networking, and engaging in this very important conversation in hopes that we will all find opportunities to work together in the future. Both Kaiser Permanente Center for Total Health and CannonDesign are committed to further investment in Health-Centered Design.

At CannonDesign, we look forward to continually working alongside our partners in many different industries to develop solutions that address population health – one of the greatest challenges we collectively face.