Healthy Side Effects of Health Reform

Healthcare reform is spurring new construction methods.

By Jeff Lage

Whatever side of the political aisle you’re on, let’s put aside the debate for a moment and look at some of the less-discussed outcomes of the Patient Protection and Affordable Care Act (ACA). By 2019, the ACA is expected to enlarge health insurance coverage to an additional 32 million people, covering approximately 92 percent of the United States population. With numbers like that, strengthening the public health infrastructure at the state and local levels is a key step to implementing the new law.

Skanska hospital construction health care The Registry real estateAt the same time, healthcare delivery will continue to move from acute care facilities to community networks. Care is becoming more consumer-centric and more coordinated. The changes are driving healthcare providers to focus investments in several types of care facilities that, only a few years ago, were the exception to the rule.

Medical Office Buildings—new, built from the ground up facilities and renovated facilities— are becoming the norm in communities across the region. Smaller than traditional hospitals, and increasingly better equipped than just a doctor’s office, MOBs offer the convenience of proximity. MOBs are also offering a better experience for patients through their design and construction— set up to be leaner, more efficient and greener.

Retail clinics are growing in popularity. Consider WalMart, which is partnering with local physician practices and health systems to offer immunizations and other services that can be provided in a more cost effective manner in a retail environment.

Other emerging trends are changing the way designers and contractors approach delivery of new healthcare buildings. Healthcare systems have a focus on bringing well-equipped laboratory and imaging spaces closer to where patients live. The increased use of information systems and “telehealth,” allowing the use of mobile devices (bringing x-rays in the palm of a doctor’s hand), and digital consulting sessions with other doctors, require different sorts of facilities than they did in the past.

With these changes, the accessibility of primary care workers plays a critical role in public health. The ACA incentivizes new physicians to enter into primary care, particularly in underserved or urban areas. The U.S. Department of Health and Human Services fact sheet, “Creating Jobs by Addressing Primary Care Workforce Needs,” notes that, “The Affordable Care Act created the Teaching Health Center Program to help move primary care training into community based settings…this program is expected to support the community-based training of over 600 new primary care physician and dental residents by 2015.” This will require new facilities in locations that have not previously been covered by regional healthcare providers.

It’s not business as usual for healthcare systems. Similarly, it’s not business as usual for the design and construction teams bringing new facilities on line. The effect of healthcare reform on construction is a net positive. The ACA pushes delivery methods that offer healthcare systems better value. Some delivery methods are already gaining a foothold in healthcare while demonstrating their value in construction across a variety of sectors.

One of the first delivery methods put into action was design-build. Design-build has been good for California in almost every sector from healthcare to complex transit projects. In this arrangement, the contractor and designer work hand-in-hand, gaining the benefit of efficiency. Clients have a single point of contact with their design-build teams, eliminating the need to make sure the two parties are on the same page. For project teams, this has advantages including faster resolution of constructability issues, better coordination of permitting and procurement to speed the construction schedule. This method is evolving, bringing more parties to the table.

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Rendering courtesy of Skanska

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