Towards a New Healthcare Architecture – Part 1 of 3

healthcare reform_pt3

It has been just over a month since the Supreme Court deemed The Patient Protection and Affordable Care Act (ACA) constitutionally sound, and I recommend that we stop debating about whether it is fair, accept that it has passed  and deal with the implications of the ruling. The ACA will certainly have enormous impacts on an individual’s personal, financial and professional life; but more importantly – it points our country in the direction of a new era of healthcare delivery – a new path that is long overdue.

Before I address implications of the ruling, what do we agree on?

• I haven’t met anyone that openly disagrees that the richest, most powerful and socially responsible country in the world should be able to develop a solution to ensure that their citizens are cared for when they are ill.
• Patients and Providers both agree that the current fee-for-service model is broken.
• Economists point out that spending over 20% of the nation’s GDP on  healthcare costs is financially unsustainable.
• Everyone understands that increasing efficiency and improving outcomes will become  a necessity if we want to control spiraling health costs.
• Finally, those in need should be cared for, and the organizations that are in the business of caring for people should be the vehicles for that care and should be able to do so effectively and affordably.

So in my opinion, it is not the why, but the how – the financial hurdle – which is fueling the debate about implementing the ACA.

Big challenges must be met with big solutions – there is no simple fix here.  At Array, we challenge ourselves everyday to discover if there is “a better way.”  And since the design for healthcare environments is our business, it behooves us to understand the business of healthcare, so the environments we create support those operations . . . better.

The provisions of the ACA mandate that providers serve more people, at a lower cost, while improving performanceand tie a caregiver’s reimbursement to the successful application of these provisions.  Nobody said it would be easy!

This is the first of a three-part blog post detailing how we as healthcare architects can collectively work  with healthcare providers to achieve the goals set out in the ACA.


The ACA requires that healthcare providers move from a concentration on pushing as many patients as they can through the doors (the volume-based approach) to a concentration on the effectiveness of that care (the value-based approach).  In order to do so, providers must reorganize their structure to account for a patient’s entire continuum of care.

With an aging population, an increasing chronically ill population and an impending explosion of newly insured patients— a bigger, highly organized network of service providers is better suited to this value-based approach; it becomes a business of population management.  If this network is situated to share information effectively, refer patients to each other to capture more business and then collaborate on the care of those patients to reduce errors and improve on a more holistic health – all while treating the patient as a partner in their own care through education, people will be healthier.

We have seen more and more mergers and acquisitions of hospitals, employee practice groups aligning or being hired by these systems, and a philosophy towards Accountable Care Organizations and Medical Home concepts prevailing.  This is the infrastructure that can facilitate a better model of care.

How can a healthcare architecture firm help health systems achieve their goals in this area?  By providing comprehensive strategic master planning, service line analysis, comprehensive demographic research and volumetric trends that provide healthcare decision makers with the data they need to begin their migration to the new value-based reimbursement platform.


The healthcare industry faces an interesting challenge:  the supply (the doctors and nurses performing the service) is far out-weighed by the demand (an ever-growing population of chronically ill, aging people requiring care).  Re-organization cannot happen without eliminating wasted time and resources.

How can a healthcare architecture firm help health systems achieve their goals in this area?  By eliminating waste and  “Thinking Lean and Green.”

Lean thinking is a means by which each process, each task, is evaluated for its effectiveness as part of the overall process flow.  Solutions are usually simple, but the impact of this rigorous thought exercise has incredible impacts on operational efficiency, effective care delivery and bottom-line value.

Many institutions have requirements for sustainable building strategies for their healthcare spaces.  These institutions understood that the motive for doing so wasn’t to save the earth or to use it as a PR tool for their health system (although these were beneficial results), but rather the business case:  If considered at the proper stage, minimal upfront investment meant considerable long-term savings for their facility.  When passing this question through the lens of ACA, we might also consider how healthier interior environments support positive results, and how a patient’s positive perception of their environment can affect HCAHPS scores (read: reimbursement).