The presentation will focus on our unique integrated cost modeling approach during project conception using our Healthcare Cost Advisor modeling tool. One of the most critical factors in successfully delivering a healthcare facility on budget and on time is estimating the total project when little more than the gross area is known. CEOs, CFOs, COOs and Project Directors make very important programmatic decisions when detailed information, on which to base those decisions, has yet to be developed. Today's fast-paced market demands a proactive change in the approach to estimating. Gilbane Building Company has developed a collaborative estimating approach based on benchmark costs that specifically focus on Conceptual Cost Modeling to develop 'what-if' scenarios and model potential project costs earlier than traditional methods. Recent experience using these methods has shown accuracy of Guaranteed Maximum Prices (GMPs) to within 3% of conceptual model costs. Our Healthcare Cost Advisor uses our database of historical projects with customized input from the owner, design team, and our experienced estimators to answer the necessary questions early in the development of a project so that comprehensive project budgets are accurately developed. As the project proceeds through the design process, our proactive involvement during the design phase enables the team to work through any scope creep or budget impact issues collaboratively, and early, to protect the owner's budget without sacrificing the functional program or architect's vision of the project, and architects don't have to waste time in re-design. The process begins with the development of a comprehensive conceptual cost model using a modeling tool - our tool is our Healthcare Cost Advisor - and has proven to be an invaluable roadmap throughout the design process to help Architects and Owners avoid costly surprises later on. Unique case studies by the project teams for Mercy at the Fore (Portland, ME) and University Hospital (Shaker Heights, OH) will be presented to demonstrate how this process enabled the buy out of these projects to be within 1% of the conceptual budget developed 30 months prior.