On May 11, healthcare industry leaders met with President Obama at the White House and pledged to work towards $2 trillion in cost reductions over the next decade. The proposed cost-saving initiatives are intended to help finance healthcare coverage for more than 45 million currently uninsured Americans. The group represented hospitals, physicians, insurers, drug manufacturers and labor. A few days before joining the presidential summit, Jay Gellert, CEO of Health Net, Inc. and Chairman of Americas Health Insurance Plans (AHIP) Policy Committee briefed 20 participants at the semi-annual National Leaders Think Tank forum in Tucson on the impact of significant health care reform on the medical facilities planning and investment strategies. Event organizers and attendees included healthcare facility owners, designers and builders. This Case Study (ASHE Panel) addresses the four key questions raised at Think Tank 4.
1. Can facilities play a more significant role in cost containment and system reform?
2. What are the benefits and consequences of restricting capital and making financing more difficult?
3. Could a higher level of early investment yield longer-term savings?
4. How will health reform affect facilities planning and development?
If meaningful healthcare reform actually forces a paradigm shift in American healthcare delivery systems, then the questions behind these questions become challenging new tipping points. At issue are key concepts that until recently were held as conventional wisdom.
SUBMITTED FOR CONSIDERATION: ASHE PDC 2010

Do continuing advances in wireless technology still support the notion that new construction is more cost effective than renovation of existing facilities? Is the quest to deliver state of the art medical centers counter-intuitive to the immediate need for widely dispersed outpatient treatment centers? What is the correct medical services delivery model beyond 2030 when population growth is tempered by the gradual decline in the number of remaining Baby Boomers? To what degree will newly-revitalized preventive care programs and community clinics impact what heretofore had been a steady increase in Emergency Room visits by the uninsured? Is it time to separate service delivery from traditional notions of capital facilities construction? The imperative of reducing the unit cost for care directly challenges design standards that have brought increased square footage to patient rooms and procedure suites. Changes in nursing practices should be deciphered as what they are, a response to a worldwide critical shortage of nurses. It was difficult for Think Tank 4 attendees to imagine higher levels of facility investment than are occurring today. Is there support for a new model for guerilla healthcare, one that envisions modern day, hyper-technically advanced, modular and mobile equivalents of the 60s era TV series MASH units?
Who was it that said when everything changes, change everything.