Big Plans for Big Boxes

Pros and Cons of Retail-To-Healthcare Conversions

Session DescriptionIn the progressively challenging financial environment facing the delivery of healthcare, institutions are increasingly considering repurposing existing “big box” facilities for healthcare functions.  Opportunities exist in this approach, but challenges also lurk.

Session Objectives• Identify potential benefits of repurposing

an existing facility and assess likelihood of fruition

• Assess appropriateness of potential investment

• Assemble a list of potential pitfalls

• Explain examples of pros and cons that might not be readily evident

Introduction

- Drive for more with less cost, yet higher quality

- Disruptive innovation & digital transformation

- Ambulatory settings to reduce costs / provide access

- Industry trends in facility conversion

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Presentation Format

- Original Drivers / Strategy  - Guiding Principles1- Selection of Neighborhood / Search For Facility- Experience of Conversion Process

- Suitability for purpose- Economics: planned cost vs. actual- Challenges / restrictions / surprises

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3 - Lessons Learned

1ORIGINAL DRIVERS / STRATEGY

GUIDING PRINCIPLES

Patient Care Pavilion and John Peter Smith Hospital Fort Worth Campus

JPS Health Network

nation’s largest hospital-based family medicine residency

30 primary careand specialty clinics

20 school-basedhealth centers

1.1 million patientencounters annually

2INPATIENT LOCATIONS

System Facilities

$1.7B ECONOMIC IMPACT – CREATING

MORE THAN 12.5K JOBS IN TARRANT COUNTY

ACADEMIC PARTNERS: UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOLBAYLOR MEDICAL CENTERUNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTERTEXAS A&M HEALTH SCIENCE CENTER

49UNIQUE

LOCATIONS

JPS Project Strategy

- Moving from fee-for-service to medical home model

- Improve the patient experience- Increased access with design- Community education- Locate services near our

patients- Provide services at one location - Proximity to other services- Reduce operational costs- Design and build a prototype for

the patient-centered medical home

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Source: Data Bank CHC Revised January 2010.pdf + JPS Contacts.

6 JPS Sites

located within a

3.5-mile Radius

JPS Clinical Access

3.5 Mile

Radius

JPS Project Guiding Principles

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1112131415

Promote Flexibility Standardize Room Sizes For Future Alternative Uses

Optimize EfficiencyLimit Travel Distances To Frequently Used

Spaces

Seek To Share Spaces, Staff and Functions

Provide Family “Self-Testing” Room For

Unscheduled Use

Include Quiet/Meditative Space Option For Patients

JPS Secondary Guiding Principles

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Greater Houston Area

TCH Background

2INPATIENT CAMPUSES

(3RD UNDER CONST.)

System Facilities

10MAJOR

BUILDINGS

8MILLION

SF

7 CORPORATIONS

OVER 10,000 EMPLOYEES

ACADEMIC PARTNER: BAYLOR COLLEGE OF MEDICINE

Texas Medical Center

West Campus

The Woodlands

Texas Children’s PediatricsAnd Community Cares

Health Centers

TCHP – The Center forChildren & Women

Urgent Care

MFM/Therapy Center/Imaging

TCH Project Guiding Principles

Change “sick engine model” to “well engine model” delivered by a health care team

Leverage medical home concept within existing expenditures by downstream savings – ED & NICU

8 year implementation trajectory for a positive ROI

Multiple Center locations anticipated (2 created to date)

Target population: children and pregnant womenUltimate size: 359,000 members Center 1, Year 1: 16, 408 members; Year 2: grow by 40%; and Year 3: grow by 26% (ultimately serving 28,884 members at this location)

Patient and Family-Centered Medical Home New model of delivery: personal physician leads team of individual who collectively take responsibility for the ongoing care of patients

Enhanced afterhours and weekend access to

care

Equip healthcare team with timely data to identify how to best serve patients and families

Physically dispersed into community that is served

Lower cost physical setting

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2JPS HEALTH NETWORK

JPS Patient Demographic Study

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Note: Driving times are averages used in Microsoft MapPoint, and may not adequately reflect rush times and other non-controllable traffic factors.

The zip codes with the largest populations < 250% FPL and uninsured are within 20 minutes of JPS’ main campus, with the exception of North Arlington’s 76010, which is inside of 30 minutes.

Areas of Poverty include Central Tarrant County, Northern part of Arlington, South Central Tarrant County*Because this is a service area analysis, there are pockets of wealth, but overall the average HH income is below $35,000 for these areas

Patient Origin: All Zip CodesJPS Arlington

Family Practice & Urgent Care

% of patient visits from each

zip code

Cumulative % of patient visits from

each Zip Code76010 3,291 12.9% 12.9%76014 2,486 9.7% 22.6%76018 1,679 6.6% 29.2%76017 1,491 5.8% 35.1%76011 1,388 5.4% 40.5%76013 1,269 5.0% 45.5%75052 1,232 4.8% 50.3%76002 1,184 4.6% 55.0%76063 1,147 4.5% 59.5%76001 1,063 4.2% 63.6%76012 915 3.6% 67.2%76015 805 3.2% 70.4%76006 759 3.0% 73.3%76016 650 2.5% 75.9%76040 497 1.9% 77.8%76112 355 1.4% 79.2%76039 326 1.3% 80.5%76119 295 1.2% 81.7%76180 246 1.0% 82.6%76120 276 1.1% 83.7%75051 281 1.1% 84.8%76140 259 1.0% 85.8%

All Others 3,618 14.2% 100.0%Grand Total 25,512 100.0%

Current State – Patient Origin

Connection membership 2/28/11 = 12,400

JPS Patient Origin Study

Operational Parameters: Workload VolumesFuture Scenario Projections

JPS Site Selection

JPSCampus

ArlingtonMedical Home

JPS Conversion

$7.2M Original Construction Budget

$6.1M Final Construction Cost

2 Bidders After 16 Pre-Bidders (Complexity, Building Access, Unknowns From Limited Investigation, Aggressive Schedule)

Different Footprint From When Project Started

Approvals Required By Neighboring Tenants – Couldn’t Add Coffee Shop

Arlington, TX

Cooper Commons

Medical Home – Space Program Summary

Total Area50,400

sf Quantity of RoomsAdmin / Public Area 11,045 sf

Diagnostics 7,770 sf 2 Gen Rad, 2 US, 2 Mammo, 1 Bone

Exam Modules 16,560 sf 40 Exam Rooms, 8 Consult Room

Women’s Clinic 5,785 sf 12 Exams, 2 Consult, 2 Centering

Dental Clinic 1,730 sf 5 Operatories

Behavioral Health 1,170 sf 5 Exam Rooms

Support Services 4,170 sf

Education 2,170 sf