Is Design-Build Like an ACO?

Posted on October 30, 2011

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Accountable Care Organizations (ACOs) remain scary territory in healthcare reform. Healthcare providers are still trying to figure them out. Generically defined, they are a unified group of care providers responsible for providing a total treatment package to a patient in exchange for a single payment of fee; it is a “payment for quality” not a “payment for quantity” model. Fundamentally, I think most people feel ACOs will be good for the entire healthcare system, but there is still trepidation until they are fully understood.

Design-build is not too dissimilar to ACOs on many levels.

  • Design-build is still scary territory to many hospital. Many hospitals probably acknowledge design-build would benefit them if they better understand how it worked.
  • Conceptually, hospitals understand single-team responsiblity from design-build is better than managing and self-integrating many, siloed professionals, but things are so comfortable the way they do them now. Just like healthcare, hospitals question whether changing teams and methods is a choice they must do now because they are so comfortable with the status quo.—even though the status quo is quickly changing.
  • The market (and legislation) is pushing hospitals toward ACOs much like it is pushing hospitals toward design-build. And still, there are some providers out there who say ‘I am not doing it’, just like there are some hospitals who say they will never do design-build.

In the end, design-build delivers similar benefits of ACOs:  improved cost, improved quality and improved results from an outcome-focused approach. And the last point there, outcome-focused, is the big one. A collection of independent professionals with their own specialties, personal and business motivations will be difficult to manage toward a unified, and successful outcome. That team will be out to perform their piece, charge for it, and go home.

However, a team hired to achieve a goal will get innovative to find the best and most effective way to reach a goal, whether health care or project-focused.

At the end of the day, a patient wants a positive outcome, not proof that someone did what they were paid to do. Likewise at the end of the day, hospitals do not want a collection of architects, engineers, contractors, subcontractors and consultants arguing they did what they were paid to do. Hospitals need a team that delivers a project just the way they imagined it. This total solution is what design-build provides.

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