Is Design-Build Like an ACO?

Posted on October 30, 2011


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.