What’s Driving the Trend Toward Healthcare Villages?

Introduction

The trend towards healthcare villages is being closely followed by innovative healthcare providers, who recognize that the industry’s future will encompass addressing the entirety of population health to transform from a healthcare system that has historically focused on treating the sick, to a value-based one designed to keep ‘customers’ well.

In concert with local governments, urban planners, social service agencies, developers, and retailers, healthcare providers are viewing healthcare villages as a community destination — an integration of healthcare, life sciences/research and development (R&D), educational, residential, hospitality/conference, social agency, healthy lifestyle retail, entertainment, recreation, cultural, and wellness services — scaled by land size and community need.

It is a vision of a health-oriented place where people come to live, work, learn, and play. These medically oriented, mixed-use developments utilize an outside-in urban planning perspective to connect to surrounding neighborhoods, open space, parks, public transportation, and active transportation options to improve access to community-based services and nature, while promoting physical activity.

This article will explore the key drivers behind this trend and highlight a few examples of the various types of healthcare villages under development around the United States. Finally, we will summarize the key questions health systems need to address when considering implementing a healthcare village development strategy.

Key Drivers Behind the Trend

Population Health Movement

Healthcare villages, when properly planned, create healthier communities by promoting:

• Physical activity: Including pedestrian-friendly paths and bike trails connected to nearby parks, nature, and other recreational areas. For example, well-designed communities that strategically locate grocery stores and pharmacies within a five-minute walk from where people live and work increase the likelihood people will choose the healthier option to walk versus drive.
• Access to fresh and healthy food options: Including community farms and gardens, green grocers, farm-to-table restaurants, and farmers markets.
• Continuity of care: Combined with traditional inpatient and outpatient care, healthcare villages also encompass wellness, fitness, integrative and personalized medicine, skilled nursing, and multigenerational senior living options ranging from independent living, assisted living, and memory care. Healthcare providers can improve the continuity of care delivery through the co-location and better integration of these programs and services.
• Emerging care delivery models: The use of virtual care is rapidly advancing via remote monitoring and wearable medical device technology combined with artificial intelligence/predictive analytics. Virtual care integrated with the human touch of home health house calls by the local village provider will dramatically improve community health and reduce costs.
• Social connection: Increased human interaction has been proven to improve mental and physical health. Isolation and loneliness, especially among the elderly, leads to poor eating habits and the progression of obesity, frailty, and chronic disease. Seniors prefer to age in place, so mixed-use healthcare villages offer seniors the ability to do so while continuing to maintain their established social and cultural connections and overall sense of well-being as part of the fabric of their community.
• Advancements in medical technology and therapies: By co- locating healthcare providers and customers with biomedical and medical technology innovators, it creates a better environment for collaboration in a ’living laboratory‘ to advance research and development of new medical technologies and drug therapies more quickly.

‘Blue Zones’ Movement

In 2004, Dan Buettner partnered with National Geographic and longevity researchers to identify pockets around the world where people live measurably longer and better. After identifying five of the world’s so-called Blue Zones, Dan and his team identified lifestyle characteristics that each of these zones shared.

Moving naturally, having the right outlook, eating wisely, and connecting with others are the four main tenets of Blue Zones, which closely align with healthcare village planning principles designed to create healthier communities and promote population health.

Using research findings from the original study, Buettner started Blue Zone projects with cities, states, and businesses to help improve health outcomes. Early success stories include [1]:

• $12 million savings in annual healthcare costs for the southern California communities of Manhattan Beach, Hermosa Beach, and Redondo Beach, which are served by the Beach Cities Health District.
• 15% drop in obesity in Iowa City from 2014 to 2015.
• In Albert Lea, MN, participating businesses experienced a 21% decline in absenteeism.
• Naples Community Hospital (NCH) has experienced a 54% drop in employee healthcare spending in the past three years for a combined savings of $27 million. In addition, 34% of NCH employees recorded improvements in their body mass index.

The successes from these Blue Zone projects provide evidence, although somewhat anecdotal, of the potential population health benefits to healthcare providers, businesses, and communities that are driving the demand for healthcare village developments.

Consumerism Movement

Consumers today seek the ability to obtain medical care on demand when they need it in a convenient one-stop shopping environment. A survey conducted by Press Ganey found that those who waited five minutes or less for treatment expressed 95% satisfaction with their experience, while the level of satisfaction dropped to 80% when the wait topped 30 minutes.

In another survey, more than 60% of the top 10 preferences respondents gave for access to primary care were related to convenience, with cost a distant second at 20%.

Integrating the full continuum of healthcare services into mixed-use destination centers where people live, work, learn, and play meets today’s consumer’s requirement for convenient, on-demand access to high-quality healthcare.

New Urbanism Movement

Healthcare villages also advocate many of the basic principles encompassed by the New Urbanism movement, which include [2]:

1. Walkability
2. Connectivity
3. Mixed-use and diversity
4. Mixed housing
5. Quality architecture and urban design
6. Traditional neighborhood structures
7. Increased density
8. Green transportation
9. Sustainability
10. Quality of life

Healthcare villages are therefore at the intersection of multiple movements that are gaining traction across the country — population health, blue zones, consumerism, and New Urbanism.

Changing Demographics

Baby boomers in the United States are approximately 80 million strong and marching past the age of 65 with expectations for a vibrant and active retirement. These boomers represent a generation with the greatest buying power in Unites States history. As they stand poised to pay a larger proportion of their healthcare costs, baby boomers want healthcare providers that will meet their demands for excellent customer service, easy access, high performance, efficiency, and a differentiated experience. Healthcare providers that can execute well on the key principles of a healthcare village are well-positioned to attract this important and significant senior demographic.

Continued Shift to Outpatient Care

Inpatient admissions continue to decline while the demand for outpatient services continues to grow at a rapid pace due to advancements in medical science and technology, the consumerism movement and the need to deliver healthcare services in the lowest possible cost environment. As most health systems need to expand their ambulatory footprint in their communities to accommodate the demand for outpatient care, they continue to look for optimal locations for new outpatient facilities. Healthcare villages offer health systems the ability to locate ambulatory services in new mixed-use developments where customers live, work, learn, and play.

Keeping Patients in a Health System’s Network

Containing patient leakage from a healthcare provider’s network is one of the biggest challenges facing health systems today. A healthcare village offers customers the convenience of one stop shopping for all their healthcare needs where they live, work, learn, and play, greatly reducing the likelihood that they will seek services from outside the sponsoring health provider’s network.

Talent Acquisition and Retention

Competition for and retention of top talent — from physicians, scientists, and researchers to highly skilled nursing staff — is one of the top challenges facing healthcare providers and life sciences/R&D firms alike. Creating a vibrant amenity-rich environment that will offer a discerning and highly educated workforce with a differentiated experience to live, work, learn, and play in a walkable, transit-oriented neighborhood, greatly enhances an organization’s ability to compete for and retain top talent.

Neighborhood Revitalization Efforts

Some of the best hospitals in the United States are located in neighborhoods that have experienced various degrees of urban decline over the past few decades. Some of these forward-thinking hospitals and health systems are embracing the concept of creating healthcare villages to serve as catalysts to revitalize surrounding neighborhoods while improving the health of the communities they serve. Many of these revitalization efforts are being implemented as part of creative public-private partnerships. MetroHealth System and the Cleveland Clinic are both implementing such strategies to revitalize their surrounding neighborhoods in Cleveland, Ohio. The Sea View Healthy Community in Staten Island, NY, is another example of a healthcare village serving as a catalyst for neighborhood revitalization.

What kinds of healthcare villages are there?

The concept of healthcare villages has been evolving for more than a decade. The first healthcare village in the United States was the Metro Health Village near Grand Rapids, MI, which opened in 2007. The 170-acre healthcare village is an entire community of support services, retail shops, restaurants, paved walking trails, a family-friendly play park, and more – with Metro Health Hospital at its heart. In addition, the village has a conference and education center used for seminars and programs such as cooking and yoga classes, free health screens and support groups for people living with cancer or diabetes, a Veterans Affairs clinic, a multifaceted senior living facility, a YMCA, and a Hyatt Place hotel.

Metro Health partnered with Ankura and a local mixed-use developer to plan and develop the campus on a parcel in Wyoming, MI. Ankura served as Metro Health’s program manager to oversee the planning, design, and construction of the 208-bed acute care osteopathic hospital within the healthcare village.

Healthcare villages come in all shapes and sizes, ranging from 30-acre parcels to communities spanning more than 600 acres. Below are a few additional examples:

• Lee Health Medical Village at Coconut Point

Significant growth in the senior population is accelerating the demand for multispecialty care in the southwest region of Florida, including chronic-care management and focus on healthy lifestyles. In response to this community need, Ankura assisted Lee Health System in the strategic facility planning for a 170,000-square-foot healthcare village on a 30-acre parcel in Estero, FL. The first phase of the $140 million healthcare village is now under construction, with initial occupancy scheduled for fall 2018, and will include Lee Health’s home for holistic health and care-coordination services, the Healthy Life Center, an outpatient surgery center, free-standing emergency center, advanced diagnostics, and rehab services. An esplanade will link to walking paths, an outdoor pavilion, and a parking area that will also be used for public events such as farmers markets and art fairs. The paths also connect visitors and staff to adjacent retail centers and restaurants.

• Inova Development District

Inova Health System acquired the former Exxon Mobil headquarters campus across from its main campus in Fairfax, VA, in 2015. The 117-acre parcel is envisioned to become an international destination for holistic, health and wellness, scientific discovery, and lifelong learning. It will usher in the next generation of regional and national mixed-use places.

Anchored by the Inova Center for Personalized Health, the district will be a place with seamless connections for patients, their families, doctors, researchers, entrepreneurs, students, and residents to form a community and ecosystem where they can live, work, learn, play, and be well.

Ankura assisted Inova with developing the Strategic Master Facility Plan for the district, which is organized into six themed sub districts:

• Center for Personalized Health
• Innovation and education
• Arts and culture village
• Town square
• Eco-wellness neighborhood
• Sports and wellness zone
• Viva White Oak

Viva White Oak is a planned 300-acre mixed-use community being jointly developed as a public-private partnership between Global LifeSci Development Corporation and Montgomery County, MD. Montgomery County is ranked as the sixth-largest life sciences cluster in the country by Jones Lang LaSalle. [3]

Viva White Oak recently received zoning approval to proceed with the planned development and expects to break ground in May 2018, with initial occupancy projected by 2022. The more than 12 million square feet of buildings and more than $3 billion investment will include internationally pre-eminent biomedical and biotechnological enterprises, a consortium of biomedical universities, a full-service hotel and conference center, restaurants, shops, professional offices, residences, parks, and an elementary school. The community will be located adjacent to the newly consolidated US Food and Drug Administration headquarters, and the new, state-of-the-art Washington Adventist Hospital currently under construction. Together, the 660-acre FDA/Federal Research Center property, the 50-acre Washington Adventist Hospital, and the 300-acre Viva White Oak – constituting more than 1,000 acres of world-class biomedical and biotechnological innovation.

• Johns Hopkins University Belward Research Campus

Another life sciences-focused healthcare village being planned, also located in Montgomery County, is the Johns Hopkins University Belward Research Campus. The 100-acre campus, which is planned in accordance with New Urbanism principles, has 1.4 million square feet of space planned in phase one, to be built out over the next 10 years up to 4.7 million square feet overall at completion. As part of Montgomery County’s Great Seneca Science Corridor, at least 40% of the development will be dedicated to life sciences/R&D and related uses. The balance of the space is envisioned to be a combination of health and wellness-anchored programs and services, educational, hotel and conference, senior living, and healthy lifestyle retail.

• Lake Nona Medical City

The 650-acre health and life sciences park known as Lake Nona Medical City is a landmark for Orlando, FL, and a premier location for medical care, research, and education. Lake Nona Medical City represents a deliberate strategy to create a centralized focus of sophisticated medical treatment, research, and education in Central Florida. Based on the proven theory that a cluster of healthcare and bioscience facilities in proximity to one another will accelerate innovation, this intellectual hub opened in a coordinated fashion with a collaborative mission in 2010. In the next decade, Lake Nona Medical City will be home to some of the nation’s top hospitals, universities, research institutions, and life sciences companies. The Medical City’s pioneering institutions are already forming networks and synergies, which are transforming Orlando into a global destination for healthcare, research, and medical education, while creating an economically improved region. Medical City is anchored by:

• University of Central Florida Health Sciences Campus
• Sanford Burnham Prebys Medical Discovery Institute
• Veterans Affairs Medical Center
• Nemours Children’s Hospital
• University of Florida Research and Academic Center
• MD Anderson Cancer Research Center
• Florida Hospital Health Village

Florida Hospital Health Village is another healthcare and life sciences discovery-oriented, mixed-use urban community located on 172 acres within downtown Orlando. Offering a wide spectrum of powerfully aligned resources, the health village supports rapid translation of products and services to reduce time to market. The objective of the village is to cultivate a life sciences and healthcare innovation community while fulfilling the three goals of simultaneously improving the patient experience, improving the health of populations, and reducing the per capita cost of healthcare. The Florida Hospital and Adventist University of Health Sciences is immediately adjacent, enhancing opportunities for collaborative initiatives.

Florida Hospital Health Village includes the Innovation Ecosystem, which is composed of the following unique assets:

• Florida Hospital Innovation Lab: A vital center of innovation that uses design thinking to solve the most pressing healthcare challenges
• InnovatOR Suite: One of the world’s most technologically advanced combined operating rooms and imaging centers
• Center for Innovative Patient Care: An inpatient living laboratory maximizing patient care and recovery
• Institute for Surgical Advancement Prototype Lab: A creative space for physicians, engineers, researchers, and other health care professionals to bring their ideas to life for the development of new medical equipment
• BioResearch Center: A unique workspace designed to promote collaboration among thought leaders
• Nicholson Center: A global clinical education and training center offering simulation, wet and dry labs, education center, and digital learning
• Health Performance Strategies: A ‘mind/body /spirit’ series of programs and services based on Florida Hospital’s CREATION Health philosophy to resist disease, advance health, and guide people toward a more satisfying life
• Adventist University of Health Sciences: Provides a real-world education experience in 17 distinguished programs for more than 2,200 students
• Research Enterprises: A global pacesetter in research, with clinical and translational research across eight Florida Hospital campuses that operate under one license, one medical staff, and one Institutional Review Board
• Big Data: Firms locating in Florida Hospital Health Village have real-time access to vast amounts of patient data in a city with a population ideal to test national rollouts from the largest Medicare provider in the United States

Destination Medical Center

The Destination Medical Center (DMC) is a 20-year, $5.6 billion economic development initiative in Rochester, MN, the largest in Minnesota history. DMC is designed to position Minnesota as a global center for the highest-quality medical care and to generate high-value jobs, new tax revenue, and businesses. DMC will be anchored by Discovery Square, led by Mayo Clinic, which is striving to become the Silicon Valley of medicine, and will include more than 2 million square feet for health, research, education, and technology.

Conclusions

Given the major trends driving emerging healthcare village models, the key questions health systems need to address when considering a healthcare village development strategy are:

1. What are our organization’s vision and key objectives for considering a healthcare village strategy? How does this fit with our ambulatory network strategy and population health goals?
2. What are the dynamics of our market that would support a healthcare village strategy? Bear in mind the following:

• Demographic trends
• Population growth
• Socio-economic factors
• Physician supply and demand
• Competitors

3. Which healthcare services and programs will the market support? And which services fit best in a healthcare village environment?
4. How do we best determine which area(s) within our primary service area are most attractive for a healthcare village?
5. What are some of the lessons learned by other healthcare providers that have embarked on implementing a healthcare village development strategy?
6. How do we best determine what other complementary services should be considered for the healthcare village, considering the following?

• Life sciences/R&D
• Senior living
• Residential
• Fitness and wellness
• Hospitality/conference centers
• Educational
• Healthy lifestyle retail
• Restaurants/entertainment
• Social service agencies

7. How much land is required and what appropriate sites are available in the desired target area?
8. How will the rapidly emerging ’mobility ecosystem’ of autonomous vehicles and ride-shares impact our planning?
9. What are our competitors doing in this space and what is their likely response that could impact our strategy?
10. What creative public-private partnerships are available with local, state, and federal governments, and other quasi-public agencies?
11. What other private partners do we need on our team to help execute our strategy?

• Real estate advisers
• Urban planners and master facility planners
• Major academic and research institutions
• Life sciences, medical device, technology, and energy companies
• Senior living and wellness-center operators
• Master developers

12. What is our required capital investment, funding options, and projected return on investment?
13. What is a realistic timeline from vision to reality?
14. How do we measure results and progress toward our targeted goals?

Innovative and forward-thinking health systems have the opportunity to reap the many benefits that can be generated from healthcare villages. In the words of Daniel Burnham, “Make no little plans; they have no magic to stir [our] blood!” [4]

[1] Blue Zones, “The Blue Zone Movement,” https://www.bluezones.com/services/blue-zones-project/
[2] New Urbanism, “Creating Livable Sustainable Communities,” www.newurbanism.org
[3] JLL, “Life Science Outlook 2017,” http://www.us.jll.com/united-states/en-us/research/industry/life-sciences-companies
[4] Charles Moore (1921) Daniel H. Burnham, Architect, Planner of Cities. Volume 2. Chapter XXV “Closing in 1911-1912;” p. 147]

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