Caulum said that it used to be simple when the question was how big a box the box would be. Now that has changed to whether or not it is even a box, he said.

But the handoff from care, from whatever the setting is, is where all the waste happens. “It is something that needs to be better addressed. The continuum of care has to ring out the waste of the handoff,” Caulum said. “How is that care provided? How is that structure of that care provided? More access has been provided but really nothing has been done to the complexity of that delivery system and how is that going to be adjusted.”

One tool that Caulum said helps is the electronic medical records, which is a tool, but there will always be a real estate component, he said. “Will it be in a hospital bed, maybe? Is it in the house, maybe? As providers, we are wrestling with the component of the where. The drive of consumerism will change the platform. The complexity of the system has to simplify through e-visits or cash pay, but there will always be a real estate place, just maybe not through a standard setting.”

Managing through the continuum of care is key, agreed Courtney Hanfland, system director of real estate transactions at Catholic Health Initiatives. “Without that, we are stuck.”

When talking about delivering care in outpatient settings, Hanfland said that when she sits with market leaders to plan a project, she thinks about providing value and convenience and how to locate a project in places with ample parking and not have the inconvenience of going to a downtown campus.

And considering patient satisfaction is key, but it is very subjective, added Hanfland. “We have leveraged a lot of technology within our facilities, and we have tried to incorporate things like pharmacy, co-locating specialists with primary care and more. Our footprints aren't necessarily getting smaller, but what is included in that footprint is different. We are shifting our thinking of what a facility needs to be.”

From Hanfland's perspective, understanding what to build is about a lot of listening and understanding. “We have certain standards and best practices that we set, but you have to customize for the market and you have to listen to the needs from the market,” she said. “You have to look at all of the data from that market and customize a solution. What we are building is Texas is very different than what we are building in Minnesota.”

It is a very complex and changing environment that systems have to adjust and adapt to, said Brian Dunlay, VP of finance and planning at Welltower. He said that “for a provider of capital to help them facilitate these plans in this changing environment, our goal is to be able to deploy the capital efficiently.”

But the biggest thing for his company, he said, in addition to providing facilities in the right markets efficiently and appropriately, is understanding the needs and being able to design buildings more effectively. “The biggest challenge we have with it is how to connect our operators with the systems. There is still work to be done.”

The biggest change is having a greater awareness to what providers need and the changing landscape of healthcare, Dunlay added. “Understanding the things that help the patient get from point A to point B as effectively as possible, and making the space more efficient is key.”

As a developer of high tier in patient rehab facilities, Paul McCleary, VP of business development at Medistar Corp., said that there is a huge need for truly skilled caregiver labor. “The operators that we are currently working within the rehab space right now have a variety of approaches. Many are technology driven. But the goal is to keep the patient from dropping and from falling through the cracks and having complications.

SCOTTSDALE, AZ—The places people go to get care have changed—from traditional MOBs and hospitals to post-acute facilities, freestanding emergency departments, long-term and skilled nursing facilities and more. Sources at RealShare Healthcare Real Estate on Thursday discussed the response of healthcare systems and the changes in the continuum of care as well as what providers are doing to adopt to the evolution of the continuum of care.

When moderator Neil Carolan, SVP of business development and leasing of Rendina Healthcare Real Estate, asked panelists how the continuum of care is affecting their profession, sources agreed that it really provides a lot of opportunities.

“Hospitals today are 65% occupied,” said Winnie Fritz, SVP of clinical services and operations at HCCA Management Co. She pointed to opportunities in things like new technology, mobile vans to people's homes, E-ICUs to name just a few examples. “Whatever you dream of is where you can provide care today… it is about having creative solutions.”

Ross Caulum, assistant VP of corporate real estate and corporate director of construction at Scripps Health, said that the advances in technology have lead to going from spending weeks in the hospital to just a few hours. “Some of us have held up the iPad to say this is the next medical clinic…technology advances will outstrip our imagination.”

Caulum said that it used to be simple when the question was how big a box the box would be. Now that has changed to whether or not it is even a box, he said.

But the handoff from care, from whatever the setting is, is where all the waste happens. “It is something that needs to be better addressed. The continuum of care has to ring out the waste of the handoff,” Caulum said. “How is that care provided? How is that structure of that care provided? More access has been provided but really nothing has been done to the complexity of that delivery system and how is that going to be adjusted.”

One tool that Caulum said helps is the electronic medical records, which is a tool, but there will always be a real estate component, he said. “Will it be in a hospital bed, maybe? Is it in the house, maybe? As providers, we are wrestling with the component of the where. The drive of consumerism will change the platform. The complexity of the system has to simplify through e-visits or cash pay, but there will always be a real estate place, just maybe not through a standard setting.”

Managing through the continuum of care is key, agreed Courtney Hanfland, system director of real estate transactions at Catholic Health Initiatives. “Without that, we are stuck.”

When talking about delivering care in outpatient settings, Hanfland said that when she sits with market leaders to plan a project, she thinks about providing value and convenience and how to locate a project in places with ample parking and not have the inconvenience of going to a downtown campus.

And considering patient satisfaction is key, but it is very subjective, added Hanfland. “We have leveraged a lot of technology within our facilities, and we have tried to incorporate things like pharmacy, co-locating specialists with primary care and more. Our footprints aren't necessarily getting smaller, but what is included in that footprint is different. We are shifting our thinking of what a facility needs to be.”

From Hanfland's perspective, understanding what to build is about a lot of listening and understanding. “We have certain standards and best practices that we set, but you have to customize for the market and you have to listen to the needs from the market,” she said. “You have to look at all of the data from that market and customize a solution. What we are building is Texas is very different than what we are building in Minnesota.”

It is a very complex and changing environment that systems have to adjust and adapt to, said Brian Dunlay, VP of finance and planning at Welltower. He said that “for a provider of capital to help them facilitate these plans in this changing environment, our goal is to be able to deploy the capital efficiently.”

But the biggest thing for his company, he said, in addition to providing facilities in the right markets efficiently and appropriately, is understanding the needs and being able to design buildings more effectively. “The biggest challenge we have with it is how to connect our operators with the systems. There is still work to be done.”

The biggest change is having a greater awareness to what providers need and the changing landscape of healthcare, Dunlay added. “Understanding the things that help the patient get from point A to point B as effectively as possible, and making the space more efficient is key.”

As a developer of high tier in patient rehab facilities, Paul McCleary, VP of business development at Medistar Corp., said that there is a huge need for truly skilled caregiver labor. “The operators that we are currently working within the rehab space right now have a variety of approaches. Many are technology driven. But the goal is to keep the patient from dropping and from falling through the cracks and having complications.