Reimagining the Embedded Clinic

The COVID-19 pandemic is pushing healthcare providers and companies to find better ways to keep people healthy and safe. A new generation of embedded clinics may be the answer.

As healthcare providers and employers look for better ways to keep people healthy in the wake of the COVID-19 pandemic, the concept of embedding health and wellness facilities in corporate headquarters, schools and commercial spaces is drawing new attention.

“There’s a need for facilities in many environments,” says LPA Director of Healthcare Muhsin Lihony. “Moving forward, it will be paramount for healthcare providers to reduce the load on their inpatient facilities, while employers want better ways to respond to issues and keep their employees healthy.”

But the next generation of embedded facilities will operate fundamentally differently than pre-COVID-19 models, designers say. They will be technology driven, designed as connection points between healthcare providers and patients. Spaces will be adaptive and digitally enabled and will feature an agglomeration of health and wellness virtual and onsite services to fill the needs of the health-focused, connected consumer.

“What’s important is reshaping the perception of what health and wellness is,” says M. Anza Vang, Director of Business Strategy & Implementation for Providence St. Joseph Health. “Workforce wellness really needs to be about this philosophy of creating a supportive structure conducive to employees’ well-being and building healthy habits that are an embedded routine in our daily lives.”

Ms. Vang has worked with LPA designers on embedded clinics in the past, and she recently joined an online charrette to discuss how the concept can be updated and scaled to meet the new demands of the marketplace. This starts with changing our collective mindset about health and reimagining the healthcare delivery process, she says.

“Our program is not ‘co-located services under a single roof,’ but rather it’s an interdisciplinary, multifaceted approach to integrated lifestyle medicine,” she says. “The hypothesis is that if we deliver seamlessly integrated health and wellness services into the ordinary patterns of life, we will enhance the patient’s relationships with health and care—and the natural result is better outcomes and lower costs for all.”

Foward Thinking Q3 2
The next generation of embedded clinics

A Concept That Makes Sense

The embedded-healthcare concept addresses many of the key challenges shared by healthcare providers and employers. Providers are looking for ways to offer consistent care for patients across the entire journey, outside the traditional methods. The pandemic emphasized the need for multiple ways for doctors and nurses to connect with patients, outside emergency rooms, medical office buildings (MOB) and community healthcare providers. At the same time, nimble, efficient clinics will make more economic sense as Medicaid and Medicare continue to adjust reimbursement policies to include telehealth and remote access.

“It will make more sense operationally and financially for healthcare providers to support clinics versus hospitals, which are more expensive to operate and don’t get the same return on investment,” Lihony says.

For companies, embedded clinics provide infrastructure to respond to issues quickly and conveniently, while building and maintaining relationships with patients as a long-term approach to keeping employees healthy. Facilities can help create a daily sense of confidence that the workplace is committed to employees’ well-being. Studies of existing clinic models have shown that people appreciate the easy access to providers. Going forward, embedded clinics can play a key role in recruiting and retaining employees, while delivering a cost-effective approach to mitigating rising healthcare costs.

Spaces will be adaptive and digitally enabled and will feature an agglomeration of health and wellness virtual and onsite services to fill the needs of the health-focused, connected consumer.

“Going forward, I sense that employees will want to be able to connect with their healthcare provider in a more convenient manner,” says Greg Schneekluth, LPA’s Regional Managing Director. “That capability will be part of a company’s overall benefits package.”

With the increase in remote working, many companies will be looking at available space. Directing that space toward health and wellness turns an underutilized space into an asset. It also provides a framework to help businesses adjust to the new approach.

The embedded model already has proven success stories. LPA and Providence teamed to develop a 4,600-square-foot facility in the Irvine headquarters of an international data-storage company. The facility offers a concierge medical home model with visits between 30 and 60 minutes—which enables more health promotion across behavioral and lifestyle health, physical medicine and functional movement, and integrative primary care services provided at the wellness center. After five years, nearly 95 percent of employees at the Irvine headquarters use the center, and their response is an average overall satisfaction score of 98.2 percent and net promoter score of 94. The program also offers complex care management services, saving the company about $18,000 per enrollee a year, Providence St. Joseph estimates.

Foward Thinking Q3 3

A New Model

The next generation of the clinic will offer more virtual experiences, serving as a touchpoint for examination, information and resources, says LPA Director of Healthcare Rick Wood. The clinics will address the whole patient, making health an essential part of the workplace. “It’s going to be part of our normal routine,” Wood says. “Every day there is going to be a healthcare check-in.”

Rooms will be private for telehealth connections and virtual appointments. There won’t be a large waiting room or a check-in area. Patients will enter directly into a private room where their latest readings and data will be scanned and submitted for review. These centers will serve as an initial screening hub for patients to help categorize them and direct them to the right facilities, relieving the burden on emergency rooms and inpatient facilities, Lihony says.

Spaces will be designed for flexibility and different scenarios, reflecting the needs of the specific workforce and the state of the individuals’ health. “Smaller, more nimble facilities are going to make it easier to address issues and create opportunities,” Wood says.

Foward Thinking Q3 4

The center can be designed to quickly meet demands in case of emergency. Protective gear and testing resources will be onsite. Health protocols and daily monitoring can be funneled through the clinic. Centers can be designed for easy expansion using prefabricated modules, Schneekluth says. “Adaptability is the key,” he says. “If you’re investing in the space, it should be flexible enough to be used for different purposes.”

Any facility will need to be designed to meet the specific needs and culture of the company, addressing the mental health and overall physical well-being of the staff. Respite areas and nap pods can be part of the mix, creating a place to relieve stress and to focus. Smaller customized individual workout zones using remote technologies can help replace the gym.

The new facility won’t look or feel like a traditional medical center, Vang says. “Wellness should be an aura that exists in any space, and facilities can be an essential part of creating that experience,” she says.

Foward Thinking Q3 5
In the new facility, the traditional reception area is replaced with a digital, one-touch check-in procedure, which directs people to the appropriate destination.

Responding to the New Era

An embedded health and wellness facility on a corporate campus can play many roles in the daily activity of the community. The facility can serve as a catalyst to develop better health habits or a navigation tool to lead individuals to opportunities for enhancing their well-being. At a time when many companies could see half or more of their staff working remotely, a center can provide an important link between the workforce and the office. “Maybe they should be called ‘health behavior enhancement centers,’” Lihony asks, as the online charrette concluded.

Foward Thinking Q3 6
Facilities can be welcoming environments promoting a healthy lifestyle.

The pandemic has changed the equation for the clinics, the charrette participants agreed. In worst-case scenarios, corporate-based facilities—as well as centers in schools and retail complexes—can provide an essential role in keeping people safe and relieving the burden on traditional inpatient facilities.

“What matters is the versatility and the ability of these clinics to quickly respond to the needs of the communities, businesses and schools,” Lihony says.

The New Embedded Clinic

The reimagined healthcare center will focus on technology, health and wellness and the flexibility to quickly respond to different conditions. In an efficient, secure space, the design supports stronger connections between providers and patients, while offering an amenity that promotes a healthier lifestyle among employees.

Foward Thinking Q3 7

1: Secure Entry

Patients enter through a no-touch check in process. A UV sanitation station sterilizes hands and personal items. From the entrance, patients are directed to the location of the appropriate resources.

2: Virtual Exam Rooms

The traditional reception area is replaced with a digital check-in procedure. The positions serve as an initial screening hub for patients before they are directed to the proper resources (see image on opening page).

3: Pandemic Response

During an emergency, pressurized modular units can be easily attached to the main facility, creating a secure, scalable zone to treat patients.

Foward Thinking Q3 7 A Foward Thinking Q3 7 B

4: Co-lab Spaces

Open, centralized spaces provide areas for physicians to collaborate together. Information on patients is readily available on movable, touch-screen walls.

5: Exam Rooms

Universal exams rooms can be easily reconfigured into private rooms during a crisis. The conversion will double the number of available exam rooms.

6: Outdoor Connection

Flexible spaces address the health and wellbeing of the staff. During a health crisis, operable glass folding walls can open up outdoor spaces to safely accommodate small groups.

Foward Thinking Q3 7 C Foward Thinking Q3 7 D