Windrock Health is a fictional composite based on nearly 90 of our clients’ stories. It is a story that encompasses the unique, and yet shared challenges, pain points and realities that so many systems have faced and continue to face in this complex, evolving industry.
Windrock Health has provided great care to the five communities in which they serve for half a century. While historically they have invested in their inpatient campuses, recent shifts in methods of care delivery combined with strong pressure from competitors within both the healthcare and retail space has signaled the need for Windrock Health to think outside their walls.
A few years ago, a new urgent care provider launched several retail clinics across Windrock’s markets. At the same time, Windrock’s primary competitor opened several primary and multispecialty care offices that absorbed important market demand, particularly in Windrock’s suburban and rural markets. In response, Windrock’s executive team pushed to build a handful of urgent care, primary and specialty clinics—the locations of which were determined primarily by manual demographic analysis, zip code data, gut feel…and sometimes just where they found convenient property available. Rumors of micro hospitals, ASCs, and other outpatient investments by current and new entrant competitors have recently circulated and made it clear that healthcare is undergoing a seismic shift, and in order to both survive and thrive, Windrock is going to need a strategy that provides more certainty and precision than anything they have done in the past.
In short, Windrock will need to discover and embrace a completely new way of Ambulatory Network Planning.
Of course, like most health systems, change will require breaking through numerous layers of bureaucracy and political boundaries. Any large project is a slow-moving freighter, often dragged down by an anchor of meetings and constantly in danger of death by committee. Change will require information everyone can count on, breaking through traditional silos, and proactive versus reactive decision making.
To add to the pressure, Windrock’s Board of Directors has recently challenged the executive team to move beyond tactical actions in all areas of growth—and has demanded a new era of more calculated, strategic decision-making and planning.
Next month, we will speak with Windrock Chief Strategy Officer, David Weichert, to learn a bit more about how the organization has decided to move forward.
Four weeks into the project launch of STRATUS, we caught up with Windrock Health’s Chief Strategy Officer, David Weichert, to get his insight about the process so far. Over the past weeks, Windrock Planning has worked closely with the RES team to build out their market Whitespace Analysis.
This Whitespace Analysis is the critical starting point for any RES project, illustrating the ideal network of ambulatory locations by analyzing millions of intersections in each market and uncovering the network that maximizes service line market share and preferred payer mix, while minimizing competition and cannibalization. Effectively, the ultimate, data-driven network of outpatient locations to maximize access, convenience, and patient coverage without constraints or inefficiencies. The team is then able to compare this to their existing portfolio, revealing opportunities for expansion, consolidation, and relocation and forming the foundation of Windrock’s growth and transformation strategy, all seamlessly delivered and maintained in the online STRATUS platform.
The results were presented to the Windrock executive team last week— this was the first time they had the opportunity to truly understand the value this information and insights could give to their organization.
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Q: What were the main challenges you were looking to solve with RES?
A: Initially, we were looking for a tool that would help us with mapping our market and creating demographic reports. We were also looking for “the next site” that we should add to our network.
When I saw the folks at RES at a conference, I was in the middle of several projects that I really needed to verify. I was worried that we were operating more on “guestimates” than on solid data. At a system level, I also knew we needed to take a close look at our existing portfolio, and find ways to clean it up.
So primarily that was the focus. However, once I understood more about the RES platform, I quickly realized it could help solve another of our nagging issues…. Once we fully socialize the results and recommendations, I hope to generate a few million dollars in consolidation savings that I can turn around and reinvest in the right expansion opportunities.
Q. How important is this to your organization?
A: We’re betting the future of our health system on ambulatory, and we’re adapting to what our patients want by providing convenience, experience, and engagement through our facilities.
The bottom line is that we have to get this right. With the big push for patient convenience and value-based care, we must have a strong ambulatory presence moving forward…and there’s just not a lot of margin for error.
Q: What made your team choose to go with RES over other alternatives?
A: What a lot of people saw in RES was the marrying of really advanced outpatient healthcare and demographic data with a cloud-based, visual GIS platform that we can log into to see the results and then change the strategy ourselves. No one else is really doing that. That really got people excited.
We had honestly struggled before that. We tried to develop our own “tool” a few years ago when we just couldn’t find something that was already built that would meet our needs. We ended up with a really manual internal process with limited data that we forced to work for a while, but it was really slow and manual.
Q: What were some of the challenges in the decision-making process to engage RES?
A: At first, the executive team thought we already had all the data we needed. Yes, we had a lot of OUR data, but we definitely didn’t have data on the whole market though. And our own data wasn’t organized in a central location. .
The light bulbs really turned on when they saw STRATUS during the RES demo. At that point, there was no slowing down. We had a signed proposal within 2-weeks and were viewing initial results for our market 30-days afterward. RES was super responsive and thorough in explaining the process, methodology and assumptions of the program. Once our executive team was comfortable with that the product, they signed up quickly!
Q. What has been the response so far with stakeholders?
A: It’s still pretty early in the process, but I would say that STRATUS is already helping our leadership with multiple short-term decisions we had to make.
From a system level, we now not only understand how many sites we need and where they need to be, but also how to communicate the strategy to everyone involved. For us, it’s always been a fight for resources across different service lines and market leaders and we’ve been sort of stuck in the middle as a mediator. STRATUS puts everyone on the same page, in the same system, and raises confidence across the board. I can already see that we will be better at working as a team toward the same goals and objective, all operating from the same playbook. And now we can prioritize opportunities at a system-level, first to last, so we know where our capital will get the biggest return.
For example, just this week we used STRATUS to analyze a project we have been considering for some time. As it turns out, it wasn’t a great investment for us, so we used the projections in STRATUS to justify canning it. We also used STRATUS to identify a hidden opportunity that we hadn’t thought of before, and hope to allocate capital to it instead.
Q. Have there been any surprises with the data so far?
A: Yes, specifically from the Whitespace Analysis. First, we were able to verify that we had made some good decisions in the past with some of our existing clinics, so that was nice validation to have. We were also able to analyze some past projects that were more political, real estate deal driven and now have the evidence we need to get rid of them. But the Whitespace Analysis also identified a number of opportunities we hadn’t expected. Ones that the data could see, but those of us on the ground simply hadn’t.
One of the best things about the process is that it’s objective…it’s just facts and data…there’s no black box or alternative agenda involved.And we can use the recommendations to drive consensus across all parties in the organization, even with those that in the past have wanted to maintain status quo or may have resisted this kind of change.
Q. What are you really hoping to see with RES and STRATUS moving forward?
A: For us, the biggest win will be in creating the 3-5 Year Growth Plan, getting support from the board and capital committees, and actually getting started on transforming our network. By having data driven recommendations, I really think this “new way” of creating and executing strategies will speed the process along—from plan creation and interim adjustments to consensus and approval. It’s going to be so nice to have less bias, opinion, and politics involved!
Obviously, when all of that happens, we are hoping and expecting a really great return on investment. So far, we are pretty excited and very optimistic.
Early this year, prior to the launch of STRATUS, the Windrock Strategy and Real Estate Teams were tasked to find a location for a primary care practice in one of their outlying markets. When they began looking into possible sites, the leader of the medical practice group, Dr. Shelton, recommended a few parcels of land just outside one of their main service areas.
While the property was in the general service area they were targeting and the price was reasonable, the team wasn’t certain if this was the optimal location. They spent several months and dozens of meetings trying to come to a decision, but the majority of the discussion seemed to be based on gut instinct and local market influences, while the limited data points presented simply were not enough to give them the confidence they needed to pull the trigger.
The team was divided. The analysts felt fairly certain that the proposed parcels would not yield the volumes the business case stated was necessary, but the clinical leadership, led by Dr. Shelton, disagreed, stating that the property was in a new growth area, with private and municipal development plans in discussion that would lead to large growth in the near future.
In fact, Dr. Shelton, who had dabbled in commercial real estate over the last several years was sure that this was the right location at the right price. In his view, the analysts’ hesitance didn’t take into account his “gut feeling”, honed by years in medicine and a few successful real estate deals under his belt.
In his defense, it’s difficult to argue with emotion when objective facts are scarce and unconvincing.
It soon became clear that a part of Dr. Shelton’s insistence about Parcel 001-019-05 had a bit to do with the fact that the owner of the property was an old school mate of his. Despite this revelation, he remained adamant…and the team remained stuck, caught between a desire for data and someone in a powerful position who “didn’t need data”.
Luckily for the team, and for the organization, this all came to a head right around the time that STRATUS was launched at Windrock Health. After the whitespace analysis was complete, it became crystal clear that not only would this site not be optimal, but the team now had undeniable data stating that the site being proposed would have most likely resulted in an utter failure—something the practice could ill afford if they were going to continue on their growth trajectory.
With STRATUS, the Strategy and Real Estate teams were able to create a custom scenario for the site in minutes and compare it to other opportunities identified from the whitespace analysis. And, to ensure that they adequately addressed the claims about large growth in the area, the teams also created a custom scenario with inflated growth projections exceeding many times the highest national percentiles. Even under this scenario, the projected performance still remained well below other existing opportunities in the market.
During the next team meeting, the reports were brought in. There was some initial pushback from Dr. Shelton, but the facts were indisputable. The RES team was also present to answer the clinical team’s questions about the data and methodology, including assurances that growth in the area was already “baked in”.
While he was still not pleased with the result, Dr. Shelton wisely decided to re-route the discussion to a site that had been validated by STRATUS and progress resumed with the team presenting clear projections on volumes and staffing needs at the new location. With the assurance that this new practice was ultimately going to prove to be a success, Dr. Shelton’s mood brightened considerably and Parcel 001-019-05 was never mentioned again.
Over the last two weeks, the team has also been working closely together to narrow the whitespace analysis results to identify the next two practice locations where they can begin working on approval documents. And, with solid data that the whole team now trusts, the process is expected to move quickly to decision—something that will greatly help Windrock stay ahead of their competition in the market.
Jamie Carlyle is the Senior Manager of Strategic Growth for Windrock Health. In her role, she is directly responsible for evaluating site selection and feasibility based on system requests and strategy. We were curious to know what her first impression was when she was introduced to RES and STRATUS, as well as how it has changed her daily work and the way her team operates within the organization. We wanted to better understand the challenges that her team faced–especially considering that these are the individuals that we consider our “super users”. It has often been analysts like Jamie would have helped RES evolve STRATUS into a better, more useful tool for our clients.
Before STRATUS, how were you facilitating ambulatory planning?
Well, that was a long road and we went a couple of directions. Early on, we would look at demographics and our past experience to try to narrow down sites. We would get a map out and plot all the locations and estimate the population—you know the drill. We also relied heavily on insights and correlations from the inpatient world, which isn’t always apples to apples with ambulatory. We were doing the work, but it was very manual and took a lot of time. On top of that, there was a lot of discussion with the team and various stakeholders…but it’s difficult to make a decision that you feel confident in.
Through the years we also worked with a retail analytics firm that provided some level of healthcare analytics—but what we got were mainly reports with site scores, customer profiling, etc.that we struggled to translate into a business case. We spent more time than we cared to trying to translate those metrics into a financial, staffing and development perspective, and even then it confused our decision makers. It just didn’t give us actionable market opportunities.
And yet, you said that you continued to work with this firm. Why was that?
I would say there were two reasons. The first was that we didn’t know there was another option. I mean, at that point, it was clear we needed a more efficient way to bring more meaningful data together but we couldn’t find the right tool that was already built or that really brought value for the price. So, we built something ourselves that partially worked but with serious limitations. For example, you couldn’t update it on the fly so every time there was a change we were back to square one.
The second reason, and this came into play even after we had discovered STRATUS, was price. The retail analytics firm was cheaper. The team who dealt with this everyday understood that what RES provided was a game-changer…but there were some people who were really resistant to it because it was more expensive than what we had been doing up to that point. The reality though is that the consultant was never going to get us where we needed to be—it was just retail analytics dressed up as healthcare—and what we could both save in terms of avoiding bad decisions and gain by being in the right locations would pay for STRATUS a hundred times over. In fact, we achieved payback on our subscription with the first major decision we made using it!
So price was a concern at first. Was there other pushback from the team?
I think that at first there were some reservations with the analysts. There was pushback within the team from those feeling either threatened or resistant to change. A few wanted to stick with the old way of doing things. I think one or two were a little wary that something like this would make them replaceable. But the RES team did a great job of addressing these unspoken concerns. And, although there was a learning curve to understand what was really packed into this, once we got past that we all saw fairly quickly that this was going to completely change the nature of our work. It’s a powerful tool for us to leverage and in case like Dr. Shelton…we kind of get to look like heroes…without needing a degree in advanced spatial analytics. So, we’ll take that!
What are some of the things you are seeing with STRATUS that you haven’t been able to before with your prior methods and tools?
Well, for starters, with the whitespace analysis that RES did at the beginning of the project we had a starting template for growth and optimization for the entire market. And the resolution that Stratus provided changed the way we look at service lines and patient access. We aren’t using zip codes anymore…it’s at the street and neighborhood level. We can also narrow down payer mix and financial aspects of certain streets, neighborhoods, and even submarkets and understand where our competitors are now, and where they may go in the future.
How were these insights more actionable that what you had before?
Instead of the sites scores or “fuzzy” metrics that we were using before, RES gave us a list of recommendations with opportunities ranked first to last, allowing us to focus our time and energy on the best opportunities first and then work our way down the list. The metrics STRATUS match what our decision makers are specifically looking for in terms of volumes, FTEs, sizing, payer mix, etc. RES told us that they built the tool from the business case backwards and so far the output shows that.
You say that STRATUS has changed the nature of your daily work. Can you elaborate?
Beyond the Whitespace analysis, having ongoing access to the data via STRATUS allows us to turn on and off various layers and create scenarios to model the impact of changes in strategy. For example, this week one of our analysts ran what would happen if we added a new location in one of our Western submarkets where new residential development is going. Within a few minutes, we had a clear answer. Being able to model those “what if’s” as they arise is huge for us.
How would you say this has changed how your team works with the organization?
The first thing we noticed is that it has changed the way opportunities are viewed and debated within the system. Instead of being reactive, we can be proactive by having a vetted short, medium and long term plan with an accompanying pipeline. Because we now also have consensus on the analytics at all decision levels we can confidently make decisions and get approvals quickly.
What do you think this will mean for Windrock in the next 3-5 years?
Several of our markets are in an extreme growth phase and our success or failure will be decided within the next 1-2 years…not 5. We need the first mover advantage in these markets and need to establish a reach with those new patients with attractive, convenient and accessible sites. Healthcare is extremely competitive right now and the moves we make, what we build and acquire, and our speed will determine our survival and ongoing success. STRATUS helps us hit the mark on all of these critical points.
Are there things that you would like to see that STRATUS doesn’t currently provide?
Yes, there are some areas that the tool doesn’t cover that would be great—our leadership has been leaning toward adding some ASC’s and imaging sites…but currently STRATUS doesn’t have this data. The good news is that our team has been working closely with the RES guys to make this a reality. It’s good to know that as we identify ways to improve the tool, RES is willing to listen and make changes.
As the summer comes to a close, we are still hot on the trail of the Windrock Health story, our fictional composite based on nearly 90 of our clients’ experiences.
Last month, the local business journal published an article reviewing the last year of Windrock’s L.A.S. (Life after STRATUS) at the organizational level. This month, we will be speaking with the Director of Real Estate, Nick Massey, about the difference that STRATUS has made on the real estate side in speeding up approvals and implementation of projects.
Can you describe your role at Windrock and a bit of your background?
Before Windrock, I worked in commercial real estate for a long time, working mostly within the retail, banking and telecom industries managing large real estate portfolios of up to a thousand locations. That was really a big part of why they brought me here two years ago; to bring a bit more sophistication and experience to the real estate process for Windrock.
Before STRATUS, can you explain a bit about how your team worked?
When I came, the organization had 35 locations and really no one at the helm of the real estate department. As you can guess, there wasn’t much of a planning process to speak of and most activity was reactionary at best. I added two dedicated real estate planners to my staff and we outsourced the basic functions to become more efficient. However, it was still very difficult to pull off real estate transactions with any success because we could not get the business leaders to make decisions or give us clear direction…everything was a guess or resulted in a stalemate. I was really beating my head against the wall.
How was the organization making decisions before and moving into implementation?
It was either based on the opinions of the business leaders, broker recommendations or existing relationships. Like I said, we had very little factual data to back up where we should locate our ambulatory facilities. The business leaders have financial responsibility for the outcomes, but with the lack of data combined with a lot of political pressure it meant we didn’t get to a lot decisions….good or bad.
Can you give us some examples of the biggest challenges/issues with that process?
Speed to market was the biggest issue we faced. Let’s say one of the execs decided we needed a multi-specialty clinic in a particular submarket. So, the next step would be for our real estate team to go out to find available properties. We would come back and present the sites after months of looking, then the waffling would occur…everyone forgot what they asked us for and why…no consensus on the need, and the whole process would flounder. A few months after that we would come to a decision, but by that time, the properties we identified would no longer be available…either leased to a competitor or another retail business. Then we would have to start the whole process again. Add to that the fact that our brokers got burned from doing a ton of work with no completed transaction and you have a pretty vicious cycle.
Now that your organization is using STRATUS, how has that process changed in regards to getting approval and moving to implementation?
It’s as different as night and day. Now, when our real estate team gets a request to find properties, there is already consensus within the organization on what service lines have opportunity, the number of physicians needed and therefore the approximate size of the real estate required. All this is provided by STRATUS and all of our business leaders have full faith in the outputs generated. Our strategy team works with them closely to build 3-5 year strategic plans and our real estate team greatly benefits.
Now, I am able to engage our brokers with very concise instructions: Find me all options that fit these requirements within 1 mile of this particular intersection. With this specific direction, our brokers can spend their valuable time finding true opportunities for us rather than wrangling us for a decision.
Additionally, now we are trying to solve for a network of optimal locations across a market, not just the next best site. This allows us to be proactive in creating real estate opportunities for the future…even if sites are not available today. It sure makes prioritizing sites across the market much easier as well. Not only can we compare the expenses like we have done traditionally, but now we can layer in accurate revenue projections to get a true ranking.
How would you compare STRATUS to other similar systems you have seen?
STRATUS is unlike any other system I have seen in the past. It’s a complete package for ambulatory planning…others just give you bits and pieces. Its amazing RES could accommodate the complexity of our organization with all the specialties and has given us the flexibility to create our own scenarios and build solid business cases from that. The underlying complexity and reliability of the results makes it defensible so we can present, decide and move quickly into the market and site selection.
How would you compare real estate for healthcare to retail world you came from?
Healthcare is going through a similar evolution that retail and banking industries went through over the last several decades. Healthcare continues the shift to a more retail-like environment with the focus on convenience to the consumer, i.e. patient. As it relates to real estate, now we aren’t just competing with other healthcare organizations, we are competing with retailers who have had this nailed down for a long time. With STRATUS, we can compete even with those guys. And, as hospitals continue to consolidate, STRATUS will be critical for the consolidation of portfolios and identifying opportunities in an extremely competitive environment.
When we last checked in on Windrock’s journey toward ambulatory transformation, Nick Massey, Windrock’s Director of Real Estate, discussed how STRATUS has effectively bridged the difficulties of blending operational strategy and site selection. Now that STRATUS has enabled Nick and his colleagues to make tremendous headway toward gaining internal support to pursue specific sites in the market, Windrock is now facing additional financial and execution challenges that may prevent them from realizing their strategic objectives.
Let’s take an in-depth look into some of the internal communications that highlight these challenges and see how the use of STRATUS and Windrock’s collaboration with the RES Development team enabled Windrock to continue advancing their ambulatory optimization Initiatives.
INTERNAL MEMO
TO: SENIOR MANAGEMENT TEAM
FROM: JAMES SINCLAIR, VP of OPERATIONS
RE: NETWORK STRATEGY FOR MULTISPECIALTY FACILITIES
Senior Management Team,
My Operations team is nearly complete with preparation of our network strategy business case recommending new outpatient facilities. Once scrubbed by finance, this package will be submitted to the Building, Land, and Technology Committee (“BLT”) for approval in October. It will then be submitted to the Executive Committee in January, prior to final Board approval in February.
The business case outlines 3 markets of interest – Cherry Hill, Greenway, and Montgomery.
- As you’re aware, Cherry Hill and Greenway have been in our strategic plan for the past 2+ years, but we were unable to reach internal consensus until STRATUS was infused into our Strategic Planning Process earlier this year. We are planning a 30,000 SF urgent care and primary care facility in Cherry Hill and a 60,000 SF urgent care, primary care, multi-specialty, and diagnostic facility in Greenway. We have sites under contract for both projects that have been vetted by STRATUS’s projections.
- Montgomery was identified by STRATUS and is new to our strategic plan. Ever since, we have been seeking solutions for a 45,000 SF urgent care, primary care, and multi-specialty clinic and are continuing to search for acceptable land.
As you know, the goal across our network is to establish the ideal number, service line mix and facility size, and ultimate placement of sites to achieve optimal network coverage, efficient deployment of resources, and maximum revenue. Additionally, this rollout will introduce a new programmatic approach for the development of new sites, utilize our new operational design prototypes, and be the first test of our new marketing and branding plan. This new approach will make us more convenient to our patients, more visible to our community, and promote innovative multi-functional spaces for our medical group physicians.
INTERNAL MEMO
TO: SENIOR MANAGEMENT TEAM
FROM: SUSAN VANDROSS, VP FINANCE
RE: NETWORK STRATEGY FOR MULTISPECIALTY FACILITIES
The finance team has reviewed the initial scope and budgets for the Cherry Hill, Greenway, and Montgomery ambulatory sites. As you are all aware, historically leadership has always insisted that the system maintains ownership of all real estate.
Following this directive, we have determined that Windrock can finance the Cherry Hill and Montgomery projects —with the caveat that Greenway must be reduced from 60,000 to 30,000 SF.
Unfortunately, we are unable to approve funding for the Montgomery project at this time.
INTERNAL MEMO
TO: SENIOR MANAGEMENT TEAM
FROM: SUSAN VANDROSS, VP FINANCE
RE: NETWORK STRATEGY FOR MULTISPECIALTY FACILITIES
In our last communication, we had determined that we could only approve 2 of the 3 proposed outpatient sites including a downsizing of one site due to a longtime policy of funding our own projects. However, this past week, we worked closely with members of the leadership team to review ROI and other market projections. Upon completion of our review, it is apparent that all 3 sites are highly beneficial and there are distinct competitive advantages to pursuing them all at this time. As you know, our new CEO has dictated a new directive of prioritizing first-to-market opportunities. Thus, our finance committee has agreed to pursue new financing and development strategies that would enable us to move forward on all projects and ensure we stay ahead of our competition.
INTERNAL MEMO
TO: SENIOR MANAGEMENT TEAM
FROM: NICK MASSEY, DIRECTOR OF REAL ESTATE
RE: NETWORK STRATEGY FOR MULTISPECIALTY FACILITIES
Great news, team! We have spent the last several weeks looking into ways to pursue the full 60,000 SF scope of the Greenway project in addition to the 45,000 SF project in Montgomery. I am happy to report that we have been in negotiations with the RES Development team and have agreed to terms that will enable both of these projects to move forward. For Greenway, they have proposed to act as a 50/50 Joint Venture. For Montgomery, they were able to assemble and gain control of an off-market, 4-acre site and have proposed a 15-yr build-to-suit lease structure that meets the terms required by our Finance team. In two weeks, we will be submitting a letter of intent for each of the 3 projects to BLT for approval.
INTERNAL MEMO
TO: SENIOR MANAGEMENT TEAM
FROM: JAMES SINCLAIR, VP of OPERATIONS
RE: NETWORK STRATEGY FOR MULTISPECIALTY FACILITIES
Excellent work, everyone. This sounds like a great plan. As discussed during our meeting this morning, we’re on the agenda for the BLT meeting in two weeks so let’s wrap up the packages quickly as we need to move on these opportunities.
I’m certain BLT will appreciate the effectiveness of combining our new data-driven strategy with this progressive financing and development.
This will definitely be a compelling package!