It was interesting to sit in the audience on the last day of the HEALTHCARE DESIGN Conference, listening to futurist Joe Flower prognosticate about healthcare, just hours before President Obama would win re-election. As closing keynote, Flower offered his predictions, noting (almost as an aside), “I believe Obama will win today”—and then continued as if this was a foregone conclusion. Well played, Futurist.

Whether or not the rest of his presentation will prove prescient (read here for Jennifer Kovacs Silvis’s overview), Flower did add a few more considerations to the mix as the future of the Affordable Care Act is now secure. With the ACA asterisk removed, the questions take on more urgency: What will ACA, and Obama’s second term in general, mean for our industry and the built environment?

Joe Sprague, senior vice president and director of health facilities for HKS Inc. (Dallas), says that as far as the election goes, “On the positive side, we have some clarity now. Unfortunately, there’s little incentive for hospitals to invest their capital.” Adds Sheila Cahnman, group vice president and regional leader for HOK (Chicago), “A decisive election result should at least remove some hesitation from the healthcare marketplace. But other more pressing expenditures, such as electronic medical record implementation and physician practice acquisition, are still likely to trump large-scale U.S. hospital revitalization projects for the next few years.”

In Flower’s view, the “big box” general hospital is the least likely model to make money in the future. A healthy discussion among members of our LinkedIn group, the HEALTHCARE DESIGN Connection, stirred up other predictions, some more dire than others—more medical office buildings and fewer emergency departments (or perhaps more MOBs with EDs attached), more clinics and home-based direct primary care, a drying-up of traditional sources of capital.

Sherri Bowman, principal with Array Healthcare Facilities Solutions (Philadelphia), takes a broader view. “Everyone will be demanding increased efficiency,” she posted (reprinted here with her permission). “We should all be looking at ways to incorporate efficiency into our approach at the very beginning. Many more of our clients are taking our recommendation to incorporate Lean design principles and simulation modeling during the early phases of their projects. It’s a significant increase over last year, when they were worried about how much it would add to the design cost. (Not that much, in fact!)

“We need to be leading the charge on how to help our clients in this new ‘efficient-focused environment,’” she continued. “The buildings we design are more than the sum of their parts—we know design impacts people—in any environment. Evidence-based design has shown how we can help improve patient outcomes. Now we need to move to efficient-based design and help our clients improve both outcomes and their bottom lines.”

Whether the buildings are clinics, MOBs, specialty centers, or hospitals, we’re going to see a lot more people in them as health insurance becomes more readily available. The conversation is far from over, and we hope you’ll continue to share your perspectives and opinions with us via LinkedIn, Twitter (@HCDMagazine), and Facebook.