Locating Mammography Services to Fulfill Community Need CASE STUDY
A prominent radiology group in a medium metropolitan market wanted to increase the rate of breast cancer screenings by offering a convenient, boutique mammography site to its community. Before searching for real estate, the group needed to understand the potential for volume from the surrounding zip codes. They also needed to know what space requirements would be warranted for their selected location based on that volume potential.
CHALLENGE
EXECUTIVE SUMMARY
What is the potential need for
Array performed both a strategic market and space planning analysis to give the
mammography services and where
client specific location suggestions and detailed numbers to use when presenting
would be best to locate a boutique
the business case to their board.
mammography clinic to capture this need?
Demographic Analysis and Mammography Need Assessment
SOLUTION
After mapping locations where the group currently provides radiology services, Array worked with the client to generate an initial county preference. Using these
Through this study, Array provided the
inputs, a demographic analysis was conducted on zips within a 30-minute drive—
client with two options for potential
the distance that patients in this area are accustomed to driving for outpatient
locations and space programming to
care. A zip-code level population
determine the size of the building they
breakdown by gender and age,
would need. Using this information, the
combined with the most common
client had the necessary information to take
clinical guidelines for the frequency
the next steps of searching for available real
of mammogram screening, led to
estate in those markets with the requisite
estimates of the maximum screening
space as well as presenting the business
need within each sub-market. With
case for board approval.
no other competitors in the market,
Top four zips account for 75% of the gap in (more concentrated population/need) Zip Code
Population Female 20-39
Population Female 40-54
Population Female 55+
Addressable Market
Actual (AB 2019)
Gap
Zip Code 1
4,166
3,239
7,758
8,411
2,938
5,473
Zip Code 2
1,815
1,839
5,688
5,631
1,979
3,652
Zip Code 3
2,407
2,025
3,440
4,318
1,567
2,751
Zip Code 4
1,237
1,268
4,082
3,989
1,399
2,590
Zip Code 5
851
770
2,198
2,235
774
1,461
Zip Code 6
710
880
1,560
1,920
686
1,234
Zip Code 7
286
340
777
858
317
541
Zip Code 8
346
310
692
771
285
486
Zip Code 9
250
241
726
725
264
461
Zip Code 10
431
310
557
681
246
Zip Code 11
30
33
66
77
29
48
12,529
11,255
27,544
29,618
10,484
19,134
Total
435
Legend Largest Gap Medium-Sized Gap Smallest Gap
the client’s de-identified data showed
that only 40 percent of the maximum 3screens were being delivered. After an initial Where is the gap between addressable and actual screens greatest based on geography?
review with the client, a second county where an active competitor exists was identified for analysis. In this case, market estimates for current mammogram screenings showed, that the client was only performing one-third of the market’s existing screens, and existing screens only accounted for 35 percent of the market’s recommended screening level.
PROJECT HIGHLIGHTS
15%
1900
2
Mammogram growth expected over next 10 years
Square feet of physical space needed
Potential locations identified
Forecasting Future Demand
CLIENT PROFILE
While the project had a short-term time horizon, it remained important to have
Confidential Client Southeastern US
an eye to how demand will change in the absence of any intervention. Proprietary
A preeminent multispecialty practice within
the area at both the service line and modality level. These projections indicated that,
its area, this client’s team includes board-
based on changing factors like age, population growth, environment of care, etc.,
certified radiologists, vascular surgeons,
expected mammography growth will be 15 percent over the next 10 years. Further,
neuro-interventional radiologists, and the
2-D mammography will slowly fade out while 3-D, or tomosynthesis, will grow in
physician assistants and support personnel
popularity for both screening and diagnostic purposes. On the diagnostic side, MRIs
necessary to deliver exceptional service to
and ultrasound should experience growth around 50 percent over the next 10 years.
every patient.
Knowing these specifics fosters confidence that increased demand is imminent and
sources were used to give insight into the 5 and 10-year demand projections for
informs programming options at the future site.
The practice is highly subspecialized and includes more than 40 radiologists and
Location Modeling
several vascular surgeons who provide full-service diagnoses and treatments for
Using the results of the mammography needs assessment, a need gap was determined
nine hospitals, dozens of outpatient facilities,
by subtracting the actual number of screens being performed on patients within
hundreds of referring physicians, and
each zip code from the expected number. Along with median household income and
thousands of patients throughout the region.
insurance coverage, this gap was used in a weighted average scoring methodology that ranked which zip codes were the most desirable targets for building a sustainable
That are primarily adjacent to each other at the county intersection. practice. The resulting scores were heat mapped to determine if any beneficial adjacencies of highest-ranked zip codes existed.
Targeting a location in 28704 could p both counties. This could have the a less cannibalization as it is geogra distant from current Mission Imagin the prior suggested location in Bunc However, ARA must weigh the pot cannibalization with the added barrie - taking market share away from ano the ramifications that may
TOOL County 1
Rank of Target
23
Interviews One of the benefits in seeking out a consultant is the network that they bring with them. Our job is not to know
County 2
everything on our own; our job is to know where and who to turn to and fill in
1
County Line
any knowledge gaps. That’s why during
Clustering of Top Zips
strategic interviews, we frequently leverage our network to talk to individuals who are
4 experts in their fields. During this project,
Where do large gaps align with demographically desirable patient populations?
Figure 1: Heat map of ranked zip codes
we interviewed the team to get their insights into market dynamics and we
After identifying two areas that demonstrated these adjacencies, travel patterns were
interviewed both radiology and oncology
examined to surface frequented, convenient locations. With a location pinpointed
experts to learn the specifics of best
in each area, satellite images indicated the proportion of each zip codes’ residential
practices for this offering. Using third-party
population that fell within a the 15-minute drive time radius of each location. Using
sources is helpful in gaining unbiased
these estimates, the potential capture was compared against the pro forma to
viewpoints that can inform the project.
understand what percent of the gap needed to be captured to fulfill the business plans.
Page 2 | Case Study
In addition to the strict numbers, the pros and cons of each option, such as
“MISSION FIRST” MINDSET
encroaching on competitors’ territory and cannibalization, were presented to the client so that they were fully informed of the impacts of each location.
The client came to Array with a novel model of care concept that put mission first. As
Best Practice Analysis
a primary goal, the client was not trying
Through reviewing literature, conducting interviews, and attending industry webinars,
to capture market share from another
a best practice workflow was developed. This listing of industry best practices
player or defend their share from another
demonstrated how the client can most effectively tackle the gap and increase
player, but just trying to increase the rate of
mammogram rates.
mammogram screens since they are low in that region. With the mission in mind, the analysis required a balance of achieving
What does good look like in breast cancer screening? SCREEN TRIGGER Make sure there are multiple avenues in which patients may receive the reminder to be screened Direct to Consumer: Patient initiates encounter or screening clinic reaches out directly to patient to remind them Provider to Consumer: PCP, Gynecologist, Urgent Care, notified the patient of a need for a screen Payors prompt patient to be screened Public health efforts: health fairs/other events, independent organizations, or coordination with county/Medicaid programs to get names and conduct outreach
BARRIERS
DELIVERY
Find ways to overcome the common barriers that either prevent patients from scheduling or cause them to be lost after scheduling, including:
Mammograms conducted annually for those 40-54 and either annually or biannually for those 55+ Utilize 3D mammogram/ tomosynthesis when possible
Integrating easy-click buttons and reminders in systemwide EHRs for other providers to use
the mission while creating a sustainable
FOLLOW UP
Provide the ability for online schedule for other healthcare providers as well as patients
Have a provider in office/ accessible who can provide realtime radiology reads of the screening
Provide a convenient location nearby where patients live/work/play
Provide access to other cancer screening types for highrisk women
business plan. Further, it required thinking
Have results available for patients within 24 hours Be able to schedule follow-up appointments (a second screen or diagnostic testing, etc.) within two days if one is warranted. Offer streamlined breast screening services. In other words, have multiple modalities available at the same location and with same-day follow-up as an option.
creatively about best practices and market trends since the data did not always align with the new model.
Focus on accessibility by considering weekend or evening hours
TRANSFORMATION
Be knowledgeable on sources of assistance (like state Medicaid programs) that can help cover screenings or help with costs of follow up care if needed) Accept a variety of insurances
Our core mission is the same as that
Eliminate long wait times in clinic and between process steps
of our clients: improve the quality of our work, increase our efficiency, and
Space Programming
motivate our staff to reach for success.
As an integrated practice, our architectural team provided a space program to the
At Array, we are establishing a culture of
client. They applied their knowledge of industry benchmarks and standards to the novel
continuous improvement at all levels of our
model of a boutique mammography clinic and determined that the client would need
organization. We seek to empower team
find a leasable space of around 1,900ofsquare feet. feet. geted per to day would translate to leasable space 1,900 square
members to be agents for good change. We begin all endeavors by considering
# of Units
NSF
Total NSF
1 1 1 1
160 85 80 65
160 85 80 65
Gowning & Subwaiting Facilities
1
255
255
Clean Linen Closet Mammography Tech/RN Workstation
1 1 1
20 180 50
20 180 50
Clean Supply Room
1
75
75
Soiled Workroom/ Holding Room
1
85
85
Housekeeping Room Communications Room
1 1
50 50
50 50
Staff Lounge
1
200
200
Name
process before exploring solutions. Our
Comments
team can guide your organization through
Entry/Reception Waiting Room Check-in Desk Staff Work Room Public Toilet
6 seats / 25 NSF each; 1 TV /10 NSF
pre-design, ensuring clear goal-setting; target outcomes; process analysis and
Clinical/Screening Area
design; and decision support. Our Lean-led Waiting accommodated inside dressing rooms; 3 dressing rooms / 50 NSF each; 1 soiled linen hamper / 10 NSF; 1 toilet room / 65 NSF
clear path to the right project before you begin to design.
Common Staff/ Support Space 1 Vestibule / 30 NSF; 3 Supply Storage / 15 NSF Each 1 Vestibule / 30 NSF; 1 Trash Container / 15 NSF 1 Recycle Container / 15 NSF; 1 Soiled Linen Cart / 25 NSF Table with chairs / 80 NSF; Pantry / 50 NSF; 5 Staff Lockers / 1 NSF each; Staff toilet / 65 NSF
Subtotal
1,355
NSF
Total
1,897
DGSF
Grossing Factor
1.40
approach to project definition provides a
How can we ensure effective resource utilization? Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative that organizations utilize their resources
Conclusion
effectively. Our skilled and experienced
At the end of the project, two attractive locations were identified for the client to
consulting team can help your organization
investigate further for real estate opportunities. The client also had a specific list of
develop a strategy for utilization
other factors to consider when choosing a location along with some programming
optimization, ensuring that every resource
suggestions that will allow them to successfully close the gap, not just offer more
is providing the highest value while
services with the same capture rate.
improving process flow.
Case Study | Page 3
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Published: JUNE 2022