Locating Mammography Services to Fulfill Community Need

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

DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.

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delivery spectrum. Our knowledgeable

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problems and develop a method to improve

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efficiency and utilization.

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Published: JUNE 2022