Chicago-based architect Bertrand Goldberg originally constructed the 13,500-square-foot dining room in the 1970s. With a cast-in-place concrete exterior and 4-foot-square windows, the cafeteria was a dark and enclosed space.

In order to improve the patient experience, Bruner/Cott & Associates, based in Cambridge, Mass., and New Haven, Conn.-based Cama Inc., formed a design team to tackle the overhaul. They incorporated evidence-based design concepts such as incorporating nature and daylight into the plan. Gone are the small windows and concrete exterior, now replaced with full-height glass walls and planting beds built off the side of the second-story cafeteria. The glass walls are also etched with an abstract grass pattern that becomes more translucent toward the top.

Inside, the team got rid of the windowless hallway that separated the two dining rooms, adding 2,000 square feet of dining space. The 292-seat area now includes high and low banquette seating options, an infused water station and a yogurt/juice bar. An expanded salad bar was relocated outside of the serving area to allow customers to more easily line up for meals. The catering kitchen and staging area were also moved to another floor.

Designers added aesthetic touches, including quartzite counters, an exposed ceiling, decorative green glass and sculptured wall tile, to the interior. Originally, the floor was going to be replaced with polished concrete, but construction workers found an original terrazzo floor underneath layers of carpet and rubber, which they decided to restore.

In addition to the cafeteria, Brigham and Women’s Hospital is working on a two-phase addition and renovation to the NICU, which should be completed by November 2017.
 

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Blue Cross Blue Shield established the contracts in January 2009 as a result of concerns with the fee-for-service reimbursement model, which, according to the health care network, unintentionally rewards doctors and hospitals for the quantity and complexity of services provided rather than the quality and outcomes of care.

“Fee-for-service payments create incentives to provide more and more services, even when there may be better, lower-cost ways to treat a condition,” said Karen Davis, president of the Commonwealth Fund. “It’s not realistic to tell hospitals and doctors that they must improve quality if by doing so they are likely to lose money.”

In an effort to address the concerns while balancing financial goals, the Blue Cross Blue Shield team came up with the Alternative Quality Contract, a global payment model that combines a fixed per-patient payment with substantial performance incentive payments.

In a statement, Blue Cross Blue Shield of Massachusetts described the goal of the setup as “to enable the delivery system to give the patient the best result from the most appropriate treatment, by the right kind of provider, at the right, and in the most appropriate setting.”

Under the five-year budget-based agreement, the Boston Medical Center will manage the growth in health care spending to a level that falls below BCBSMA’s network average expense trend.

The center works with a network of community health centers in Boston, including seven that will participate in the AQC contract: Codman Square Health Center, Dorchester House Multi-Service Center, East Boston Neighborhood Health Center, Greater Roslindale Medical & Dental Center, South Boston Community Health Center, South End Community Health Center and Upham’s Corner Health Center.

The AQC contract will also include Boston Medical Center’s community-based primary care physicians who are part of the Boston University Affiliated Physicians group, which has practices in Boston’s Back Bay and South End, Foxboro, Norwood and Taunton.

The agreement brings into the AQC nearly 800 additional physicians who care for about 13,000 of BCBSMA’s in-state HMO members. In other words, about two-thirds of doctors in BCBSMA’s in-state HMO network provide care to about 76 percent of BCBSMA members.

An independent study conducted by the Harvard Medical School and Brandeis University, published in the New England Journal of Medicine and Health Affairs, found the contract appears to be achieving its twin goals of improving care and slowing costs particularly in managing chronic illness, preventive care screenings and treating depression.

The studies found that in the first year of AQC, medical spending was nearly 2 percent lower among participating physicians and hospitals compared with those working in traditional fee-for-service contracts.

For physicians and hospitals with no previous experience in a global payment model, spending was 6 percent lower than that of providers in traditional fee-for-service contracts, researchers found.

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The 5,700-square-foot Advanced Multimodality Image Guided Operation (AMIGO) suite, designed by Boston-based architecture firm Payette, includes a central operating room linked to adjacent imaging rooms on either side, allowing the patient to remain positioned on the operating table while the ceiling-mounted MRI can move to the patient during a surgical procedure.

In addition to the imaging equipment, the clinical care and research facility includes surgical navigation tools and image registering and integration software.

“Building an operating suite of this complexity is unprecedented,” said Brendan Whalen, project manager of the suite from BWH Real Estate and Facilities. “Never before has a project involved so much design planning around surgical suite safety. Because of the radiofrequency energy and magnetic field from the MRI and energy from radioisotopes, and x-ray equipment, the suite has extensive lead, steel and copper shielding to protect staff and patients from these emissions.”

The project required suspending a moving 33,000-pound magnet system on a ceiling mounted track in order to use in the multiple processes, permitting rapid and seamless transitions between imaging and intervention.

“The integrated systems provide immediate access to imaging and enable the precise, minimally-invasive image-guided techniques,” a statement from the design firm said. “The end result is a safe and expeditious experience for the patient and a more effective application of intraoperative imaging for the surgeons, radiologists, nurses and technologists providing care.”

The infrastructure for the various systems was “deftly” concealed behind walls and above ceilings, kept neutral in appearance to prevent competing with critical patient information displays, the firm stated.

Kinetic qualities of the suite were captured on the floor, with the arc of the operating table’s rotation and the limits of the magnet’s Gauss lines rendered in a palette of colors.

While the suite was designed as innovative for today’s standards, it also allows for future growth and development, the firm said.

“The project team strove to create an environment that was ‘future-proof,’ using insights from previous installations at BWH and other hospitals that incorporated intraoperative MRI only to better anticipate future needs and accommodate growth and change,” the statement said.

Project Team:
Construction Manager: Suffolk Construction of Boston
Mechanical and Electrical Consultant: BR+A Engineers of Watertown
Plumbing and Fire Protection Consultant: RW Sullivan of Boston Structural Engineer: Weidlinger Associates, Inc. of Cambridge

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