Medical Mall Model: a consideration for Ghana?

As hospital-based systems rethink and redesign their care and business models, medical malls can be part of that evolution in the Ghanaian healthcare system.  Trends in patient expectations and public health needs could make medical malls the hospitals of the near future, according to a Nov. 16 Harvard Business Review report.

For instance, in a  2019 Healthcare Consumer Trends Report by NRC Health, 51% of patients say that convenient access to care is the most important factor in deciding where they receive health care services. Medical malls can also be economic engines and sources of jobs, especially in underserved communities.

Medical malls, which can be integrated into a converted shopping mall, can either be a mix of healthcare services and retail spaces or purely a medical center. These malls often include at least five healthcare tenants. In the recent Harvard Business Review report led by Berry et al.,(2021), potential opportunities include but are not limited to:

• Emphasizing care that is continuous rather than episodic and more coordinated and integrated when mall tenants use the same electronic health record system
• Positioning the medical mall as a hub of care delivery — with telehealth, in-home care, and the hospital itself as “spokes”
• Deriving revenue from clinical and nonclinical services beyond the walls of the hospital — and from tenants’ rents, if the mall facility is owned by a hospital or health system
• Expediting a shift to efficiency-based payment incentives given the service-delivery efficiencies that medical malls can offer
• Mitigating payers’ increasing resistance to reimbursing the costs of hospital overhead when hospital-level care is unnecessary

What exactly is Medical Mall?

In Japan, Ito (2020), agrees that Medical Mall model started due to competition for location and clinical department.   He explained that, in Japan, a medical mall is not a medical facility as defined by the Medical Care Act; rather, it is generally an establishment where multiple clinics and pharmacies are concentrated in a specific space.

He emphasized that, medical practitioners are not trained in management, and their knowledge in this area tends to be poor. However, medical malls often involve multiple clinics and pharmacies, plus a consulting organization that provides management support for handling issues in public relations, finance, accounting, organization, and facilities.

On benefit, Porter and Teisberg (2006) agrees that medical mall practitioners receive management support from this organization, which allows for division of function and collaboration, thus improving the quality and efficiency of clinics. As the quality of health care improves, costs can be controlled.

Hence, Medical malls may be superior to existing clinics in terms of management. Ito (2014) further cemented this position by saying that Medical malls also benefit  physicians, such as enabling the provision of high-quality medical care in a comprehensive manner and the sharing of expensive testing equipment by establishing a network system in which multiple physicians work together to practice group medical care. This is expected to improve ability to attract customers and profitability.

Users are not left out, benefit from the plurality of clinical departments with high specialization, as in the outpatient department of a hospital. Therefore, users can access more highly specialized medical care more efficiently compared with other clinics.

Genesis of Medical Mall business

Wince (2011) explained that medical mall business started as a result of the increasing instance of health insurance companies restricting payments to hospitals.  Wince posits that the idea of offering a group of outpatient services together under one roof was seen as a way to take some of the pressure off of hospitals having to serve a wide variety of medical needs while patients are hospitalized.  In Japan, Ito (2020), agrees that Medical Mall model started due to competition for location and clinical department.   But what services are appropriate for this model?

The Healthcare ‘Shopping Mix’

In the US, over 50 medical malls can be found (Wince 2011).  In terms of implementation, they differ, but the retail shopping center formula of providing a convenient group of products and services in one location has translated well to the healthcare industry.

One of the earliest American medical malls was created in 1995 in Jackson, Mississippi, on the site of Jackson’s first shopping mall.  When the mall failed, Dr. Aaron Shirley, a midtown resident and former project director for Mississippi’s largest community health center, had a vision to convert the defunct mall into a state-of-the-art medical facility that would provide quality health care to local residents.

The Jackson Medical Mall, 850,000 sq. ft. in size, now houses the Hinds County Health Department Clinic, as well as numerous University of Mississippi Medical Center specialty clinics, including cardiology, obstetrics and gynecology, and oncology, and the Mississippi Health Advocacy Program.  In the spirit of a true shopping mall, the facility also includes grocers, restaurants, beauty salons, shoe stores, and a credit union.

In 2009, Vanderbilt University renovated the One Hundred Oaks Mall and moved specialty clinics into 440,000 square feet on the ground floor. Upon check-in, patients are given a pager similar to those used in restaurants, allowing them to explore retail and restaurant venues located on the second and third floors. The clinics offer over 20 specialty practices, ranging from Imaging and Bariatric Surgery to Pediatric Care, Allergy Clinics, and OBG/YN, as well as a bevy of convenient shopping.

Hospitals Win/Patients Win

By choosing the medical mall “retail” format, hospitals can renovate an existing shopping center site or area adjacent to the hospital building with new equipment and without expensive and disruptive remodeling of the hospital.  The new facility can offer ambulatory care and diagnostics at one location in proximity to the hospital and allow for a more flexible suite of healthcare services.

For patients, clustering medical services means the possibility of getting several medical treatments in one trip and less time in the hospital because more services can be performed on an outpatient basis.  An added benefit is that patients can do some shopping when they come in for medical treatment!

Physician / Investor-Established Medical Malls

For instance, in 1998, Wince (2011) highlights how a group of 30 doctors who leased space at St. John’s Mercy Medical Center built the new 85,000-square-foot facility, Patients First Health Care, in Washington, Missouri.  Their incentive was not only to be able to offer a combination of services to patients in one location, but also to provide larger offices to physicians who previously worked in the crowded St. John’s Mercy Medical Center.

The physician/investor-initiated medical malls tend to be smaller in size than hospital-financed malls and to be located near retail centers.  The owners of physician/investor-initiated medical malls benefit from limited overhead, easy access for patients and physicians, increased patient referral base, and more control through ownership.

More important (and feasible) than ever before

By offering a convenient and efficient alternative to emergency rooms and in-patient care for medical treatment, the mall concept can play a role in lowering healthcare costs and potentially slow the rise of health insurance premiums. The number of “out-of-pocket” patients is growing steadily and could potentially become the healthcare norm. The Medical Mall model offers hospitals, private practitioners & specialists, and developers alike new market in which to better care for their patients.

As healthcare providers plan for the next 5, 10, and 20 years, it is critically important that they look to new strategic partners who have the experience and passion of serving a consumer-minded patient constituency.

Hannah Mitchell (2021) provided Five insights:

1. Medical malls have the potential to enable health systems to deliver care more flexibly, address healthcare inequities and lower overhead costs, according to the report. The shift away from traditional hospital buildings is supported by several trends, such as patient expectations around telehealth, the proliferation of ASCs and health technology that enables diagnostic testing outside of hospitals.
2. Traditional hospitals will still be vital in treating life-threatening illnesses and acute care, but medical malls offer an innovative way to drive revenue, patient populations and growth. Medical malls can decrease costs by sharing services and costs with other tenants, such as an IT center, a telehealth center or a medical supply distributor. If a health system owns the mall, it can also get revenue from nonclinical services by collecting rent from tenants.
3. More than half of patients said convenient access to care is the No. 1 factor in deciding where they receive care, according to the National Research Corporations’ 2019 healthcare consumer trends report. With ample parking and convenient locations, medical malls can offer flexible and convenient care options many patients are looking for — and potentially bridge gaps in inequitable care by bringing care to patients.
4. Jackson (Miss.) Medical Mall Thad Cochran Center, which partners with the University of Mississippi Medical Center in Jackson, has made it part of its mission to eliminate health care disparities. The mall has attracted several multimillion-dollar grants to help fund that goal.
5. Vanderbilt Health’s One Hundred Oaks Mall in Nashville, Tenn., aims to make care convenient by offering free shuttles to transport patients to a nearby children’s hospital and a hospital for adults. Outpatient health services at this medical mall account for half of the mall’s 880,000 square feet. The system also has multiple off-site clinics that work with the mall, which also offers virtual care.

Take home

I believe that it is time for the Health Care Systems Should Invest in Medical Malls in Ghana.

The writer is an honorary Professor of Naturopathy Holistic Medicine, holds MBA and a chartered Management Consultant (ChMC), Chartered Institute of Management Consultant, Canada.  President, Nyarkotey College of Holistic Medicine and currently, final year LLB law student. E mail: collegeofholisticmedicine@gmail.com