How Real Estate Can Be A Weapon In The Fight For A More Equitable Health Care System

Health care, like any sector of real estate, is inextricably tied to location. Just like the rest of real estate, the events of the past year have forced health care to look at location, and its role in equality, harder than ever.

In the wake of the summer’s nationwide protests against police brutality and systemic racism, hospital systems and health care providers have confronted more than ever the role they have played in the marginalization of communities of color. Location will be a key weapon to address the issue, according to panelists at Bisnow’s Philly Health Care Update digital summit on Thursday.

“There’s a very intense conversation going on in terms of what our role is and how we help restore credibility in certain communities regarding the basic health care practices we need to sustain ourselves going forward,” Thomas Jefferson University Hospitals Senior Vice President of Real Estate and Facilities Clayton Mitchell said during the event. “We now know that we need to be much more intentional in our communications and in how we deliver care to those communities.”

Though the protests helped to draw attention to the issue, the coronavirus pandemic already was functioning as a microcosm of the disparities in health outcomes between neighborhoods. Even before accounting for the higher levels of job loss and barriers to remote learning while schools are closed, the way COVID-19 has ripped through Black and Brown communities has been impossible for anyone watching the data to ignore.

The single factor with the highest correlation to negative COVID-19 indicators in Philadelphia is ZIP code, Jefferson Health CEO Stephen Klasko said during his keynote address at the event. 

“That’s horrible in a city with five university medical systems,” Klasko said.

Under Klasko, Jefferson has been pushing hard via acquisitions and partnerships to integrate digital and technological tools that give its doctors more data and more access to their patients, and thus more ability to stay on top of preventive care. He acknowledged such a push comes with risks of only deepening the health divide if Jefferson does not consciously address the digital divide.

“We need to make sure that all of these technologies aren’t making just the wealthy healthier,” Klasko said. 

As health systems have spent the last few years trying to get closer and closer to dense centers of population and affluence, any movement to be more socially conscious in the distribution of health care will have to be location-focused.

“We have to be conscious of our spend, our presence and the services we provide to the community,” Mitchell said. “If there’s a silver lining to COVID, it’s that [it showed] we have to be more intentional in how we build and prepare, especially for the most vulnerable communities to a black swan event.”

One of the “looming dangers'' facing the health care system overall as the immediate needs of the pandemic start to recede is the projected rush of elective or non-emergency procedures that so many have been putting off due to a fear of exposure to the coronavirus at a hospital. One way to mitigate that “second tsunami,” as Mitchell described it, is with more urgent care and primary care facilities, mostly in spaces vacated by shrinking and dying retailers, panelists agreed.

Usage of retail-based health care outposts has grown during the pandemic as consumers have considered them relatively safer than emergency departments, which have declined in usage during the pandemic, Mitchell said. In this way and several others, the pandemic did for health care real estate what it did for many other sectors of the industry: accelerated an ongoing trend, University of Pennsylvania Health System CEO Kevin Mahoney said.

One lingering effect of the historical trauma many communities of color feel regarding the health care system is a distrust of vaccines  — one that panelists agreed is every bit as understandable as it is dangerous for those demographics. 

A sustained “ground game” focused on education, with home visits and pop-up clinics for convenience, will be necessary in getting enough of the population vaccinated to reach herd immunity in as little time as possible, Johns Hopkins University and Health System Vice President of Economic Development Alicia Wilson said. As a development executive in a cash-poor time for hospital systems, Wilson said she is “more intimately involved in health care delivery than I ever thought I would be.”

“Equity demands what equality never would,” Wilson said. “So you have to think about access points in a creative way.”