Neighborhood Outpatient Center

With 26 physicians and 3 physician assistants, Colorado Mountain Medical (CMM) is the dominant primary care provider in Colorado’s Vail Valley. CMM wanted to expand its practice to provide more services at competitive rates, while doing so in a more centralized location with ample parking. Healthcare services in the Vail Valley have historically been provided in scattered locations, which tend to be hospital-centric. CMM envisioned providing patients with the convenience of evaluation, diagnosis, testing, treatment, therapy, and other specialty services under one roof in a highly visible, state-of-the-art outpatient center. 

It was particularly important to CMM to provide Vail Valley patients with a more convenient and affordable emergency care alternative. The area’s only hospital, Vail Valley Medical Center (VVMC), is expensive and primarily focuses on orthopedic care. VVMC’s emergency department (ED) is also difficult to access on the eastern edge of the service area. 

Project Challenges

CMM’s existing lease was due to expire 20 months from the start of the site search for the future Buck Creek Medical Plaza. In response, NexCore Group fast tracked the development process, which included finding and acquiring an optimal site, securing entitlements, recruiting an ED anchor and other specialty providers, and designing and delivering the building by June 2016.

To complicate matters, the medical office market in the Vail Valley is unique, given the geography, topography, and concentration of government-owned land. The U.S. Government owns 82% of all available land, most of which is leased to the area ski resorts of Vail, Beaver Creek, Bachelor Gulch, and Arrowhead. Only 18% of land remains for commercial and residential uses.

Site Acquisition

After an extensive site search, NexCore found a 2.15-acre piece of land known as Buck Creek Lot 1A that the Eagle River Fire Protection District bought at the top of the market in 2007. Located just off I-70 in Avon (home of Beaver Creek ski resort and commercial hub of the Vail Valley), the parcel was perfect for CMM’s needs, but when NexCore tried to buy it, the Fire District rejected the offer.
 
NexCore then went to the Town Manager of Avon, Virginia Egger. Ms. Egger was aware of and had the first rights to buy a two-acre lot adjacent to the Fire District land known as Lot 1B. The owner of Lot 1B entered into contract with NexCore, who purchased Lot 1B.
 
As NexCore began the design process on the outpatient center, it concurrently helped the Fire District determine the best way to build on Lot 1A, so that there would be a synergy between the two lots. In the process, the parties determined they were better off swapping parcels, and NexCore agreed to buy the Fire Division land parcel.

Speed-to-Market

From there, things went into high gear to ensure quick delivery of the building. The Town of Avon participated with the Fire District on a bridge loan, and the planning department set their conditions and deadlines. NexCore and the Fire Division met all of the deadlines and the Town of Avon was able to help NexCore fast track entitlements, which included amending the Avon Comprehensive Plan and rezoning both lots. 

The site constraints, including limited buildable area, riparian easements and height restrictions, necessitated a creative design solution to achieve not only the operationally efficient floor plate configurations that providers are seeking in today’s healthcare environment but also the site density to satisfy project economics and space demand. The three-story, 48,400 square foot outpatient center sits atop a partially subterranean parking structure adjacent to an integrated on-grade parking deck. 

All of this was accomplished in record-setting time, with NexCore breaking ground on the facility seven months after the site was identified.

Design of High Performance Clinic

CMM needed an efficient and cost-effective physician clinic. The Vail Valley region demands high rental rates, and maintaining costs was a key driver for CMM. Additionally, improving capacity and productivity in a smaller footprint was part of the design challenge.

NexCore’s Site & Facility Planning Process helped CMM correctly size and configure the operational components in the optimal form to achieve the desired economic targets. The planning process included a benchmarking tour of several high performing clinics in the Seattle area. The tour represented a new generation of physician clinics that incorporate innovative technologies and design concepts to meet patient demands and the challenges of healthcare reform. 

The NexCore project team incorporated universal exam rooms (designed for use by all specialties and provider types, allowing for flexible use of rooms to improve scheduling and room utilization) and centralized, collaborative care team areas into the CMM clinic. The result is a high performance physician clinic designed to deliver business plan results. CCM’s clinic occupies approximately 19,200 square feet on the second floor of the 48,400 square foot outpatient center.

Robust Services

NexCore recruited a strong mix of specialty providers to Buck Creek, which was 94% leased at opening. The service mix creates a built-in referral network for tenants and is projected to generate 88,000 annual patient visits.

NexCore also recruited Centura Health (Colorado's largest health system) as the emergency care anchor, bolstering the facility’s image as the area’s premier medical destination. The combined emergency/urgent care center allows patients to be triaged according to need and reduces the cost of care.  

Building services include:

• 24/7 Emergency Department & Urgent Care
• Family Medicine
• Internal Medicine
• OB/GYN
• Pediatrics
• Allergy/Immunology
• Dentistry/Endodontics
• Dermatology
• Dialysis
• Ear, Nose & Throat
• Gastroenterology
• Physical Therapy
• Podiatry
• Urology

Results

When the NexCore team completed the three-story, 48,400 SF Buck Creek Medical Plaza in June 2016, it realized a long-standing but elusive goal of developing a new outpatient and emergency care center in the Vail Valley that consolidates a robust service mix under one roof. No other medical facility in the area offers the same image, referral base, modern delivery models, parking capacity, or convenient location along I-70. More specifically, the NexCore team was able to achieve the following for its tenants and the Vail Valley community:

• 62% Revenue Generating Space. CMM's revenue generating space represents 62% of its total clinic space, which is 15% higher than the typical benchmark for this tenant type.
• 7% Growth in Outpatient Volume. CMM's outpatient volume increased by 7% after the first year in its new clinic (2016-2017), without increasing staff or hours of operation.
• $1 Million Physician Investment. Physician-tenants have invested over $1 million in Buck Creek Medical Plaza, with priority returns in a successful facility. 
• High Ratio of Exam Rooms to Total Space. CMM's ratio of total space to number of exam rooms is in the highest 10% of national benchmarks, which reduced the practice's real estate costs. 
• Less Circulation Space. CMM's circulation space is 10% lower than typical benchmarks for this tenant type, which lowers operational costs by improving practice efficiency. 
• More Affordable Emergency/Urgent Care. The combined emergency/urgent care center at Buck Creek allows patients to be triaged according to need and reduces the cost of care.

Buck Creek Medical Plaza won Heathcare Real Estate Insights' 2016 award for "Best Medical Office Building and Other Outpatient Facilities in the 25,000 to 49,000 Category".