A hospital tower that tops out beside an occupied hospital is a construction management problem before it is a building problem. Wyoming Medical Center's West Tower reached its top in June 2013 with four stories, 46 patient rooms, about 750 tons of structural steel, a separate 5,000 square foot MRI building and sky bridges tying into the working hospital. The steel was the visible part. The hard part was keeping patients, ambulances, utilities and a construction crew from getting in each other's way for the length of the job.
Construction manager at risk, or CM at risk, puts the builder on the owner's team while the architect is still drawing. We review the design for cost, schedule and constructability, price it at each milestone, and when the drawings are far enough along we offer a guaranteed maximum price. We then bid the work to subcontractors in open competition, show the owner every number, and return the savings. The owner keeps an independent architect and gets the builder's judgment before ground is broken.
It is a good fit for owners who want to control the design but want cost and schedule discipline. If the design is not yet defined, the front-end work looks like our preconstruction estimating, and if the owner prefers one contract for both design and construction we offer design-build delivery as an alternative.
The time saved is in the overlap. While the architect finishes interior drawings, we can bid site work, foundations and structural steel, and order long-lead equipment. On a campus project the schedule is often controlled by shutdown windows, utility tie-ins and outages, so those get scheduled first and the building is fitted around them.
Winter is the other schedule driver. Casper's climatic criteria call for a 3 foot frost line and severe weathering, so the enclosed-by date matters. We lay out a schedule that gets the building closed in before the worst of the weather and puts interior work in the months when it can be heated and protected. We update it monthly and share the logic, not just the dates, so the owner and the architect can see which decisions are holding up which work.
During design, we attend design meetings, produce estimates, run constructability reviews, advise on materials and systems, break the work into bid packages and prepare a schedule. During bidding, we advertise packages, qualify subcontractors, run bid openings and recommend awards with the owner. During construction, we manage the subs, quality, safety, schedule, cost and closeout.
The contract has a fee, the general conditions and a guaranteed maximum price, with a contingency the owner can see. Savings returned at buyout go back to the owner or to a shared savings clause, depending on the agreement. We keep the books open, which public owners and boards generally appreciate. A phased construction on occupied sites plan is part of the scope whenever the building is in use during the work.
CM at risk suits owners with complex programs and a need for transparency. Healthcare is the clearest case. Wyoming Medical Center is a 249-bed Level II trauma center, and its affiliation with Banner Health became official on October 1, 2020 in a roughly $200 million deal. Any hospital addition has infection control, life safety and utility concerns that must be planned before the first pour, and the builder has to be in the room for it.
Education campuses are the other natural fit. Casper College occupies more than 200 acres and 28 buildings on a hill between Casper Mountain and the North Platte River. A project on a campus like that has to work around classes, events and parking, and education and school owners value the builder's role in coordinating the calendar, sometimes with sequencing that runs through summer break.
On an occupied campus, safety is bigger than the crew. We prepare an infection control risk assessment for healthcare, a pedestrian and vehicle traffic plan for schools and colleges, and hot work and lockout procedures coordinated with the owner's facility staff. Each sub signs on to the plan, and our superintendent walks it daily.
We also protect the site against the unexpected: a water main that does not match the drawings, a duct bank that turns up where it should not, a ceiling full of material the drawings did not mention. We survey early, use ground scanning where it helps and keep contingency in the GMP for what we cannot see. Healthcare systems owners tend to ask for this level of preparation, and we offer it on every project.
The GMP is built from our estimate of the work, the general conditions, our fee and a contingency. We set it when drawings are far enough along that the remaining risk is small, and we list the assumptions. After that, buyout shows whether subs came in above or below the estimate, and the owner sees the difference line by line.
The things that move a GMP are changes by the owner, concealed conditions and market swings. We reduce all three by pricing early, locking in key subs and including allowances for known unknowns. Colleges and public owners such as education institutions also use the open-book format to answer their boards and funding agencies, and we produce reports in the formats they need, including monthly cost reports, change order logs and buyout summaries that tie back to the GMP.
Tell us the owner, the site and the opening date. We will return a preconstruction scope, a fee proposal and a schedule that shows where early bid packages save time.
In CM at risk the owner hires the architect and the builder separately, and the builder manages the construction and guarantees the price. In design-build, one company holds both contracts. CM at risk gives the owner more control over the design; design-build gives one point of responsibility.
As early as possible, ideally during schematic design. The earlier we start, the more the price and schedule advice can influence the design. We have joined later, but the savings are smaller.
It depends on the agency and the type of project. Public owners should confirm with their counsel what delivery methods they may use and how they must be procured. We can describe the process and the documents involved.
Savings after buyout are returned to the owner or shared according to the contract. We bid trades in open competition, so savings are visible. Contingency not used also returns.
We plan the work by zone, schedule noisy and dusty work for set windows and protect air quality with barriers and negative pressure where needed. The West Tower at Wyoming Medical Center, with sky bridges tying into the occupied hospital, is a reminder of what is at stake.