Mayo Clinic challenged the design and preconstruction team to reduce baseline budget cost by 10 percent. Several project approaches were used to facilitate a more efficient design and construction process, starting with “big room” planning, where all stakeholders met in a proactive, face-to-face environment. Using Lean practices, the team focused on collaboration and innovation to drive value while holding a hard line on the target cost throughout the design. Big room meetings continued throughout the project and as a result, MBJ was able to identify a key integrated steel delivery process that considerably shortened the schedule. We reduced bid uncertainty by delivering a connected steel fabrication model concurrent with an early steel bid package at end of schematic design. By leveraging the team’s steel expertise and BIM automation technology, we optimized the steel member and connection design after fabricator award. As a result of these efforts, the team reduced the cost of the project by $1.1 million.