The healthcare industry is undergoing a transformative shift. Changing patient preferences, the migration from inpatient to outpatient care, the demographic surge in aging populations, and capital constraints are all reshaping how health systems approach their real estate footprint. We view this as a critical moment, one where forward-thinking real estate strategies can become a catalyst for long-term growth, innovation, and community impact.
The Decline of Inpatient Revenue and the Rise of Patient-Centered Spaces
According to recent industry analyses, inpatient care is projected to represent only 25% of healthcare system revenue by 2030, down from 40% in 2019. This is not a downturn in performance, but a strategic pivot in care delivery. Outpatient facilities, ambulatory care centers, and specialty clinics are becoming the new front doors for care.
Healthcare providers who embrace this shift are reimagining their environments to reflect a hospitality-inspired experience. Amenities once seen as “nice-to-have” are now a differentiator. Investments in comfortable family spaces, integrated technology, and healing-centric design aren’t just about aesthetics, they improve patient engagement and outcomes.
We help clients design real estate strategies that elevate the care experience while optimizing ROI and operational flexibility.
Rethinking Real Estate: Asset Optimization and Portfolio Strategy
For decades, real estate has been an overlooked component of healthcare financial strategy. That’s changed. Today’s capital constraints, rising interest rates, and soaring construction costs demand that health systems treat their real estate as a core strategic lever.
We guide healthcare clients through a comprehensive facility and portfolio assessment to uncover underutilized or non-core assets. Whether it’s identifying leasing opportunities to generate third-party revenue, repositioning vacant space for new services, or divesting unneeded parcels, these moves unlock vital capital for reinvestment.
A vacant wing of a hospital could become a specialty clinic or community wellness center. A shuttered facility might be repositioned into workforce housing. The goal is the same: make every square foot work harder for patients, providers, and communities.
Sale-Leasebacks: Liquidity Without Losing Control
One of the most underutilized capital strategies in healthcare is the sale-leaseback model. This approach allows providers to monetize owned assets while retaining operational control. Through careful structuring, health systems can sell a property to an investor and lease it back under terms that suit long-term clinical and financial goals.
We help healthcare leaders evaluate sale-leaseback options with institutional investors who are aligned on impact and value. These arrangements are especially compelling for non-core facilities or administrative buildings and can provide a significant influx of capital for expansion, technology upgrades, or workforce development.
With our guidance, clients can pilot sale-leasebacks on smaller assets, gaining confidence in the model before scaling it systemwide.
New Markets Tax Credits (NMTC): A Powerful but Overlooked Tool
The NMTC program is one of the most effective financing tools available for healthcare providers looking to build or expand in underserved communities, but it remains underutilized. Structured through Community Development Entities (CDEs), NMTCs can contribute up to 20% of project capital in the form of low-interest, flexible financing.
We navigate the complexities of the application process and connect clients with CDEs looking for high-impact investments. This tool is particularly valuable for not-for-profit systems looking to build in high-need areas, as well as developers pursuing mixed-use healthcare campuses.
Real Estate as a Strategic Growth Engine
The healthcare landscape is evolving faster than ever before. Success requires a long-range capital projects roadmap that prioritizes adaptability, fiscal discipline, and community relevance. Whether the need is to develop new outpatient centers, modernize inpatient facilities, or unlock trapped equity in existing assets, real estate should not be static.
We believe real estate is a dynamic asset, one that should evolve alongside the mission and future of care. By deploying innovative strategies, leveraging partnerships, and aligning facility planning with financial objectives, healthcare systems can turn their real estate portfolio into a driver of growth, resilience, and impact.
