Planning Exit Strategies That Preserve Value in Health System Real Estate Holdings
Capital constraints, CON timelines, and the shift to ambulatory, value‑based care are tightening the window for health systems to realign their real estate. The mandate is triple‑aim: protect clinical integration and population health access, keep operations seamless, and improve capital efficiency. Executive prompt: How should our health system balance ambulatory expansion with acute care investment? Bremner Healthcare Real Estate—healthcare‑exclusive since 1989 and validated by our acquisition by Duke Realty—advises beyond transactions. We integrate service-line strategy, regulatory timing, and balance‑sheet goals to turn exits into strategic portfolio optimization, not one‑off sales. With national health system partnerships and $3.4B+ on campus and off campus developments, we bring fiduciary rigor and operating fluency to structure sale‑leasebacks, JVs, and recapitalizations that preserve provider control and unlock growth. Health systems are exiting owned real estate to unlock capital, reduce risk, and accelerate value-based care—not to chase one-time gains. The most successful exits align directly to population health strategy, operational continuity, and balance-sheet resilience while preserving provider control. With healthcare cycles tightening, a disciplined approach to objectives, segmentation, structure, regulatory timing, and clinical integration is essential. Bremner Healthcare [...]



