Use a structured, data-driven framework that compares after-tax NPV, balance-sheet impact, and strategic flexibility; lease when preserving capital and speed-to-market produce higher risk-adjusted value, and own when long-term control, low cost of capital, and site durability outweigh the opportunity cost. Why it matters Ambulatory growth is essential, but capital is scarce. The own-versus-lease choice determines how much balance sheet capacity you preserve for clinical systems, digital infrastructure, and core hospital upgrades—and it shapes your bond rating trajectory. Ownership can lower long-run occupancy cost and maximize control; leasing can accelerate market entry, transfer residual risk, and keep cash free for higher-return clinical initiatives. Under ASC 842, leases appear on the balance sheet, but structure still influences leverage, liquidity, and rating agency views on risk. How it works Start with a six-part decision framework: define the use case and time horizon, quantify total cost of occupancy, run a financial comparison, score strategic factors, apply decision rules, and optimize the deal structure. Define the clinical program and market horizon. If a site’s value depends on durable referral patterns, protective CON barriers, or long-term ambulatory throughput [...]

Capital constraints, CON laws, and the shift to ambulatory care are reshaping value-based delivery. Leaders must hit the trinity of clinical outcomes, operational throughput, and financial performance while preserving ratings and liquidity. One question we’re hearing: How should our health system balance ambulatory expansion with acute-care investment to maximize capital efficiency and population health impact? As healthcare-exclusive strategists since 1989—validated by our acquisition by Duke Realty—we integrate operations, population health, and capital planning to turn strategy into execution. Bremner leads strategic portfolio optimization that repositions underutilized space, frees trapped capital, and improves access—linking ROIC to care models and system goals. What follows is a CFO-ready, fiduciary playbook you can take to the board. Health system leaders are confronting a trilemma: protect margins, expand access, and modernize facilities under value-based care and persistent capital constraints. The fastest ROI increasingly comes from repositioning underutilized space, right-sizing ambulatory networks, and embedding digital into the care model. As a healthcare-exclusive platform since 1989—validated by our acquisition by Duke Realty—and a partner to national health systems on $100M+ on and off-campus developments, Bremner translates strategy into measurable [...]

Capital constraints, CON scrutiny, and the ambulatory shift are colliding with rapid value-based care adoption. Boards now expect real estate to advance clinical outcomes, operational throughput, and financial performance—measured in HEDIS/STARs, first-contact resolution, and risk-adjusted ROI. How should our health system balance ambulatory expansion with acute care investment while maximizing capital efficiency? Bremner Healthcare Real Estate—healthcare-exclusive since 1989 and validated by acquisition by Duke Realty—builds population health footprints and clinically integrated hubs through strategic portfolio optimization, aligning location, capital structure, and care models to reduce leakage and PMPM. We act as healthcare real estate strategists embedded in operations and capital planning, not brokers of square feet. Healthcare real estate strategy is now inseparable from value-based performance. Boards are asking how location, capital structure, and care models translate directly into HEDIS improvement, leakage reduction, and PMPM savings. Bremner’s healthcare-exclusive focus since 1989, institutional validation via acquisition by Duke Realty, and track record of $3.2B+ on-campus and off-campus developments and national health system partnerships demonstrate a proven method for execution. The sections that follow connect population health, clinical integration, finance levers, and compliance into [...]

Capital constraints, Certificate of Need scrutiny, and the accelerating shift to ambulatory, value-based care are forcing health systems to rewire networks for population health. The bar is triple: clinical integration, operational throughput, and financial resilience. Executive prompt: How should our health system balance ambulatory expansion with acute care investment to optimize capital efficiency and strategic portfolio performance? Bremner Healthcare Real Estate is a healthcare-exclusive strategist and developer, translating care models into access, cost, and growth—since 1989 and validated by the Duke Realty acquisition. We align service lines, finance, and market execution, treating real estate as the operating system for integration and site-of-care shift. From JV ASCs to $100M+ campuses, we build board-ready, rating-agency-transparent plans that advance population health while protecting the balance sheet. Health systems are retooling their portfolios to support clinical integration, value-based care, and margin resiliency. Real estate is the operating system for these ambitions, translating strategy into daily workflows and patient access. The right facilities plan improves network integrity, protects the balance sheet, and accelerates growth in the settings patients prefer. With decades as a healthcare-exclusive partner since 1989—validated [...]

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 [...]

Capital is tight, CON regimes are unpredictable, and value-based contracts keep shifting care to ambulatory settings. The imperative is clear: expand access and standardize quality while protecting the balance sheet and preserving clinical control—simultaneously advancing clinical, operational, and financial performance through population health, capital efficiency, and strategic portfolio optimization. Executive question: “How should our health system balance ambulatory expansion with acute care investment?” Bremner Healthcare Real Estate is healthcare-exclusive since 1989—our market leadership validated by acquisition by Duke Realty. We’re strategists first, translating care models and capital plans into JV structures, governance, and campuses that perform—not just property transactions. Health systems are turning to real estate joint ventures to expand access, accelerate ambulatory strategies, and protect balance sheets—without compromising clinical control. When designed around population health and value-based outcomes, a JV becomes an operating asset that advances the care model, not just a financing tool. Bremner has been healthcare-exclusive since 1989, with market leadership validated by our acquisition by Duke Realty and programmatic partnerships with national health systems. Our track record includes $3.4B+ on campus developments that tie capital to performance, governance, [...]