BLOGS
How should health systems decide whether to own or lease ambulatory facilities for maximum capital efficiency?
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 [...]
Maximizing ROI: Health System Finance, Real Estate, Population Health, Value-Based Care, Clinical Integration, CON
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 [...]
Health System Finance, Healthcare Real Estate Investment for Value-Based, Population Health, Clinical Integration, CON
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 [...]
Clinical Integration, Health System Finance, Population Health, VBC, CON Strategy, Healthcare Real Estate Investment
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 [...]
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 [...]
Structuring Healthcare-Real-Estate Investment JVs: Health-System Finance, Population Health, Value-based Care, Clinical-Integration, CON Strategy
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 [...]
Five Real Estate Questions Healthcare Professionals Should Be Asking
Healthcare real estate is a fast-paced dynamic world; a strong real estate portfolio is critical in empowering systems and physician groups to achieve the “Holy Trinity” of healthcare. Quality of care, convenience, and cost-effectiveness. Outdated spaces, on the other hand, are a drain on all three, and operational and profitability challenges impact your ability to deliver the exceptional standard of care to which you hold yourself. When investigating opportunities, it is essential to ask some tough questions and dig deep into your current assets, as well as your future goals. Here are five healthcare real estate questions (and a bonus “big” question!) to ask as you start the process: Do our existing real estate assets provide our community with a top-rated healthcare experience? Healthcare providers and systems need to take an unflinching look at their existing portfolio. Is it meeting their needs? More importantly, is it meeting the needs of [...]
Strategy, Financing, Development: An Innovative Perspective in Healthcare Real Estate
One of the largest problems within the delivery of healthcare is aging infrastructure and the buildings themselves fail patients and providers alike. Whether they create compliance issues, simply underperform because of lacking space and equipment, or are in the wrong location, they are a real problem that has only been further exposed by the COVID-19 pandemic. Aging infrastructure has made it tough to find enough dedicated facilities in hospitals for COVID-19 care, so many patients flood emergency rooms each day, potentially exacerbating the spread of the virus. COVID-19 has also shown a real demand for additional outpatient facilities to treat affected individuals. The reality is that often new facilities could position entire health systems for better patient care in terms of COVID-19 or the next health pandemic to face people. The Reality of COVID-19 Few responses to the COVID-19 pandemic have been as heroic as those mounted by hospitals and [...]