Health Systems Are Rewriting Their Real Estate Playbooks

Across the country, health systems are reevaluating how they use real estate. The last few years of rising costs, changing reimbursement models, and shifting patient behavior have forced many systems to ask a simple question: what do we really need to own?

The old model favored expansion—large campuses, new towers, and multi-acre footprints designed to keep everything under one roof. But that approach no longer fits today’s realities. Many systems are offloading non-core assets, selling older buildings, and redirecting capital into outpatient growth, digital infrastructure, and clinical partnerships that expand reach without the same overhead.

We are seeing more sale-leasebacks, joint ventures, and management partnerships that give systems flexibility while keeping them operationally secure. Even strong operators are being more cautious about new development, prioritizing sites that support surgical, imaging, and specialty care over general medical office. Every square foot now has to earn its keep.

This shift is not a retreat—it is a strategy. Systems are optimizing for access, cost efficiency, and patient experience rather than scale for its own sake. The result is a leaner, smarter real estate footprint that can adjust as care delivery continues to evolve.

If you are watching this trend and want to understand how health system divestments and partnerships are changing valuations in your market, let’s talk through what the next year is likely to bring.

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