6 Trends Shaping Healthcare Portfolio Decisions

Healthcare delivery is transforming at an unprecedented pace. Outpatient growth, payer pressures, and new compliance requirements are fundamentally reshaping where and how care is delivered. The organizations that thrive will be those making data-informed decisions to strategically align their networks while de-risking their balance sheets.

Here are critical trends shaping healthcare real estate every decision-maker needs to understand:

Health systems and corporate medical groups are accelerating the shift to care outside traditional hospital settings. Medical Outpatient Building (MOB) demand remains steady while occupancy rises due to limited new, purpose-built supply. Sun Belt and high-growth metros lead this demand as systems pursue retail-like access strategies to serve expanding populations. The Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System finalized by the Centers for Medicare and Medicaid Services in 2026 continues to provide incentives supporting ambulatory access that reinforce the viability of MOB investment..

What this means for your portfolio:

Prioritize flexible ambulatory locations that can accommodate evolving service lines and support rapid market entry.

The Medicaid "unwinding" removed more than 25 million people from coverage by late 2024 with increased work requirements for applicants, significantly increasing bad debt risk to health systems that support individuals with this type of coverage. This shift demands location decisions grounded in comprehensive payer mix analysis and eligibility churn data.

Portfolio impact:

Use demographic and payer analytics to drive location strategy and identify markets with durable, profitable patient populations.

The 2024 Change Healthcare attack financially impacted 94% of hospitals, forcing widespread business continuity upgrades. Healthcare organizations now must consider IT infrastructure and redundancy at the facility level.

New requirements for healthcare facilities:

Integrate dual fiber entries, generator interfaces, and enhanced connectivity into lease specifications and site selection criteria.

New guidance pushes hospitals toward zero operational carbon by 2030, with material implications for facility design and lease specifications. Green specifications now include electrification readiness, energy metering, and low-carbon tenant improvements.

Planning consideration:

Embed sustainability requirements into lease negotiations alongside regional mandates like California seismic standards and New York City's Local Law 97.

Outpatient platforms increasingly require sophisticated infrastructure including imaging power loads, procedure-ready exam pods, negative pressure options, and behavioral health space. Emergency Department boarding issues create additional demand for psychiatric and behavioral access points. Innovation and continued expansion of outpatient services is driving MOB occupancy rates.

Design implication:

Plan for higher-acuity procedures and co-located services when evaluating space requirements and infrastructure needs.

Pair projected workforce growth with innovative lease and financing options to shape a 3–5‑year capital plan that keeps your balance sheet agile.

Capital strategy:

Consider sale-leaseback opportunities to unlock equity while preserving operational flexibility, particularly as market liquidity improves.

• Consider flexible leasing over ownership to potentially preserve cash and accelerate market entry.
• Use data-driven location strategies combining demographics, payer analytics, and access patterns
• Plan for adaptive reuse of retail and office space where medical space is scarce
• Embed future-ready specifications including sustainability and cyber resilience requirements
  
  

The healthcare delivery landscape demands speed, flexibility, and discipline. Organizations that align their network strategy with portfolio design and capital markets will be positioned to scale access while preserving capital and future options.

Ready to develop a market-informed leasing roadmap for your healthcare portfolio? Connect with JLL's healthcare specialists to align your ambulatory strategy, portfolio planning and capital optimization.