The healthcare industry faces challenges and market perturbations. That's having impacts on CRE property owners and investors. A shift from inpatient to outpatient treatments, and the rapid development of outpatient office buildings, are an important example.

Then there is a report from DPR Construction, a major self-performing general contractor (they largely have all in-house crews rather than using subcontractors), that caregivers find themselves having to consider scale to "evaluate the best path forward to support patients and caregivers, and create financial sustainability."

The healthcare systems manage larger portfolios of real estate. DPR suggests four different ways to manage those holdings:

• Rationalized portfolios
• Redistributed portfolios
• Re-envisioned portfolios
• Refocused portfolios

The first type, rationalized, is one "where existing real estate assets become highly streamlined, right-sized to changing strategic and operational objectives of the health system, and continuously monitored for their performance and returns to the system." Owners modify their portfolios to recognize that real estate is a major expense. Rationalizing the space — resizing assets, whether up or down, to match strategic and operational goals — becomes the driving approach. Owners push to monitor performance and keep finding efficiencies and savings.