What To Build—and Where—in 2026: Healthcare Real Estate Strategy Forecast

Ankura's Healthcare Real Estate Solutions team tracks critical economic, regulatory, and market trends to guide strategic investment decisions that will define capital allocation, service line priorities, and clinical operations in the year ahead. As the total cost of care continues to rise, organizations are expected to focus investments on initiatives that reduce expenses and enhance operational efficiency. Capital will likely flow toward projects that deliver measurable savings and drive system-wide performance improvements. Below are our predictions for 2026.

1. M&A Acceleration: Consolidation Over New Construction

Health system mergers and acquisitions are expected to intensify in 2026 as providers, payers, and tech-enabled platforms pursue geographic expansion, economies of scale, and regional synergies — often across state lines. Mergers and acquisitions (M&A) remain a critical lever for diversifying payer mix and strengthening negotiating power. Rising construction costs are tipping the scale toward acquiring and retrofitting existing facilities rather than building new ones.

Implications for capital decision makers in 2026:

• Expansion and retrofits will follow service line growth (oncology, ambulatory surgery centers (ASCs)) while consolidating services to achieve systemization.
• Integration Investments:Newly combined systems will address deferred maintenance, upgrade infrastructure, and standardize system-wide design templates across multisite rollouts in varying jurisdictions.
• Flexible Financing:Expect a preference for tenant improvements and joint ventures over debt-heavy acquisitions. Leasing will gain traction as systems seek to spread costs over time rather than absorb large upfront capital outlays.

2. CY2026 OPPS/ASC Final Rule: ASC Growth, Shifting Infusion Footprints

Centers for Medicare and Medicaid Services (CMS) finalized a 2.6% OPPS/ASC payment increase for CY2026, coupled with policies accelerating the migration of care to lower-cost settings.

Implications for capital decision makers in 2026:

• ASC Growth:Systems and/or joint venture (JV) partnerships will expand ASC capacity to absorb higher procedural volumes. More orthopedic, cardiovascular, electrophysiology, and spine codes are moving to ASCs as inpatient-only restrictions phase out — driving larger outpatient operating rooms (ORs) for total joints and orthopedic robotics and pushing lower acuity procedures into procedure rooms.
• Infusion Strategy Reset:Site-neutral payment policies and a 60% reimbursement cut for drug administration services in off-campus Hospital Outpatient Departments (HOPDs) — plus 340B recoupment — will impel systems to consolidate drug administration services at HOPD sites where justified and shift cases that do not need to be in an HOPD setting to smaller, lower-cost outpatient suites.

3. 340B Dynamics and GLP-1 Adoption Drives Investment in Drug-Delivery Infrastructure

GLP-1 adoption rates and expanded applications are reshaping chronic disease management, reducing complications from obesity, diabetes, and cardiovascular conditions. With this growth, capital priorities are expected to shift toward integrated drug-delivery infrastructure, pharmacy hubs, and virtual care platforms. 340B and contract‑pharmacy dynamics are tightening, pushing hospitals to build/own on‑campus specialty pharmacies — often as separate suites — to preserve capture and compliance.

Implications for capital decision makers in 2026:

The need to own dispensing and care‑coordination spaces — rather than relying solely on external networks — is intensifying. We expect to see accelerated growth in:

• Specialty pharmacy build‑outs on‑campus.
• Micro‑distribution hubs for cold chain and home‑delivery last‑mile with secure loading, temperature monitoring, and redundancy.
• Pharmacy command centers adjacent to clinics to handle prior authorization, benefits navigation, and logistics.
• Integrated telepharmacy to expand access and improve patient experience.
• Metabolic health/obesity clinics co‑located with behavioral health and nutrition, tied to pharmacy for GLP‑1 initiation and monitoring.

Conclusion

Policy shifts and market forces in 2026 demand a capital strategy that is both cost-conscious and efficiency driven. Every investment should be evaluated through these lenses to mitigate significant strategic risk. Health systems that delay or misjudge capital decisions may face:

• Margin Compression: Misjudging site-neutral payment shifts and OPPS/ASC dynamics could leave organizations with costly footprints that erode profitability.
• Competitive Disadvantage: Hesitating to expand ASCs or adapt infusion strategies risks losing procedural volumes to more agile competitors.
• Stranded Capital: Investing in the wrong locations or outdated facility models could lock organizations into underperforming assets for years.

Capital decisions made in 2026 will shape cost structure, market position, and care delivery for the next decade. Leaders must move decisively — and strategically — to avoid costly missteps.

Sources

• M&A Acceleration: Consolidation Over New Construction
• https://www.hfma.org/why-a-health-systems-growth-strategy-should-include-a-build-versus-buy-analysis/
• https://business.bofa.com/en-us/content/healthcare-mergers-and-acquisitions-trends.html
• CY2026 OPPS/ASC final rule: ASC Growth, Shifting Infusion Footprints
• https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center
• https://insights.wchsb.com/2025/11/26/cms-increases-hospital-outpatient-rates-2-6-while-e
• 340B Dynamics and GLP-1 Adoption Drives Investment in Drug-Delivery Infrastructure
• https://www.ashpfoundation.org/pharmacyforecast
• https://www.drugchannels.net/2025/06/340b-contract-pharmacy-market-in-2025.html

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.