Patients are moving faster than projects. Clinics near where people live and work are full, yet too many ambulatory plans are still in pre-con. 2026 is the year to close that gap. With fundamentals strong and borrowing conditions easing at the margins, systems can finally trade “wait and see” for “do and measure”: bank the right sites, streamline approvals, standardize what repeats, and use developer capital to preserve debt capacity for clinical priorities. Execution—not enthusiasm—separates openings from intentions. This outlook details where conditions are improving, what risks still deserve respect, and how leaders can translate market tailwinds into operational wins.
Outpatient Keeps Pulling the Train
Outpatient care remains the growth engine. Across the top 100 U.S. markets, medical office building (MOB) occupancy has held near record territory thanks to steady absorption and limited new supply. Smaller, fast-growing metros are even tighter, a reminder that access, convenience, and population inflows are the real capacity constraints.
Implication for 2026: Health systems will keep prioritizing ambulatory surgery, imaging, and clinic footprints closer to where people live and work—often beyond the core campus—because that’s where access and volume growth converge.
Rates & Credit: Supportive—But Not “Cheap”
Markets point to a gentler rate path than in 2024–2025, but not a return to the near zero era. Translation: debt becomes incrementally friendlier, but discipline still rules. Expect lenders to stay selective and to prize stable rent rolls, strong credits, and clean structures. Work your growth assuming “good, not free” capital.
Capital Markets
Through mid-2025 the investment market was defined by a wide bid ask spread despite healthy leasing. Trading volumes troughed, driven more by capital frictions than tenant demand. As rate visibility improves, expect the cleanest, best located, system anchored assets to clear first.
2026 Outlook: A modest thaw from 2025’s low, uneven by asset quality and tenancy. On/adjacent campus assets and long-term, credit anchored deals should lead.
Capital Markets & Investment Trends
- Sales momentum returned in 2024 and stabilized in 2025. After a sharp rebound in 2024, activity in 2025 reflected improving liquidity but selective underwriting. Expect gradual volume growth into 2026 as rates ease at the margins and price discovery narrows bid-ask.
- Pricing turned the corner. By 2025, all property pricing indices showed modest YoY gains versus 2023 declines, with MOB pricing trending up on a $/SF basis as fundamentals and rent growth improved. We expect continued stabilization in 2026 absent a macro shock.
- Cap rates stabilized. In early 2025, MOB cap rates averaged ~6.9% (first quarterly decrease since mid-2022). Traditional office remained higher and more volatile. Our base case for 2026 is flat to slightly compressing MOB cap rates if financing costs drift lower and NOI grows.
- Why this matters to health systems: Stable pricing + easing rates improve refi/recap options and developer capital terms, particularly for anchored, well leased assets with clear care delivery value.
Construction & Delivery: A Pulse After the Trough
After slowing for two years, the pipeline is showing life. MOB starts rebounded off Q4 2024 lows and accelerated into mid 2025. If that cadence holds, projects that solved entitlement, utilities, and early procurement in 2025 will open while others are still in pre-con.
Costs remain the separator. 2024 completions carried materially higher build costs, and new deliveries command higher face rents than the in-place market. That premium won’t vanish in 2026—so owners must defend it with throughput, staffing efficiency, and lifecycle savings; replacement cost alone won’t convince finance committees.
Balance Sheet Protection + Speed-to-Market
With costs elevated and debt capacity precious, systems are leaning into developer-led delivery, ground leases, monetizations, and selective JV equity to sequence rollouts without overconcentrating on-balance-sheet debt. Growth is also pushing farther off campus, which elevates entitlement, neighborhood context (access, parking, wayfinding), and municipal coordination as schedule-critical levers. Pair that with standardized clinic prototypes, early procurement and you have a replicable 2026 playbook.
Why prototypes now: Repeating 70–80% of what is in every clinic unlocks speed, reliability, and better staff/patient flow. Standardization enables parallel entitlement, bulk procurement, and predictable commissioning across multiple sites.
Risk Watchlist for 2026
- Rate-path volatility: If cuts stall, cap rate relief could be uneven, keeping bid-ask wider for longer.
- Specialty trades & long-lead equipment: Episodic tightness persists; failing to lock early packages can slip openings by a quarter.
- Neighborhood fit: As projects push off campus, traffic, parking, and signage/wayfinding can become gating items if not pre-vetted.
How Developers Help Health Systems
- Financial Expertise & Strategic Planning: Optimize capital allocation across a multi-site roadmap; align scope, lease terms, and credit with enterprise goals.
- Risk Mitigation & Cost Control: Proven GMP strategies, contingency governance, and package-level procurement to curb overruns.
- Access to Diverse Funding Sources: Lender/investor relationships enable tailored structures (ground lease, leaseback, tax-exempt pathways where eligible, JV equity).
- Efficient Project Execution: Integrated development and construction oversight compresses schedule, bringing revenue online sooner.
Bottom line: Developer partnerships unlock capital, transfer delivery risk, and preserve borrowing capacity—freeing leadership to invest in care delivery.
What we expect to be true by Q4 2026:
- Outpatient demand remains above trend; national MOB occupancy holds ~92% with select metros in the mid-90s, barring a supply surge.
- Cap rates stabilize or compress modestly from early-2025 peaks as financing costs ease and underwriting visibility improves.
- Deal volume improves unevenly, with system-anchored, best-located assets clearing first as bid-ask narrows.
- Delivery advantages decide winners: entitlement readiness, prototype discipline, and early procurement shave months and de-risk outcomes.
Sources:
- Facilities Dive. (2025, March 18). Outpatient practices migrating to office, retail spaces | JLL report.
- Avison Young Market Intelligence & CoStar. (2025). U.S. medical outpatient building market indicators.
- REJournals. (2025, March 27). Top five investment trends in healthcare real estate (CBRE data).
- HFM Magazine. (2025, Feb 18). Hospital construction costs stabilize
- CBRE. (2025, Dec 2). U.S. Healthcare Real Estate: 6 Key Trends to Watch in 2026
- PwC/ULI. (2025). Emerging Trends in Real Estate® 2026 – Medical Office Outlook
- AIA Consensus Forecast. (2025). 2026 Construction Pipeline Report