Why Creative Financing Structures Are Gaining Attention in Healthcare
For many healthcare organizations, the challenge is no longer identifying where to invest. It is funding those investments while preserving capital for other strategic priorities.
Health organizations are facing a growing dilemma: the need to invest in facilities has never been greater, yet capital has never been more constrained. Health systems continue to face pressure to expand outpatient care, modernize facilities, invest in technology, recruit providers, and manage rising operating costs. At the same time, operating margins remain under pressure, requiring leadership teams to carefully allocate capital across competing priorities. As a result, financing strategy is increasingly becoming as important as real estate strategy.
That gap between need and available capital was the focus of a panel discussion at the BOMA International 2026 Medical Real Estate Conference, held April 29 through May 1 in San Diego. The session, “Creative Lease Financing Structures,” brought together industry leaders to discuss alternative approaches that help healthcare organizations move projects forward when traditional financing may not be the best fit.
NexCore executive vice president of treasury and capital markets Craig Fimple was one of five panelists. He joined Greg Fawcett (JLL Securities), Ben Mingle (The Centurion Foundation), Howard Vogel (The Walker Group), and moderator Sean Maynard (Brown Gibbons Lang & Co.) to walk through the toolkit of alternative structures available to health systems today.
One of those solutions discussed during the panel was HealthCore Foundation, a nonprofit financing platform designed to help healthcare organizations preserve capital, maintain operational control, and advance strategic real estate projects without diverting capital from core clinical and operational priorities. NexCore is HealthCore’s development partner, helping healthcare organizations fund, acquire, develop, and maintain control of mission-critical healthcare facilities through a variety of financing structures.
Understanding the Foundation Lease Model
Among the financing structures discussed during the panel was the charitable foundation lease (CFL). HealthCore’s Foundation Lease Model utilizes many of the same principles to help nonprofit healthcare organizations preserve capital, maintain operational control, and advance strategic real estate projects.
Under a typical CFL structure, a nonprofit foundation acquires a facility and leases it back to the health system under a customized lease arrangement designed to align with the organization’s goals. Unlike traditional landlord arrangements that are designed to generate investment returns, a CFL is structured as a pass-through of the financing costs, which can result in significantly lower occupancy costs for the health system.
The structure is designed to help healthcare organizations preserve capital while maintaining operational control of critical facilities. Depending on the transaction and desired outcome, health systems may benefit from favorable purchase options and other end-of-term flexibility designed to support their long-term objectives.
Whether acquiring, expanding, renovating, or developing a facility, a CFL can help healthcare organizations move projects forward while preserving liquidity and balance sheet flexibility. Preserved capital can then be redeployed toward clinical programs, technology investments, physician recruitment, or other strategic initiatives that directly support patient care.
A Real-World Example
NorthBay Health faced this challenge when its Campini Cancer Center in Vacaville, California was operating at approximately 200% capacity, creating an urgent need to expand oncology services and improve patient access.
While the need for expansion was clear, NorthBay also needed to preserve capital for broader organizational priorities across the health system. The challenge was not whether to invest. It was how to fund the expansion while maintaining financial flexibility.
Working together, with NexCore as the developer and HealthCore Foundation as the financing partner, the organizations structured a solution in which HealthCore acquired the facility and leased it back to NorthBay, injecting valuable liquidity into the health system’s balance sheet. Additional funding included in the transaction supported expansion of the cancer center, enabling NorthBay to meet growing demand while preserving capital and maintaining balance sheet flexibility.
The structure provided 100% project funding and is projected to generate approximately $6.7 million in occupancy cost savings over the lease term.
The result was expanded oncology capacity, preserved liquidity, and continued flexibility for future capital deployment.
The panel discussion also reinforced that CFL structures are becoming an increasingly recognized capital solution across healthcare.
Financing Solutions for Nonprofit and For-Profit Healthcare Organizations
While the CFL has gained significant attention in the nonprofit healthcare sector, it represents only one of several financing tools available to healthcare organizations today.
Healthcare organizations face different strategic priorities, balance sheet constraints, and growth objectives. As a result, no single financing structure is appropriate for every situation. HealthCore’s Foundation Lease Model is one example, helping nonprofit healthcare organizations access tax-exempt financing while maintaining control of strategic real estate assets.
However, HealthCore’s capabilities extend beyond nonprofit transactions. HealthCore also works with for-profit healthcare organizations, providing taxable financing solutions tailored to an organization’s specific capital, operational, and growth objectives. When combined with NexCore’s healthcare development expertise, these financing solutions can support 100% turnkey funding of acquisition, development, tenant improvements, equipment, financing costs, and other project expenditures.
The goal is not to fit every project into the same structure. The goal is to identify the financing solution that best aligns with the organization’s needs.
Financing Strategy Is Becoming a Competitive Advantage
For healthcare organizations, the challenge is no longer how to grow. It is determining how to fund growth while preserving capital flexibility.
Whether through charitable foundation leases, taxable financing structures, turnkey development funding, or other creative capital solutions, healthcare organizations have more financing options available today than ever before.
As outpatient demand accelerates and capital becomes increasingly valuable, financing strategy is becoming just as important as real estate strategy.
This piece draws on reporting from Healthcare Real Estate Insights (HREI), which covered the “Creative Lease Financing Structures” panel at the BOMA International 2026 Medical Real Estate Conference. Full coverage, including additional discussion on CTL and synthetic lease structures, is available at wolfmediausa.com (HREI subscription required).