Discussing the possibilities and future at the intersection of healthcare and commercial real estate
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Trisha’s guest this week is Jaime Northam, Vice President of Healthcare Development at Ryan Companies. Jaime shares how she is seeing healthcare systems designed with the future and adaptability in mind, with regard to their spaces. She discusses trends she is seeing in healthcare development, to include focusing on the continuum of care, centers of excellence, integrating telehealth, and an increase in concentration of behavioral health.
[2:16] Jaime’s background in commercial real estate
Jaime has been in commercial real estate for about 22 years now, and about half of that has been in healthcare real estate. She was a senior vice president with Healthcare Trust of America, one of the largest medical office REITs in the country. Jaime has experienced most sides of the healthcare real estate industry, including leasing asset management, development, acquisitions, and dispositions. During her time in this industry sector, she has also worked across 35 markets in the U.S.
Being in the commercial real estate industry for such a long time, she has often run parallel paths with Ryan Companies. She has interacted with various team members over the years, and always held them in very high regard. She had the utmost respect for them as a company, and saw them as the cream of the crop in development.
While Jaime had no development experience prior to getting into healthcare real estate, she always had a passion for it. She loves the creativity involved with it and putting the entire deal together. She did a bit of development when she was at Healthcare Trust of America, but an opportunity came up with Ryan and it was perfect timing. It was right around the beginning of the COVID-19 pandemic, so it seemed like a good time to make that switch.
[4:26] What attracted Jaime to focus on healthcare real estate
Before Jaime got into healthcare real estate, she was doing industrial brokerage. It was booming in 2005-2008, kind of like it is now. Developers and investors were coming from all over the country to develop and build million square foot buildings. Then there was a big market crash around 2009, where a lot of development and real estate in general came to a standstill.
Jaime began to evaluate her next steps and think about where the opportunity and stability was going to be. As she was contemplating a career change, it was on the investment side. There were a lot of assets turning hands, and she focused in on the healthcare side. It was around the timeframe of the Affordable Care Act and there were a lot of changes in healthcare as a result. There was also a lot of activity related to Stark regulations and hospitals selling their assets and getting out of real estate presented tremendous opportunities.
She started with Healthcare Trust of America in 2010, and they were a really young REIT at the time. They were growing tremendously. On top of the stability and opportunity, Jaime has always had a passion for healthcare. She almost went down the path of becoming a doctor herself, so it was very fortuitous for her to be able to blend her two passions. Once she got into healthcare real estate, there was no turning back.
[8:01] The transition from a publicly traded REIT to a developer
Jaime considers working with a REIT to be a sprint and a marathon at the same time. When you’re working with a high volume of transactions and oversight of properties all over the country, they are really measured on a quarterly basis. You’re always working toward quarterly goals, and it’s exciting. Jaime did love the excitement and the challenge.
Stepping away from that and getting into development, it’s more of a marathon. The entire development process – from concept to delivery and beyond – takes years. It’s a lot of cultivating relationships, pivots, and problem-solving. You’re not seeing that daily grind with daily high volume transactions like you do working with a REIT, but it’s a different kind of busy. Ryan is also a private company, so they can be more flexible with how they approach deals and work with clients as well.
[9:55] Strategy for the next 3-5 years at Ryan Companies
Jaime shares the strategy around focusing on relationships. Ryan has been developing healthcare real estate for quite some time, especially in the midwest where they are headquartered as well as in the southeast. They haven’t done much in the western U.S. so they want to look to elevate that. Jaime is working to understand those markets and what the health systems and provider groups are doing. The strategy involves having these conversations, understanding their needs, looking at the overall strategy behind the health systems (short-term and long-term goals) and helping dive into that with them.
One of the unique features of Ryan is that they are a fully integrated platform. They offer services from strategic planning to development, construction, design, property management, capital markets, and acquisitions. They can really lend a holistic and broad perspective when they are working with clients from the get-go. It has been great so far, and there is a tremendous amount of activity out there. They are seeing a lot of ambulatory outpatient clinics, surgery centers, centers of excellence, specialty clinics, and inpatient rehabilitation. Those may continue to be the fastest growing product types of healthcare. A lot of that is fueled by the desire for better community access to care, shifting certain care services away from the hospital setting. They are serving a higher acuity care for the hospitals, and a lot of renovation and expansion projects as the hospitals look to make spaces more functional, efficient, and versatile.
They are also seeing a lot of increased activity from physicians and provider groups. More ground-up development opportunities are being stirred up, as a result of independent group growth and expansion as well as hospital-affiliated physicians. These groups are often leveraging new capital sources under increased revenue streams. Sometimes it is the result of changing reimbursements or new allowances by Medicare of certain procedures and surgeries in outpatient settings.
Health system strategies are becoming more and more centered around the full continuum of care model, all the way from preventative health and wellness to clinical care, acute and post-acute care. Rapid improvements in medical technology and more accessible virtual care and telehealth will continue to bolster those efforts in this regard. That, of course, is fueling additional redevelopment and development opportunities.
The last notable trend they are seeing is more health systems investing money and time into behavioral health. There is an influx of new and planned behavioral health hospital and clinic development across the country. It’s only going to increase as there is a rising need for behavioral health with the pandemic. Many Americans are dealing with mental health or substance abuse issues specifically related to the pandemic, and behavioral health can be available in both physical and virtual health settings.
[15:39] Healthcare real estate renovation and expansion
Across the board, Jaime reports seeing changes and renovations to hospital patient rooms and emergency rooms. Renovation and expansion are really active right now. The pandemic may have shed a lot of light on the deficiencies on how care is delivered in the hospital setting. There is a need for it to be more flexible and to accommodate varying levels of acuity. Leveraging virtual health will be important moving forward as well, so healthcare buildings will need more space to use for telehealth visits. There could even be virtual waiting rooms and triage.Another focus with renovation and expansion is better infection control and ventilation.
[18:43] The impact of the COVID-19 pandemic on healthcare development
Jaime thinks that the pandemic’s impact on healthcare is still evolving. When new spaces are being built, there is a lot more conversation about how to make the spaces more flexible and able to accommodate both current and future needs as they change or adapt their strategy. It’s all about flexibility, being able to pivot, and incorporating different needs of health systems and provider groups in the future. Certain spaces can be used as exam rooms but can also be converted into an office or some other need. There is less defined space, and the flow of the space is more open. Patients can be within the direct line of sight of the nurses, even in the midst of any chaos.
[24:59] Jaime’s first job
Jaime’s first job in high school was a legal assistant at the largest law firm in Arizona. She worked for 10 different attorneys across all different industries. She loved it, and there was never a dull moment.
[25:56] What Jaime would be doing for a living if she did not work in healthcare real estate
Jaime thinks she would have gone into medicine or medical research. She wanted to be a doctor when she was young, and even before she went into healthcare real estate she was always involved in some sort of healthcare charity or research initiative. She has always been fascinated by medicine and the science behind it.
[26:36] What Jaime is reading and listening to for news, information, and inspiration
Jaime loves reading health journals, as well as various healthcare real estate industry publications across multiple markets. For other news, she tries to keep current on current events and issues from multiple perspectives. For inspiration, Jaime loves music. Lately she has been listening to classical or jazz music. She also loves an inspirational book or magazine, and lately she has been finding inspiration in her three-year-old son’s children’s books. A lot of them have simple, powerful messages that we could all stand to be reminded of from time to time.
[28:22] What Jaime does for self-care
Jaime tries to get 30-60 minutes of exercise a day, preferably outdoors as long as it’s not 120 degrees. She also cherishes sweet moments with her toddler, and they read and snuggle before bedtime every night. Once he is in bed, Jaime also enjoys relaxing with a good book or a bath.
[29:18] Whether leaders are born or trained
Jaime thinks it’s both, and there is always room for growth. You can be a born leader, but you can also continue to get better. There is always something to learn or to grow into. Leaders have to be adaptable and have good emotional IQ as well.
Links to resources:
Vice President of Healthcare Development
Ryan Companies US, Inc.
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