News & Insights
Photo courtesy of: Greg Land
When B&D set its sights on entering the healthcare space earlier this year, Julian Sagastume raised his hand to lead the charge. With deep experience in public-private partnerships, real estate strategy, and development advisory across complex institutional sectors, Julian brings the blend of systems thinking and practical execution that healthcare organizations need now more than ever.
In this month’s Ask the Expert, we sat down with Julian to explore how health systems can leverage their physical assets to drive growth, strengthen resilience, and advance their missions.
B&D: Tell us about your background.
Julian Sagastume (JS): Before joining B&D, I worked at a real estate and policy consulting firm that helped cities think through things like inclusionary housing, incentive programs, and district-scale economic impact. I loved that work, but I found myself wanting to get closer to the implementation side—how ideas actually get funded, built, and operated.
That’s what drew me to B&D. The firm blends systems thinking with real-world execution, and over the past six years I’ve been able to work closely with higher education institutions navigating big, mission-driven challenges. That experience—helping clients align vision, financial strategy, and the built environment—translates incredibly well to healthcare. Both sectors operate at a scale and level of complexity where the physical environment is inseparable from mission delivery.
B&D: How do you see healthcare organizations thinking about their physical assets as part of their mission?
JS: Healthcare and higher ed are both mission-driven industries experiencing significant change. They’re competing for talent, striving for better outcomes, and managing financial and regulatory pressures that shift constantly.
What we do at B&D—helping clients define success, rethink their physical footprints, and chart a sustainable path forward—is exactly the kind of work health systems need. Increasingly, hospitals and health systems are looking at their campuses, satellite locations, and community partnerships through a strategic lens. They’re asking: What do we need our physical assets to do for us in the next decade? And how do we build toward that future in a financially responsible way?
B&D: How can healthcare institutions balance mission with financial sustainability and resilience?
JS: The starting point is always clarity. You have to understand what you’re trying to achieve, and then figure out how to generate the most impact for every dollar you invest.
That can mean a lot of things: setting realistic long-term goals, aligning capital plans with your mission, transferring risk where it makes sense, or structuring partnerships that bring additional expertise and capacity to the table. We see universities use these strategies when entering new housing markets or expanding research facilities. Health systems face similar decisions when expanding care capacity or modernizing campuses. Ultimately, the goal is to move quickly and strategically while staying anchored to what matters most.
B&D: What role can partnerships and P3 models play in accelerating healthcare growth?
JS: Partnerships aren’t one-size-fits-all. Their value comes from being intentional about what outcomes you want and going to the market with a clear vision. For some health systems, a P3 structure helps preserve debt capacity and enables faster expansion into a new market. For others, the attraction is operational—turnkey delivery, lifecycle performance, and specialized expertise that private partners can bring to ambulatory care centers, medical office buildings, or system-wide infrastructure.
Our experience structuring and managing partnerships in higher ed translates directly to healthcare. The underlying principles such as clarity of outcomes, risk alignment, and long-term value, are the same.
B&D: Looking ahead, what excites you most about B&D’s role in healthcare?
JS: Honestly, the opportunity for impact is huge. Hospitals are facing many of the same infrastructure challenges we’ve helped higher ed clients navigate, like aging utilities, workforce housing shortages, sustainability targets, and the need to modernize facilities to meet evolving expectations. B&D is well-positioned to support that full lifecycle: planning, financing, and delivering projects that advance both mission and margin. Bringing our systems-thinking approach into healthcare has the potential to raise the bar for what development looks like in this sector.
Thank you to Julian for sharing his insights in this month’s Ask the Expert. If there’s a topic you’d like one of our specialists to explore in a future column, we’d love to hear your ideas.
