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Capital Planning & Investment Assurance

Before a board approves, an investor closes, or a lender funds a healthcare facility, someone independent should check whether the plan behind the number holds up.

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Is the capital going into a plan that can be delivered?

This platform gives the people funding healthcare facilities an independent view of the capital plan, the project budget, and the schedule — and, once funds are flowing, of whether the project is tracking to them.

A healthcare capital plan is a bet on many things at once: demand for a service line, reimbursement, staffing, regulatory approval, construction cost, and equipment pricing. Most budgets are built by the parties who will spend them.

An independent review does not replace that work. It tests it, so that the board, the investor, or the lender is deciding on evidence it can explain.

Who this is for

Health system boards and finance committees
Approving a capital plan or a major project and accountable for the basis.
Private equity and healthcare investors
Underwriting a build, an acquisition with capital needs, or a multi-site rollout.
Healthcare real estate investors and developers
Funding medical office, outpatient, or senior living development.
Lenders
Needing an independent view before funding and monitoring during construction.
Joint venture partners
Agreeing a single view of the plan between a health system and its partners.

What the work covers

Capital plan review

Whether a multi-year plan is sequenced and sized realistically against the organization's capacity to deliver it.

Total project cost review

Whether construction, equipment, technology, fees, activation, and contingency are all in the number.

Schedule review

Whether the dates allow for approvals, equipment lead times, and phasing.

Delivery and contract review

How the chosen approach allocates risk between owner and builder.

Funding-draw monitoring

Independent periodic reporting on progress against budget and schedule while funds are drawn.

Change and contingency tracking

How changes and contingency use are trending, and what that means for the final cost.

Common questions about investment assurance

What is investment assurance on a healthcare project?

An independent review, for the people funding a healthcare facility, of whether its budget and schedule are realistic and whether the delivery plan supports them — followed, if wanted, by periodic monitoring while the project is built.

What is easy to leave out of a healthcare project budget?

The items outside the construction contract are the easiest to leave out: medical equipment, IT and low-voltage systems, owner's fees and permits, move and activation costs, temporary facilities, and the cost of running departments in parallel during phasing. A total project cost review checks each of them.

Can lenders and investors rely on the review?

The review is an independent professional opinion prepared for the party that commissions it, and it can be addressed to that party. It informs a funding decision; it does not certify a budget, a schedule, or a design, and it does not replace the lender's or investor's own judgment.

Does Niner Health monitor projects it does not manage?

Yes. Monitoring for a lender, investor, or board is most independent when the firm is not also managing the project, because the review stays independent of the work it is reviewing.

Insights on capital planning

How healthcare capital plans and budgets are built, tested, and tracked.

An aerial view of a large hospital campus of brick and white buildings, parking and green space

Capital Planning·4 min read

A health system's capital plan is only as reliable as its facility condition data

Every capital plan contains a forecast of what the existing buildings will need. If the condition data behind that forecast is old, inconsistent or incomplete, the plan's priorities are guesses presented as decisions.

Read article

A woman in a white coat and glasses reviewing a printed page at a laptop

Capital Planning·5 min read

The project budget is larger than the construction number, and the difference is predictable

A construction estimate prices what the builder will build. A healthcare project also has to pay for equipment, technology, approvals, the move and the months of activation before the first patient. Those categories are known from the start.