For Structure Tone, a decision to pursue work in the health care sector started several years ago, says Robert Mullen, the CEO. To establish a foothold, the $2 billion construction manager started modestly. “We were able to get some small projects with major health care institutions just in an effort to demonstrate what we can do and how efficient we were,” he adds.

Its appetite whetted and credentials burnished, Structure Tone decided to make a bigger push into the sector, eventually acquiring a $600 million specialist in health care construction, Philadelphia’s L.F. Driscoll, last fall.

Expanding into new markets can also involve a strategic partnership with a specialty contractor that already has a presence but can use added resources from a joint venture, says Mike Kolakowski, CEO of KBE Building of Farmington, Conn., a $221 million contractor. “We’re all looking for ways to set ourselves apart,” he adds.

And some contractors are reaching back to past achievements in order to fill the down market’s gaps. Del-Sano Contracting is reviving its experience in restoration projects and small-scale health care projects to find new opportunities, says Angelo Del Russo, the firm’s CEO. “For the past year or so, we have been spreading our tentacles into areas of the market where we’ve done well in the past,” he adds.