Here are 11 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings and Moody's Investors Service.
Note: This is not an exhaustive list. Health system names were compiled from credit rating reports and are listed in alphabetical order.
1. Advocate Aurora Health has an "Aa3" rating and positive outlook with Moody's. The health system, which has dual headquarters in Milwaukee and Downers Grove, Ill., has a leading market share in two regions and strong financial discipline, Moody's said. The credit rating agency said it expects Advocate Aurora Health's operating cash flow margins to return to pre-pandemic levels.
2. St. Louis-based Ascension has an "AA+" rating and stable outlook with Fitch and an "Aa2" rating and stable outlook with Moody's. The health system has a large, diversified portfolio of sizable hospitals, strong liquidity and growth opportunities, Moody's said. Ascension's declining debt level will help it maintain a strong balance sheet and operating leverage metrics, according to the credit rating agency.
3. Billings (Mont.) Clinic has an "AA-" rating and stable outlook with Fitch. The health system has a strong financial profile and a leading market position over a broad service area covering 43 counties, Fitch said. The credit rating agency expects the health system's leverage metrics to provide it with a sufficient financial cushion to recover from the sporadic revenue dislocation due to the COVID-19 pandemic.
4. Indianapolis-based Indiana University Health has an "Aa2" rating and stable outlook with Moody's and an "AA" rating and positive outlook with Fitch. Cost controls and patient volume will help the system sustain strong margins and liquidity, Moody's said.
5. Hollywood, Fla.-based Memorial Healthcare System has an "Aa3" rating and stable outlook with Moody's. The health system has a leading market position and depth of services, which will be bolstered by expansion of clinical facilities, Moody's said. The credit rating agency said it expects the system's cash flow to remain solid and rebuild as the pandemic subsides.
6. Midland-based MidMichigan Health has an "AA-" rating and stable outlook with Fitch. The health system has a strong financial profile, modest leverage and solid liquidity, Fitch said. The system's strong cash flow and ample liquidity provided it with flexibility during a period of heightened capital spending, according to the credit rating agency.
7. Rapid City, S.D.-based Monument Health has an "AA-" rating and stable outlook with Fitch. The health system has solid operating margins that Fitch expects to remain stable over the near term. Monument Health's operating margins will continue to support liquidity growth and capital spending levels, the credit rating agency said.
8. Tacoma, Wash.-based MultiCare has an "Aa3" rating and stable outlook with Moody's. The health system has a large revenue base, an extensive footprint and a track record of successfully executing on several projects and strategic ventures at the same time, Moody's said. The credit rating agency said it expects MultiCare's liquidity to remain strong and for debt measures to improve over time.
9. West Orange, N.J.-based RWJBarnabas Health has an "Aa3'' rating and stable outlook with Moody's. Moody's said it expects RWJBarnabas, the largest integrated academic health system in New Jersey, to see near-term revenue growth and to execute on several strategic fronts while achieving targeted financial performance.
10. San Diego-based Scripps Health has an "Aa3" rating and stable outlook with Moody's. The health system has ample liquidity coverage, an extensive footprint and strong brand and market share within San Diego County, Moody's said. The credit rating agency said it expects Scripps to weather current operating challenges and to grow operating cash flow over the long term.
11. Iowa City-based University of Iowa Hospitals & Clinics has an "Aa2" rating and stable outlook with Moody's. The credit rating agency said it expects the system to maintain strong operating performance and cash flow. The system benefits as the only academic medical center in Iowa, according to Moody's.