Here are 15 health systems with strong operational metrics and solid financial positions, according to reports from Moody's Investors Service and S&P Global Ratings.
Note: This is not an exhaustive list. Health system names were compiled from credit rating reports and are listed in alphabetical order.
1. Morristown, N.J.-based Atlantic Health System has an "Aa3" rating and stable outlook with Moody's. The credit rating agency expects the health system to continue to generate favorable operating performance and to maintain double-digit operating cash flow margins and solid debt coverage.
2. Charlotte, N.C.-based Atrium Health has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with S&P. Atrium and Winston-Salem, N.C.-based Wake Forest Baptist Health merged in October. The addition of the Winston-Salem service area and Wake Forest Baptist's academic and research programs enhances Atrium's position within the highly competitive North Carolina healthcare market, S&P said.
3. Dallas-based Baylor Scott & White Health has an "Aa3" rating and stable outlook with Moody's. The system has strong liquidity and is the largest nonprofit health system in Texas, Moody's said. The credit rating agency expects Baylor Scott & White Health to continue to benefit from its centralized operating model, proven ability to execute complex strategies and well-developed planning abilities.
4. St. Louis-based BJC HealthCare has an "AA" rating and stable outlook with S&P and an "Aa2" rating and stable outlook with Moody's. The health system has a leading market share and highly regarded reputation, particularly for its flagship hospitals that are affiliated with Washington University School of Medicine in St. Louis, S&P said. The health system has consistently produced stable earnings and cash flow, even during the COVID-19 pandemic, according to the credit rating agency.
5. Mishawaka, Ind.-based Franciscan Alliance has an "Aa3" rating and stable outlook with Moody's. The system has leading positions in key markets and a strong cash position, Moody's said. The credit rating agency expects the system to sustain double-digit operating cash flow margins.
6. Falls Church, Va.-based Inova Health System has an "Aa2" rating and stable outlook with Moody's. The system has a strong financial profile, and Moody's expects Inova's balance sheet to remain exceptionally strong.
7. Boston-based Mass General Brigham has an "Aa3" rating and stable outlook with Moody's. The health system has a strong market position, an excellent clinical reputation and strong patient demand, Moody's said. The credit rating agency expects Mass General Brigham to see increasing patient volume and maintain good cash flow as it emerges from the pandemic.
8. Rochester, Minn.-based Mayo Clinic has an "Aa2" rating and stable outlook with Moody's. The health system has strong balance sheet measures, an excellent market position and strong patient demand at its three academic campuses in Minnesota, Arizona and Florida, Moody's said. The credit rating agency expects strong patient demand and steps taken by management to allow Mayo to maintain adequate cash flow and strengthen balance sheet measures.
9. Evanston, Ill.-based NorthShore University HealthSystem has an "Aa3" rating and stable outlook with Moody's. The health system has a leading market position, and Moody's expects its operating cash flow margin to improve.
10. Renton, Wash.-based Providence has an "Aa3" rating and stable outlook with Moody's. Providence has a large revenue base and a leading market share in most of its markets, according to Moody's. The credit rating agency expects the system's operations to improve this year.
11. Palo Alto, Calif.-based Stanford Health Care has an "Aa3" rating and stable outlook with Moody's. The health system has an excellent clinical reputation, good balance sheet metrics and strong patient demand, Moody's said. The credit rating agency expects the system to generate strong margins in fiscal 2021 and to maintain stronger results for the next several years.
12. Birmingham, Ala.-based UAB Medicine has an "Aa3" rating and stable outlook with Moody's. The health system has high patient demand, strong margins and a leading market share in Birmingham, Moody's said. The credit rating agency expects UAB Medicine to generate strong cash flow in fiscal year 2021.
13. Aurora, Colo.-based UCHealth has an "Aa3" rating and positive outlook with Moody's. The health system has a reputation for clinical excellence and a growing footprint throughout Colorado, Moody's said. The credit rating agency expects the system's operating performance to remain favorable and its liquidity to remain strong.
14. Philadelphia-based University of Pennsylvania Health System has an "Aa3" rating and stable outlook with Moody's. The health system has a strong reputation and market share in a large service area. The credit rating agency expects the system's margins to approach historical averages in the long term.
15. Richmond, Va.-based VCU Health System has an "Aa3" rating and stable outlook with Moody's. The health system has a strong strategic position, and it rebuilt operating momentum before the COVID-19 pandemic, which provided the resiliency to absorb volume disruptions linked to the pandemic, Moody's said. The system's low debt will allow it to absorb pandemic-related margin pressure, according to the credit rating agency.