Here are 24 health systems with strong operational metrics and solid financial positions, according to reports from credit rating agencies Fitch Ratings, Moody's Investors Service and S&P Global in 2023.
Note: This is not an exhaustive list. Health system names were compiled from credit rating reports.
1. Atrium Health has an 'AA-' and stable outlook with S&P Global. The Charlotte, N.C.-based system's rating reflects a robust financial profile, growing geographic diversity and expectations that management will continue to deploy capital with discipline.
2. Berkshire Health has an "AA-" rating and stable outlook with Fitch. The Pittsfield, Mass.-based system has a strong financial profile, solid liquidity and modest leverage, according to Fitch.
3. CaroMont Health has an "AA-" rating and stable outlook with S&P Global. The Gastonia, N.C.-based system has a healthy financial profile and robust market share in a competitive region.
4. CentraCare has an "AA-" rating and stable outlook with Fitch. The St. Cloud, Minn.-based system has a leading market position, and its management's focus on addressing workforce pressures, patient access and capacity constraints will improve operating margins over the medium term, Fitch said.
5. Children's Minnesota has an "AA" rating and stable outlook with Fitch. The Minneapolis-based system's broad reach within the region continues to support long-term sustainability as a market leader and preferred provider for children's health care, Fitch said.
6. Cone Health has an "AA" rating and stable outlook with Fitch. The rating reflects the expectation that the Greensboro, N.C.-based system will gradually return to stronger results in the medium term, the rating agency said.
7. El Camino Health has an "AA-" rating and stable outlook with Fitch. The Mountain View, Calif.-based system has a history of generating double-digit operating EBITDA margins, driven by a solid market position that features strong demographics and a very healthy payer mix, Fitch said.
8. Harris Health System has an "AA" rating and stable outlook with Fitch. The Houston-based system has a "very strong" revenue defensibility, primarily based on the district's significant taxing margin that provides support for operations and debt service, Fitch said.
9. Hoag Memorial Hospital Presbyterian has an "AA" rating and stable outlook with Fitch. The Newport Beach, Calif.-based system's rating is supported by a leading market position in its immediate area and very strong financial profile, Fitch said.
10. Inspira Health has an "AA-" rating and stable outlook with Fitch. The Mullica Hill, N.J.-based system's rating reflects its leading market position in a stable service area and a large medical staff supported by a growing residency program, Fitch said.
11. Mayo Clinic has an "Aa2" rating and stable outlook with Moody's. The Rochester, Minn.-based system's credit profile characterized by its excellent reputations for clinical services, research and education, Moody's said.
12. McLaren Health Care has an "AA-" rating and stable outlook with Fitch. The Grand Blanc, Mich.-based system has a leading market position over a broad service area covering much of Michigan and a track-record of profitability despite sector-wide market challenges in recent years, Fitch said.
13. Novant Health has an "AA-" rating and stable outlook with Fitch. The Winston-Salem, N.C.-based system has a highly competitive market share in three separate North Carolina markets, Fitch said, including a leading position in Winston-Salem (46.8 percent) and second only to Atrium Health in the Charlotte area.
14. NYC Health + Hospitals has an "AA-" rating with Fitch. The New York City system is the largest municipal health system in the country, serving more than 1 million New Yorkers annually in more than 70 patient locations across the city, including 11 hospitals, and employs more than 43,000 people.
15. Orlando (Fla.) Health has an "AA-" and stable outlook with Fitch. The system's upgrade from "A+" reflects the continued strength of the health system's operating performance, growth in unrestricted liquidity and excellent market position in a demographically favorable market, Fitch said.
16. Rush System for Health has an "AA-" and stable outlook with Fitch. The Chicago-based system has a strong financial profile despite ongoing labor issues and inflationary pressures, Fitch said.
17. Saint Francis Healthcare System has an "AA" rating and stable outlook with Fitch. The Cape Girardeau, Mo.-based system enjoys robust operational performance and a strong local market share as well as manageable capital plans, Fitch said.
18. Salem (Ore.) Health has an "AA-" rating and stable outlook with Fitch. The system has a "very strong" financial profile and a leading market share position, Fitch said.
19. Stanford Health Care has an "AA" rating and stable outlook with Fitch. The Palo Alto, Calif.-based system's rating is supported by its extensive clinical reach in the greater San Francisco and Central Valley regions and nationwide/worldwide destination position for extremely high-acuity services, Fitch said.
20. SSM Health has an "AA-" rating and stable outlook with Fitch. The St. Louis-based system has a strong financial profile, multi-state presence and scale, with solid revenue diversity, Fitch said.
21. UCHealth has an "AA" rating and stable outlook with Fitch. The Aurora, Colo.-based system's margins are expected to remain robust, and the operating risk assessment remains strong, Fitch said.
22. University of Kansas Health System has an "AA-" rating and stable outlook with S&P Global. The Kansas City-based system has a solid market presence, good financial profile and solid management team, though some balance sheet figures remain relatively weak to peers, the rating agency said.
23. WellSpan Health has an "Aa3" rating and stable outlook with Moody's. The York, Pa.-based system has a distinctly leading market position across several contiguous counties in central Pennsylvania, and management's financial stewardship and savings initiatives will continue to support sound operating cash flow margins when compared to peers, Moody's said.
24. Willis-Knighton Health System has an "AA-" rating and stable outlook with Fitch. The Shreveport, La.-based system has a "dominant inpatient market position" and is well positioned to manage operating pressures, Fitch said.