Moody's Investors Service revised Oklahoma City-based Integris Health's outlook to negative from stable.
The negative outlook reflects the health system's revised fiscal year 2017 expectations and its weaker operating performance for the second year.
The ratings agency also affirmed the health system's "Aa3" and "Aa3/P-1" ratings, affecting $240 million of outstanding revenue bonds.
The affirmation of the "Aa3" rating is based on the health system's favorable balance sheet metrics, overall size and leading market position. The affirmation of the short-term "Aa3/P-1" rating reflects Moody's Investors Service's positive perception of Integris Health's ability to access the market given its strong revenue bond rating and its frequent participation in the market.