Consolidation continued to take flight across the healthcare sector this year, with many hospitals and health systems pursuing mergers and acquisitions to scale and reduce costs, provide additional care services and strengthen their footprint in certain markets.
Here are 12 key transactions that were announced or have been completed this year:
1. Atrium Health and Advocate Aurora Health merged into a $27 billion, 67-hospital system called Advocate Health — the fifth-largest nonprofit health system in the U.S. The Charlotte-based combined system has footprints in Illinois, Wisconsin, North Carolina, South Carolina, Georgia and Alabama. Atrium President and CEO Eugene Woods and Advocate Aurora President and CEO Jim Skogsbergh will serve as co-CEOs of the combined system until mid-2024. From then, Mr. Skogsbergh will retire and Mr. Woods will become the sole CEO.
2. Salt Lake City-based Intermountain Healthcare and Broomfield, Colo.-based SCL Health merged into a 33-hospital system with 385 clinics and more than 58,000 employees across six states. The nonprofit system also provides health insurance to about 1 million people. The health systems completed the transaction in March, less than a year after entering into negotiations.
3. Sioux Falls, S.D.-based Sanford Health and Minneapolis-based Fairview Health signed nonbinding letters of intent to merge. The combined system would be called Sanford Health, headquartered in Sioux Falls, and include more than 50 hospitals and 78,000 employees. Minnesota's attorney general will host public hearings in early 2023 to gather input on the proposed merger, which has raised some financial questions in the state.
4. Duluth, Minn.-based Essentia Health and Marshfield (Wis.) Clinic Health System are discussing a potential merger that would comprise 25 hospitals and a network of 3,800 providers. The two health systems announced their intent to join in October, and expect to reach a definitive agreement in the "coming months," according to a Dec. 12 news release.
5. Livonia, Mich.-based Trinity Health acquired MercyOne Health System from Chicago-based CommonSpirit Health. The transaction made Trinity the sole owner of Clive, Iowa-based MercyOne, which includes 16 medical centers, 27 affiliate organizations and more than 20,000 staff.
6. University of Chicago Medicine and Altamonte Springs, Fla.-based AdventHealth inked a definitive agreement to enter into an affiliation. Under the agreement, UChicago Medicine will acquire a controlling interest in AdventHealth's Great Lakes Region, which includes four Illinois hospitals, and AdventHealth will retain the remaining interest and manage daily operations of the facilities. The proposed deal is projected to close at the end of the year or in early 2023.
7. The University of Michigan Health's board of regents approved a proposed agreement that would see it acquire Lansing, Mich.-based Sparrow Health System to become a $7 billion-health system with more than 200 sites of care. The acquisition is expected to be completed in the first half of 2023, pending final regulatory approvals.
8. University Health Care System, a three-hospital system in Augusta, Ga., joined Atlanta-based Piedmont Healthcare, which now comprises 19 hospitals. Piedmont plans to invest more than $1 billion into University Health, including $200 million to expand its heart and vascular institute, funds to integrate their EHRs and an overhaul of its main hospital building.
9. Camden, N.J.-based Cooper University Health Care and Cape Regional Health System in Cape May Court House, N.J., signed a letter of intent to merge into a two-hospital system with revenue exceeding $2.2 billion a year. The health systems hope to sign a definitive agreement in March 2023, after which they will seek regulatory approval for the merger, which could take until the first quarter of 2024.
10. Greensburg, Pa.-based Excela Health and Butler (Pa.) Health System signed a definitive agreement to merge into a five-hospital system that is projected to generate more than $1 billion a year in revenue. If completed, the merger would create the third largest health system in the state.
11. Centennial, Colo.-based Centura Health acquired St. Elizabeth Hospital and St. Catherine Hospital-Dodge City from Brentwood, Tenn.-based LifePoint Health, making Centura a 19-hospital system.
12. New Orleans-based LCMC Health plans to acquire three Tulane University hospitals from Nashville, Tenn.-based HCA Healthcare for $150 million. The Louisiana Attorney General will decide whether to allow the sale by Feb. 16.