10 health systems with strong finances

Here are 10 health systems with strong operational metrics and solid financial positions, according to recent reports from Fitch Ratings, Moody's Investors Service and S&P Global Ratings.

Note: This is not an exhaustive list. Health system names were compiled from recent credit rating reports and are listed in alphabetical order.

1. Advocate Aurora Health, a 27-hospital system with dual headquarters in Downers Grove, Ill., and Milwaukee, has an "Aa3" rating and positive outlook with Moody's. The health system has a favorable liquidity position, low leverage, and healthy margins, according to Moody's. The credit rating agency expects the health system to continue to benefit from its position as a market leader within two large service areas.

2. Morristown, N.J.-based Atlantic Health System has an "Aa3" rating and stable outlook with Moody's. The five-hospital system has healthy liquidity and solid operating margins, according to Moody's. The credit rating agency expects strong patient volume, low reliance on governmental funding and other factors to continue to support Atlantic Health System's financial metrics.

3. Cleveland Clinic Health System has an "Aa2" rating and stable outlook with Moody's. The health system has strong liquidity and exceptional fundraising capabilities, according to Moody's. The credit rating agency expects the health system to maintain strong liquidity despite heavy capital spending, as cash flow, debt and fundraising will provide adequate funding.

4. Oakland, Calif.-based Kaiser Permanente has an "AA-" rating and stable outlook with Fitch. Kaiser has a lead market share in California and other key markets and a strong financial profile and operating model, according to Fitch. The credit rating agency expects the health system to maintain positive operating margins.

5. NewYork-Presbyterian, a 10-hospital system based in New York City, has an "Aa2" rating and stable outlook with Fitch. The health system has a strong brand, academic affiliations with two premier medical schools and exceptional philanthropic support, according to Fitch. The credit rating agency expects NewYork-Presbyterian's liquidity to remain strong.

6. West Orange, N.J.-based RWJ Barnabas Health has an "AA-" rating and stable outlook with S&P. The health system, which was created through the 2016 combination of Robert Wood Johnson Health System and Barnabas Health, has generated favorable operating results and cash flow since the merger, according to S&P. The credit rating agency expects the health system to continue to generate good operating income levels and cash flow.

7. Appleton, Wis.-based ThedaCare has an "AA-" rating and stable outlook with Fitch. The health system has solid cash flow and a leading market position in a stable service area, according to Fitch. The credit rating agency expects ThedaCare's operating performance to continue to improve.

8. Chapel Hill-based University of North Carolina Hospitals has an "Aa3" rating and stable outlook with Moody's. UNC Hospitals, part of UNC Health Care System, has an excellent market position and strong financial performance, according to Moody's. The credit rating agency expects UNC Hospitals to continue to grow patient volumes and maintain strong financial performance.

9. Salt Lake City-based University of Utah Hospitals and Clinics has an "Aa2" rating and stable outlook with Moody's. The health system has good financial performance and has an important role in its market as a provider of high-acuity services, according to Moody's. The credit rating agency expects UUHC to continue to grow through construction of new facilities and expansion of existing service lines.

10. Marlton, N.J.-based Virtua Health has an "AA-" rating and stable outlook with Fitch. The health system has a leading market position in a stable service area and a strong financial profile, according to Fitch. The credit rating agency expects Virtua's recent acquisition of Camden, N.J.-based Lourdes Health System to be accretive to the system.

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