13 health systems with strong finances

Here are 13 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings and Moody's Investors Service.

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

1. St. Louis-based Ascension has an "AA+" rating and stable outlook with Fitch and an "Aa2" rating and stable outlook with Moody's. The health system has a large, diversified portfolio of sizable hospitals, strong liquidity and growth opportunities, Moody's said. Ascension's declining debt level will help it maintain a strong balance sheet and operating leverage metrics, according to the credit rating agency. 

2. Billings (Mont.) Clinic has an "AA-" rating and stable outlook with Fitch. Billings Clinic has a strong financial profile and a leading market position over a broad service area covering 43 counties, Fitch said. The credit rating agency said it expects the health system's leverage metrics to provide it with a sufficient financial cushion to recover from the sporadic revenue dislocation caused by the COVID-19 pandemic. 

3. Gastonia, N.C.-based Caromont Health has an "AA-" rating and stable outlook with Fitch. The health system has robust liquidity levels and a modest debt burden, Fitch said. The credit rating agency said it expects Caromont Health to have the cushion to absorb escalating operating expenses and costs from staffing and expansions. 

4. Cedars-Sinai Health System has an "Aa3" rating and stable outlook with Moody's. The Los Angeles-based health system has an excellent reputation for clinical services and a strong balance sheet, Moody's said. The credit rating agency said it expects Cedars-Sinai to successfully integrate Huntington Hospital in Pasadena, Calif., and improve that hospital's financial performance. 

5. Johns Hopkins Health System has an "Aa2" rating and stable outlook with Moody's. The Baltimore-based health system benefits from its national recognition as a leading provider of tertiary and quaternary services, and its close affiliation with Johns Hopkins University supports its brand equity, Moody's said. The credit rating agency expects the health system to maintain its balance sheet measures and for its operating cash flow margin to return to 7 percent. 

6. Bryn Mawr, Pa.-based Main Line Health has an "AA" rating and stable outlook with Fitch. The health system has a leading market position in a favorable service area and management has a strong track record of producing solid operating results, Fitch said. The credit rating agency said it expects Main Line Health's financial cushion to absorb sector pressures. 

7. Hollywood, Fla.-based Memorial Healthcare System has an "Aa3" rating and stable outlook with Moody's. The health system has a leading market position and depth of services, which will be bolstered by expansion of clinical facilities, Moody's said. The credit rating agency said it expects the system's cash flow to remain solid and rebuild as the pandemic subsides.

8. Midland-based MidMichigan Health has an "AA-" rating and stable outlook with Fitch. The health system has a strong financial profile, modest leverage and solid liquidity, Fitch said. The system's strong cash flow and ample liquidity provided it with flexibility during a period of heightened capital spending, according to the credit rating agency. 

9. Mosaic Health System has an "AA-" rating and stable outlook with Fitch. The St. Joseph, Mo.-based health system is a market leader in a multicounty service area and has a track record of strong operating results, Fitch said. The credit rating agency said it expects Mosaic to remain profitable and benefit from a strong balance sheet. 

10. Tacoma, Wash.-based MultiCare has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with Fitch. The health system has a large revenue base, an extensive footprint and a track record of successfully executing on several projects and strategic ventures at the same time, Moody's said. The credit rating agency said it expects MultiCare's liquidity to remain strong and for debt measures to improve over time. 

11. Albuquerque, N.M.-based Presbyterian Health Services has an "AA" rating and stable outlook with Fitch. The health system has a leading market position and a track record of profitability, Fitch said. The credit rating agency said it expects the health system's capital-related ratios to remain strong. 

12. ThedaCare has an "AA-" rating and stable outlook with Fitch. The Appleton, Wis.-based health system has a leading market position and a strong financial profile, Fitch said. The credit rating agency said it expects ThedaCare's operating performance to remain stable through the disruption of the COVID-19 pandemic. 

13. York, Pa.-based WellSpan Health has an "Aa3" rating and stable outlook with Moody's. The health system has a leading market position and improved operating performance, Moody's said. The credit rating agency said it expects WellSpan's operating performance to be maintained to support capital spending. 

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