14 health systems with strong finances

Here are 14 health systems with strong operational metrics and solid financial positions, according to 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 credit rating reports and are listed in alphabetical order.

1. Roanoke, Va.-based Carilion Clinic has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with S&P. The health system has a leading market position, strong operating cash flow and healthy debt metrics, according to Moody's.

2. Wilmington, Del.-based ChristianaCare has an "AA+" rating and stable outlook with S&P, and an "Aa2" rating and stable outlook with Moody's. The health system has excellent cash flow and a light debt burden, according to S&P. The credit rating agency expects ChristianaCare's operational performance to remain near recent levels over the next two years, as the health system capitalizes on its cost containment initiatives and strong business position.

3. Santa Barbara, Calif.-based Cottage Health has an "AA-" rating and stable outlook with Fitch. The health system has a leading market position and strong profitability and cash flow, according to Fitch. Going forward, the rating agency expects Cottage Health to see moderate revenue growth.

4. Honolulu-based Hawaii Pacific Health has an "AA-" rating and stable outlook with Fitch. The health system has a solid market position and healthy operating profitability, according to Fitch. The credit rating agency expects the health system to sustain continued capital and strategic investments without the need for incremental debt in the foreseeable future.

5. Baltimore-based Johns Hopkins Health System has an "Aa2" rating and stable outlook with Moody's. The six-hospital system has a national and international brand that supports resilient clinical demand, according to Moody's. The rating agency expects the health system to continue to see benefits from its strong regional market position.

6. Philadelphia-based Main Line Health has an "Aa3" rating and stable outlook with Moody's and an "AA" rating and stable outlook with S&P. The health system, which operates four acute care hospitals and a rehabilitation hospital, is a leading provider in the Philadelphia suburbs, according to Moody's. The credit rating agency expects the health system to maintain recently improved cash flow margins, which are driven by better patient volume trends.

7. Dallas-based Methodist Health System has an "Aa3" rating and stable outlook with Moody's. The health system has healthy balance sheet measures and operating performance as well as favorable leverage metrics, according to Moody's. The credit rating agency expects Methodist Health System's expense control initiatives and revenue growth opportunities to continue to drive sustainable operating performance.

8. Evanston, Ill.-based NorthShore University HealthSystem has an "AA-" rating and stable outlook with S&P and an "Aa3" rating and stable outlook with Moody's. The health system has a strong balance sheet, good market presence and a management team that continues to execute its strategic plan, according to S&P. The rating agency expects NorthShore to maintain strong balance sheet metrics and low leverage.

9. Columbus-based OhioHealth has an "AA+" rating and stable outlook with Fitch. The 12-hospital system has a leading market position and solid liquidity, profitability and leverage metrics, according to Fitch.

10. Fort Wayne, Ind.-based Parkview Health System has an "AA-" rating and stable outlook with S&P. The nine-hospital system has stable operating performance and an excellent liquidity profile, according to S&P.

11. Chicago-based Rush University System for Health has an "AA-" rating and stable outlook with Fitch. The health system has a broad reach for high-acuity services as a leading academic medical center and its operating risk profile is strong, according to Fitch. The credit rating agency expects Rush to maintain strong capital-related ratios over the next five years.

12. Norfolk, Va.-based Sentara Healthcare has an "Aa2" rating and stable outlook with Moody's. The health system has a leading market position in its core service area, strong patient demand, and solid margins, according to Moody's. The credit rating agency expects Sentara's liquidity and debt metrics to remain at recent levels.

13. Livonia, Mich.-based Trinity Health has an "AA-" rating and stable outlook with Fitch and S&P. The health system has a significant market presence in several states and a strong financial profile, according to Fitch. The credit rating agency expects the health system's operating margins to continue to improve.

14. Madison, Wis.-based UW Health has an "Aa3" rating and stable outlook with Moody's. UW Health has healthy margins from a large and growing clinical footprint, according to Moody's. The rating agency expects UW Health's margins to remain strong.

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