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 and Moody's Investors Service.

Note: This is not an exhaustive list. Health system names were compiled from credit rating reports.

1. Advocate Aurora Health has an "Aa3" rating and positive outlook with Moody's. The health system, which has dual headquarters in Milwaukee and Downers Grove, Ill., has a leading market share in two regions and strong financial discipline, Moody's said. The credit rating agency said it expects Advocate Aurora Health's operating cash flow margins to return to pre-pandemic levels. 

2. 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. 

3. 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. 

4. Indianapolis-based Indiana University Health has an "Aa2" rating and stable outlook with Moody's and an "AA" rating and positive outlook with Fitch. Cost controls and patient volume will help the system sustain strong margins and liquidity, Moody's said. 

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. Methodist Health System has an "Aa3" rating and stable outlook with Moody's. The Dallas-based system has strong operating performance and investments in facilities have allowed it to continue to capture more market share in the fast-growing Dallas-Fort Worth, Texas, area, Moody's said. The credit rating agency said it expects Methodist Health System's strong operating performance and favorable liquidity to continue. 

9. 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. 

10. 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. 

11. West Orange, N.J.-based RWJBarnabas Health has an "Aa3'' rating and stable outlook with Moody's. Moody's said it expects RWJBarnabas, the largest integrated academic health system in New Jersey, to see near-term revenue growth and to execute on several strategic fronts while achieving targeted financial performance.  

12. San Diego-based Scripps Health has an "Aa3" rating and stable outlook with Moody's. The health system has ample liquidity coverage, an extensive footprint and strong brand and market share within San Diego County, Moody's said. The credit rating agency said it expects Scripps to weather current operating challenges and to grow operating cash flow over the long term. 

13. University of Iowa Hospitals and Clinics has an "Aa2" rating and stable outlook with Moody's. The Iowa City-based health system, the only academic medical center in Iowa, has strong patient demand and excellent financial management, Moody's said. The credit rating agency said it expects the health system to continue to manage the pandemic with improved operating cash flow margins. 

14. 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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