15 health systems with strong finances

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Here are 15 health systems and hospitals 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. Hospital and health system names were compiled from credit rating reports and are listed in alphabetical order. 

1. Morristown, N.J.-based Atlantic Health System has an "Aa3" rating and stable outlook with Moody's. The credit rating agency expects the health system to continue to generate favorable operating performance and to maintain double-digit operating cash flow margins and solid debt coverage. 

2. Charlotte, N.C.-based Atrium Health has an "Aa3" rating and stable outlook with Moody's and an "AA-" rating and stable outlook with S&P. Atrium and Winston-Salem, N.C.-based Wake Forest Baptist Health merged in October. The addition of the Winston-Salem service area and Wake Forest Baptist's academic and research programs enhances Atrium's position within the highly competitive North Carolina healthcare market, S&P said. 

3. Dallas-based Baylor Scott & White Health has an "Aa3" rating and stable outlook with Moody's. The system has strong liquidity and is the largest nonprofit health system in Texas, Moody's said. The credit rating agency expects Baylor Scott & White Health to continue to benefit from its centralized operating model, proven ability to execute complex strategies and well-developed planning abilities. 

4. Pittsfield, Mass.-based Berkshire Health System has an "AA-" rating and stable outlook with Fitch. The health system has improved its liquidity while investing in facilities without increasing its debt load, Fitch said. The credit rating agency expects the system to maintain a strong financial profile. 

5. Billings (Mont.) Clinic has an "AA-" rating and stable outlook with Fitch. The system has a strong financial profile and a leading market position over a 43-county service area, Fitch said. Despite the pandemic, Billings Clinic maintained a strong balance sheet as a result of good profitability and cash flow generation, according to the credit rating agency. 

6. St. Louis-based BJC HealthCare has an "AA" rating and stable outlook with S&P. The health system has a leading market share and highly regarded reputation, particularly for its flagship hospitals that are affiliated with Washington University School of Medicine in St. Louis, S&P said. The health system has consistently produced stable earnings and cash flow, even during the COVID-19 pandemic, according to the credit rating agency. 

7. Los Angeles-based Cedars-Sinai Medical Center has an "Aa3" rating and stable outlook with Moody's. Cedars-Sinai has good operating cash flow, and its strong reputation drives strong demand for a range of services in multiple specialties, Moody's said. 

8. Mishawaka, Ind.-based Franciscan Alliance has an "Aa3" rating and stable outlook with Moody's. The system has leading positions in key markets and a strong cash position, Moody's said. The credit rating agency expects the system to sustain double-digit operating cash flow margins. 

9. Falls Church, Va.-based Inova Health System has an "Aa2" rating and stable outlook with Moody's. The system has a strong financial profile, and Moody's expects Inova's balance sheet to remain exceptionally strong. 

10. Winston-Salem, N.C.-based Novant Health has an "AA-" rating and stable outlook with Fitch. The system has strong margins, and each of its markets has met or exceeded budgeted expectations over the last four years, Fitch said. 

11. Renton, Wash.-based Providence has an "Aa3" rating and stable outlook with Moody's. Providence has a large revenue base and a leading market share in most of its markets, according to Moody's. The credit rating agency expects the system's operations to improve this year. 

12. Chicago-based Rush University Health System has an "AA-" rating and stable outlook with Fitch. The system has a strong financial profile, and despite pressure from the COVID-19 pandemic, Fitch expects it to maintain strong capital-related ratios. 

13. Aurora, Colo.-based UCHealth has an "Aa3" rating and positive outlook with Moody's. The health system has a reputation for clinical excellence and a growing footprint throughout Colorado, Moody's said. The credit rating agency expects the system's operating performance to remain favorable and its liquidity to remain strong. 

14. Livonia, Mich.-based Trinity Health has an "AA-" rating and stable outlook with Fitch. The rating is driven by Trinity's national size and scale, with significant market presence in several states, Fitch said. The credit rating agency expects the system's operating margins to improve in the long term. 

15. Richmond, Va.-based VCU Health System has an "Aa3" rating and stable outlook with Moody's. The health system has a strong strategic position, and it rebuilt operating momentum before the COVID-19 pandemic, which provided the resiliency to absorb volume disruptions linked to the pandemic, Moody's said. The system's low debt will allow it to absorb pandemic-related margin pressure, according to the credit rating agency. 

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