When Eduardo Conrado became president of St. Louis-based Ascension in 2023, the health system was coming off a $1.8 billion operating loss. By the time he added the CEO title Jan. 1, the financial trajectory had shifted substantially, and a strategic transformation years in the making was beginning to shine.
“One of the nice things of being the president first for three years and then transitioning to CEO is just a continuation of the strategies that we’ve been working on,” Mr. Conrado said in a recent “Becker’s Healthcare Podcast” interview. “We’ve been focuson around patient experience, associate engagement, diversification of our portfolio and quality and safety as the foundation of what we do. Then we look at how we serve the communities and how we shift our portfolio to be more ambulatory.”
Like other large health systems, Ascension has divested in several hospitals over the last few years including a five-hospital system in Alabama in 2024 and eight Illinois-based hospitals earlier this year, making room for more ASCs.
The health system began repositioning toward outpatient settings roughly four years ago, after concluding that inpatient volumes would remain flat while demand for ASCs, imaging centers, outpatient physical therapy and other settings was growing fast. The pandemic accelerated that conviction.
“We are seeing a 20% CAGR on the ambulatory settings that we’ve put in place,” Mr. Conrado said. “Last year we even stepped further back and said we’re not growing fast enough on the ambulatory surgery center space. We did a definitive agreement to acquire AmSurg and that’s going to transform us.”
In mid-2025, Ascension entered into a definitive agreement to acquire Nashville, Tenn.-based AmSurg, an ambulatory surgery center operator with more than 250 facilities across 34 states, in a deal valued at approximately $3.9 billion. The transaction would expand Ascension’s ASC footprint from 58 centers to more than 300, adding specialties including gastroenterology, ophthalmology and orthopedics. Mr. Conrado described the deal as a platform that other nonprofit health systems and independent physicians could use to accelerate their own ASC growth.
The ambulatory expansion sits on top of a broader financial and operational turnaround built on fundamentals. When Mr. Conrado and his leadership team set out to improve performance across the system’s ministries, they started with the basics: how the system runs, how it directs patients to the right site of care and how it manages the revenue cycle. The painstaking operational work preceded the financial results by several years.
“We looked at the operating model. How do we run efficiently? How do we drive out into a proper site of care? And then how do we manage a revenue cycle? That to me was just the basics in terms of how do we have a consistent way to operate across all the ministries that we’re in,” he said.
The discipline eventually translated to the balance sheet.
“We’ve probably done over $2 billion turnaround over the last few years and the momentum continues into this year,” Mr. Conrado said.
The financial stabilization and the ambulatory buildout both serve Ascension’s core mission: reaching communities where access to care remains limited. The health system’s Medicaid and uninsured patient population skews heavily toward emergency departments because gaps in primary care access, transportation barriers and medication costs push people toward the highest-cost entry point available.
“We serve 1,100,000 lives in our communities that are either Medicaid or uninsured,” he said. “We’ve been looking at the high utilization of ED. That means we have to step back and look at the data and what’s the main cause for that. Part of it is access to primary care in the community and solving some of the transportation needs they have. Then there’s access to pharmaceuticals. Thomas Edison had a quote that he didn’t invent the light bulb by optimizing the candle, and that’s the approach we’re taking.”
Ascension is deepening partnerships with community health centers to complement Ascension’s own clinics, expanding Dispensary of Hope — a program that provides free prescription access to uninsured patients — across its markets and placing ASCs in communities that have historically had only hospitals for non-emergent procedures. Over a two-year horizon, Mr. Conrado expects to see improved primary care attachment, better medication adherence and a measurable decline in unnecessary ED visits.
One of the most direct expressions of that strategy is a program called Mission at Home. Ascension ran three such events last year — single-day community service days offering primary care, mammography, dental care, food, shoes and other basic services. In May, the health system plans to scale to 16 events in the same month, spanning all of its markets simultaneously. Ascension has around 4,000 volunteers signed up for “Mission at Home.”
The events are structured as intake points, not one-time gestures. Attendees who arrive without a primary care physician are connected on-site to Ascension community clinics or to federally qualified health centers in the area.
“That is not a one and done event. It’s just an entry point to give them access to the needs,” Mr. Conrado said.
Looking ahead, Mr. Conrado said Ascension’s hospitals will remain central to the system — but as sites for higher-acuity care rather than routine volume. As CMS continues to shift procedure codes into outpatient settings, the ambulatory side will absorb the difference.
“Our footprint on the ambulatory side is going to quadruple, in the next year,” he said. “That kind of sets us up for the future as more and more procedures move into the ambulatory setting. We have the portfolio to be able to match that.”
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.
