Large health systems in the U.S. have spent 2026 deciding what is no longer needed in their portfolios.
A Lown Institute Oct. 6 analysis found that seven of the country’s 10 largest health systems held fewer hospitals at the end of 2025 than they did in 2020.
Of the systems, St. Louis-based Ascension was down 27 hospitals from 2020 to 2025. The system was followed by Franklin, Tenn.-based Community Health Systems, which was down 24 hospitals, and Brentwood, Tenn.-based Lifepoint Health, which was down 20 hospitals.
In the first quarter of 2026, 68% of announced hospital transactions involved a divestiture, up from 45.6% in 2025, according to a Kaufman Hall report.
Chicago-based CommonSpirit Health is one of 2026’s most active health systems involved in divestitures. The system has sold or is working to sell eight hospitals this year, including the Oct. 1 sale of Steubenville, Ohio-based Trinity Health System, a four-hospital system, to Pittsburgh-based UPMC, and four North Dakota hospitals to Grand Forks-based Altru Health System.
The sales are connected to CommonSpirit’s Project ImpACT, a restructuring plan that the system projects will deliver $6 billion in financial improvement over five years.
Ascension shows where the road to divestitures can lead. The system went from $3 billion in operating losses in 2023 to shaving nearly $2.9 billion off that figure three years later, reporting a $120 million operating loss (-0.2% margin) in fiscal 2026.
In part, Ascension was able to reach this goal through reducing its portfolio in recent years from 140 hospitals to 91 wholly owned facilities and 27 joint venture hospitals, which cut its losses by $575 million and freed up about $500 million. Ascension then reinvested roughly $1 billion from reduced losses and freed-up capital into its existing facilities.
Exiting joint ventures is now on the table, too.
In late September, Brentwood, Tenn.-based Ardent Health agreed to sell its stake in St. Francis Campus in Topeka, Kan., to Kansas City, Kan.-based The University of Kansas Health System. Ardent president and CEO Dave Caspers said the company focuses resources “where our operating model, scale and capabilities can have the greatest impact and create long-term value.”
CHS sold its 80% interest in Tennova Healthcare-Clarksville (Tenn.) to Vanderbilt Health for $623 million in February, and Salt Lake City-based Intermountain Health shared in early October that it is exiting Trinsic, a Colorado network of more than 900 primary care physicians, and handing it to UCHealth in Aurora, Colo., after Dec. 7.
Many deals have also not made it to close. In 2026, Becker’s has reported on seven hospital and health system partnerships or proposed deals that were unwound or called off.
Schenectady, N.Y.-based Ellis Medicine and Albany, N.Y.-based St. Peter’s Health Partners, part of Livonia, Mich.-based Trinity Health, ended merger talks and concluded their Management Services Agreement and Professional Services Agreement on Aug. 16. Valley Medical Center in Renton, Wash., will also end its 15-year strategic affiliation with Seattle-based UW Medicine on Dec. 31.
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