As hospitals and health systems across the U.S. face mounting financial pressures, workforce shortages, and evolving value-based care demands, many are turning to consolidation as a path forward.
Proponents say integration allows organizations to align evidence-based practices, strengthen research capabilities, and improve patient outcomes across an expanded network of care. But even as mergers promise efficiency and scale, they raise concerns about autonomy, community identity, and the concentration of power in an already complex industry.
Here is the breakdown of clinical leaders’ outlook on the coming consolidation boom.
The benefits
Consolidation in healthcare can help larger organizations standardize evidence-based practices, streamline care delivery and boost multi-site research for more data-driven decisions that could lead to better outcomes.
“My outlook on hospital consolidation over the next three to four years is one of cautious optimism,” said Perry Gee, PhD, RN, enterprise director of nursing research and evidence-based practice and a nurse scientist at Intermountain Health in Salt Lake City. “Consolidation is likely to continue as health systems seek financial stability, workforce resilience and broader access to value-based care models.”
The larger systems also provide additional clinical expertise to rural and community hospitals, as well as resources and technology to boost quality of care.
“In my experience, hospital consolidation and the subsequent development of small-to-large integrated health systems have proven to be an effective strategy for reducing overhead costs while streamlining processes and advancing evidence-based practices to improve quality,” said Brandi Fields, DNP, RN, vice president of clinical services and quality improvement at UK King’s Daughters in Ashland, Ky. “When executed thoughtfully, these integrations can drive performance outcomes across the continuum of care impacting quality and patient experience.”
The broader transaction goals are also shifting as healthcare organizations move away from purely business-driven acquisitions to “purpose-driven deals” with the mission of expanding care delivery at the core.
“Over the next few years, I anticipate that hospital consolidation will continue, but with sharper intent shifting from survival-based mergers to strategic alliances that blend financial strength with mission alignment,” said Joy White, DNP, RN, vice president and chief nursing officer of Legacy health Good Samaritan Medical Center in Portland, Ore. “We’ll see more partnerships between hospitals, technology firms and community organizations designed to expand access, share data and strengthen care coordination.”
Dr. White hopes the new transaction paradigm will usher in an era of transformational integration for health systems to evaluate the entire care continuum to maximize economies of scale and build a more sustainable model for healthy communities.
“The systems that thrive will not only innovate but also create seamless experiences, making it easier for patients to navigate the often complex healthcare landscape,” Dr. White said. “The health systems that endure will be those that pair innovation with humanity, designing networks where prevention, behavioral health and chronic disease management are as integral as acute care.”
Successful mergers and acquisitions can facilitate operational improvements within the framework of all facilities and strengthen the predictive analytics as well as accountability for outcomes across the continuum of care for the acquired entity. But there are local considerations the larger system should keep in mind.
“Consolidation must be carefully managed to preserve local culture, communication and team engagement,” said Faimy Vanleeuwen, RN, BSN, regional director of quality at Baptist Health South Florida, North Region. “The keys to success in this area will be ensuring integration doesn’t dilute our culture of safety or the unique strengths of each hospital, but to amplify it through collaboration and system learning. Overall, I view this evolution as a positive step toward delivering high-reliability, data-driven and patient-centered care at scale.”
Not everyone is as confident.
The risks
The looming Medicaid cuts in the One Big Beautiful Bill Act, more uninsured patients as ACA premiums increase and other uncertainties around funding have more hospitals and health systems considering a sale. Hospitals may also cut staff and services in the way of financial challenges or pressure from a larger organization to change.
“This trend toward consolidation poses serious risks,” said Tiffany Love, PhD, associate vice president of nursing at Great Lawrence Family Health Center. “Much like monopolies in other industries, healthcare monopolies can drive up costs, reduce quality of care and limit patient choice. Consolidation among hospitals, insurers and pharmaceutical companies creates power among a few large entities, enabling them to set prices and restrict options, often without delivering meaningful improvements in outcomes.”
While many nurse and clinical leaders cited the opportunity for more standardization and best practice sharing as a clear benefit to consolidation, the loss of autonomy and culture could impact staffing and patient care.
“We must be mindful of the potent downsides [of consolidation] such as loss of community identity, workforce disruption and the risk of decision-making becoming too far removed from the frontline caregivers,” said Quanna Batiste-Brown, DNP, RN, vice president of patient care services and CNO of Touro Infirmary, LCMC Health in New Orleans. “My focus as CNO will be to ensure that as consolidation occurs, the voice of nursing remains central to strategic discussions. We must preserve a culture of compassionate, patient-centered care while optimizing efficiency and ensuring that our nurses are supported, empowered and equipped to deliver excellent care in any setting within the system.”
Dr. Gee also raised concern about retaining nurse autonomy and ensuring frontline clinician voices are present during strategic planning for and after the transaction.
“Nurse leaders must advocate for inclusive governance structures that prioritize patient outcomes and the professional development of nursing teams during these transitions,” said Dr. Gee. “Ultimately, consolidation must be guided not only by operational efficiency but by a commitment to compassionate, evidence-based, high-quality care.”
Post-transaction, Dr. Fields said it’s important to continue monitoring performance metrics to ensure both organizations are delivering desired results. If teams are missing the mark, they still need to make adjustments to financial and quality care operations.
“Maintaining agility with the ongoing complexities of healthcare will remain essential to ensuring sustainability and continued excellence in patient care,” said Dr. Fields. “Be open to pivot structures if the intended impact is not seen. I imagine that in the next three to four years nearly every community hospital will be either affiliated with an integrated system or will be in talks to do so.”
