In 2022, St. Louis-based Ascension began an operational transformation aimed at strengthening long-term sustainability following the financial strain of the COVID-19 pandemic. The effort included strategic divestitures, market exits and the rollout of a more disciplined operating model, Amber Sims, executive vice president and chief strategy and growth officer, told Becker’s.
Three years ago, Ascension’s hospital portfolio included roughly 139 hospitals. That has decreased to 90 wholly owned or consolidated hospitals, according to financial documents published Feb. 13. The system also maintains noncontrolling interests in 29 additional facilities.
Among the most significant portfolio actions was the 2024 launch of a joint venture between Detroit-based Henry Ford Health and Ascension Michigan, which folded 10 Ascension hospitals — including Ascension St. John Hospital and Ascension Genesys Hospital — into the combined organization under Henry Ford Health’s brand. In December 2024, Ascension also sold eight Illinois hospitals to Ontario, Calif.-based Prime Healthcare for $375 million.
At the same time, Ascension has begun positioning itself for selective growth. The system is expected to acquire AmSurg in a deal reportedly valued at approximately $3.9 billion.
The system’s financial performance has also improved. For the three months ending Dec. 31, 2025, Ascension reported a $52.6 million operating loss (-0.9% margin), compared to a $143 million operating loss (-2.2% margin) in the same quarter the previous year — a more than $91 million improvement.
Ms. Sims said she remains focused on disciplined, data-driven growth aligned with the organization’s mission. She spoke with Becker’s about how the transformation has reshaped her leadership approach, how success is measured under the new model and how partnerships fit into Ascension’s long-term strategy.
Editor’s note: Responses have been lightly edited for length and clarity.
Question: Ascension’s hospital footprint has declined from roughly 139 hospitals to 90 wholly owned or consolidated facilities. How has that shift reshaped your leadership priorities and approach to decision-making?
Amber Sims: The journey we are on today began back in 2022, when we faced an almost existential financial reality following the pandemic. We knew change was necessary, and we also understood that just implementing a new operating model was not going to be enough. Our focus was to ensure the long-term sustainability for Ascension so our communities could continue to receive the care they need. This launched a multiyear operational transformation as we thoughtfully divested some facilities to new partners better positioned for long-term success within their markets, allowing us to further reinvest in our remaining communities.
Our new operating model, along with our divestitures, gave us the capacity to accelerate growth and expand care beyond traditional brick-and-mortar hospitals, allowing us to extend our impact in new and meaningful ways. This diversification positioned us to adapt to industry change and evolving consumer demands while remaining deeply committed to the communities we continue to serve.
Under the leadership of our new president and CEO, Eduardo Conrado, we remain focused on elevating patient experience, strengthening our workforce and making data-driven investments that support long-term community health impact. We have been intentional about reinvesting in the communities where we continue to serve. We are ensuring our facilities, caregivers and growth models are positioned for the future. We are building for resiliency and positioning for growth.
Q: As more care shifts into ambulatory, virtual and community-based settings, how does that change how you define operational success compared to a hospital-centric model?
AS: Our expanding ambulatory footprint is not about growth for growth’s sake. It is a disciplined, data-driven approach that moves care closer to home to support the entire healthcare journey of our patients. When care is delivered in community settings patients already prefer, it becomes more accessible, more affordable and easier to navigate.
As healthcare executives, we must challenge ourselves to look beyond today’s revenue figures and our acute care footprint. Instead, we must recognize that a robust, sustainable revenue base and future is the natural outgrowth of how effectively we anticipate the needs, adapt models and improve the health of the populations we serve. That means expanding access while also building a more integrated model of care that ensures patients receive support across the continuum. From virtual and community-based services, including physical therapy and imaging, to acute care and post-acute recovery, care is delivered in the right setting, at the right time, with the right support.
For example, Dispensary of Hope helps patients access medications at low or no cost, while Ascension Rx extends convenience through prescription delivery directly to patients’ homes. We are also moving care into communities through ambulatory surgery centers, virtual care and care delivered at home. Our Community Health Ministries help bring primary care and essential services directly into neighborhoods where access is limited.
Taken together, this is how we measure success today — not by buildings, but by how well we support people and communities, and by the metrics that we have developed to ensure that our growth remains intentional and mission-aligned.
Q: What leadership behaviors, operating rhythms or assumptions that once worked well in a hospital-centric system have had to evolve — or be let go of — as care delivery becomes more decentralized?
AS: One of the biggest shifts has been letting go of the assumption that hospitals are always the center of care delivery. Most of this focus has been driven by the incentives and economic models across the industry. As care becomes more decentralized, leadership must become more adaptive, collaborative and data-informed. This evolution requires operating rhythms that move faster and are more responsive to community needs while realigning economic realities. It also requires leaders to think beyond traditional boundaries and embrace partnerships, digital tools and new care models that support patients across the continuum of care outside of acute settings.
We have restructured key teams, strengthened leadership across markets and stabilized our operations to support this shift. Supporting caregivers has also become even more critical, ensuring teams have the resources, capabilities, technology and clarity they need to deliver high-quality care across multiple settings. Ultimately, this transition has reinforced that leadership today is less about managing assets and more about enabling people to deliver care in new and better ways. This includes a data-driven approach to managing and enhancing consumer experience across and in between all sites of care and services.
With our work to transition the portfolio, a focus on how to better serve populations where and how they need care and the development of a new operating model to drive rigor throughout the organization, we aim to lead the way in aligning and developing new economic models that further strengthen our future.
Q: How do you manage the cultural and organizational tension that comes with this transition, particularly when some parts of the system are shrinking while others are growing and gaining influence?
AS: Managing this tension begins with transparency and a shared understanding of purpose. Change can be difficult, especially when it impacts long-standing institutions, but our mission provides a unifying foundation that guides how and why decisions are made.
Over the past several years, we have remained focused, disciplined and both mission-driven and data-informed, building greater stability across the system and creating more predictable operating performance. That clarity helps teams understand how their work fits into the broader strategy, even as parts of the organization evolve. As we have refined our definition of growth, we have also established clear key performance indicators that reinforce expectations, support accountability and help teams see how progress is measured.
When people see that decisions and actions are grounded in data, responsive to community needs and anchored in our mission, it helps relieve tensions, turning cultural divides into sustained and elevated trust across the organization.
Q: Where does the Henry Ford-Ascension Michigan joint venture stand today? More broadly, how have experiences like that shaped how you think about partnerships as a growth model as systems move away from hospital-centric care?
AS: The Henry Ford-Ascension Michigan joint venture continues to move forward with a clear focus on building a fully integrated network that delivers exceptional clinical care, quality, safety and service. The work today is centered on coordinating and adapting care across settings to meet evolving consumer expectations: expanding access, addressing health disparities, lowering costs and ultimately improving health outcomes for people across Michigan and beyond.
More broadly, experiences like this have reinforced my belief that partnerships are essential and can enhance the impact on the communities we serve. When partners come together with shared goals and complementary strengths, they can accelerate innovation, extend access closer to where people live and work and better align care around the patient rather than the facility. Done well, partnerships allow health systems to grow in smarter, more sustainable ways by creating a connected continuum of care that is more responsive, equitable and resilient for the future.
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