Becker’s asked C-suite executives from hospitals, health systems, academic medical centers and universities across the U.S. to share their outlook on the future of hospital consolidation.
The 68 executives featured in this article are all speaking at the Becker’s Healthcare 16th Annual Meeting, from April 13-16, 2026 at the Hyatt Regency Chicago.
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As part of an ongoing series, Becker’s is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.
Question: What’s your outlook on hospital consolidation over the next three to four years?
Pete November. CEO of Ochsner Health (New Orleans): As we approach the cuts outlined in the One Big Beautiful Bill Act for 2028, I believe consolidation will accelerate because organizations may not be prepared to handle these changes, making scale increasingly more important as hospital systems adapt. When executed effectively, consolidation has the potential to enhance quality, improve patient experiences and deliver better financial results. However, history is full of examples of poorly executed transactions, highlighting the critical challenge for healthcare organizations to plan and implement consolidations successfully.
John D. Couris. President and CEO of Tampa General Hospital (Fla.): I believe that hospital consolidation will continue, but to what extent will vary region to region across the United States. The same will be true for health systems and physician groups as they continue to focus not only on cost containment, revenue generation and clinical integration, but work to increase scale, diversify services, enhance payer relationships, expand ambulatory care and invest more heavily in digital health.
But I’d like to take this question and push it a bit further. The traditional consolidation strategy among hospitals and health systems is increasingly outdated. The assumption that larger systems inherently deliver better care is flawed — size does not equate to quality. Instead, value creation for the consumer — defined as the patient, payer and employer — must be the central focus. Numerous studies have shown that consolidation tends to increase costs without corresponding gains in care quality (Levins, 2023). In fact, as health systems grow, they often become more expensive, and the anticipated efficiencies or improvements in outcomes rarely materialize (Hulver, 2024). This disconnect suggests we are operating within an antiquated paradigm. It’s time to rethink the status quo and embrace innovative models that prioritize affordability, access and measurable improvements in patient outcomes. Health systems and health system leaders must ask: How can we deliver higher-quality care at lower cost — and share that value with the consumer? The future of healthcare depends on answering that question with bold, consumer-centric solutions.
Nkem Chukwumerije, MD, MPH. President and Executive Medical Director of The Southeast Permanente Medical Group (Oakland, Calif.): Major health systems throughout the country have been expanding their influence for years by acquiring smaller hospitals. Financial pressures on smaller hospital systems are a primary driver of this trend, often resulting in partnerships with larger, more profitable organizations. Throughout these transitions, it’s essential to keep quality, patient-centered care at the forefront while maintaining affordability for individuals and families.
Leong Koh, MD. Executive Medical Director of Northwest Permanente (Oakland, Calif.): The outlook on hospital consolidation for the next three to four years is mixed. On the one hand, many hospitals, including a growing number in suburban and urban areas, are still struggling with rising operational costs and staffing shortages following the pandemic. On the other, some financially stable health systems are acquiring other hospitals to expand into new markets. Larger health systems are looking beyond traditional hospital mergers to acquire outpatient facilities, such as ambulatory surgery centers, urgent care centers, and physician practices. However, ongoing uncertainty in the economy and changes in federal policy are likely to result in a lower number of hospital mergers than the 72 transactions reported in 2024.
Stephen Parodi, MD. Executive Vice President of External Affairs, Communications and Brand at The Permanente Federation (Oakland, Calif.): Rising costs, staff shortages, and increasing patient needs continue to challenge the health care industry’s existing approach to care. Economic pressures have driven hospital consolidation, and I do not see those abating any time soon. We need to search for true solutions and modern innovations that can address the changes we are seeing in population demographics and a new health care workforce. Delivering more care into homes through team-based approaches that address social, mental, and physical health will be a critical move necessitated by these emerging realities. Part of this strategy is providing advanced care at home, a setting where patients feel more comfortable and empowered to address some more complex medical conditions. Working together across the continuum of cases, these programs must scale so we can address the real-world challenges of overcrowded emergency departments and communities where hospital bed capacity is insufficient. We will need clinician expertise, regulatory reforms, and significant innovation to address the acute care needs of the U.S. population.
Jochen Reiser, MD, PhD. President and Professor of John Sealy School of Medicine, and John D. Stobo, MD Distinguished Chair, The University of Texas Medical Branch; CEO of UTMB Health (Galveston, Texas): The pace of hospital consolidation has slowed but will continue over the next few years. This will continue as a function of economic pressure on smaller institutions that lack the resilience necessary to withstand increasing consolidation in the market and increased competition from unconventional and non-traditional sources. Established systems will focus on integration to leverage scale and look to expand new sources of revenue.
Peter Pronovost, MD, PhD. Chief Quality and Clinical Transformation Officer and President of UH Veale Healthcare Transformation Institute (Cleveland): Hospital consolidation will increase in the coming years, but for different reasons than in the past. Historically, mergers were driven by the desire to expand market share and negotiate higher prices, often without improving value. Neither quality nor total cost of care improved. Many systems operated independently, lacking the clinical and operational integration needed to realize efficiencies and therefore benefit from ‘systemness.’ Today, consolidation is increasingly a matter of survival. Many health systems are losing money, and the cuts in federal programs are growing faster than health systems can improve margin. Encouragingly, many systems are now more integrated, both clinically and operationally, creating new opportunities to improve value. The conditions are ripe for improving value from consolidation. If the caregivers in our health systems believe their job is to improve value, belong to a learning community where everyone drives quality improvement and help build disciplined management and shared accountability systems that require results from everyone in the chain of care – from the market, to the hospital, to the unit, to the practice, to the clinician – hospital consolidation can be a positive force to improve quality and value. In my view, it all depends on whether health system leaders can guide their organizations along this journey to believe, belong and build.
David Ohm. Chief Strategic Development Officer of MultiCare Health System (Tacoma, Wash.): Hospital consolidation is expected to gain momentum over the next three to four years as health systems aim for increased scale, efficiency, and resilience. The reduction of regulatory barriers and favorable market conditions may facilitate more mergers, particularly among regional providers. This trend has the potential to broaden access to specialized care, enhance infrastructure investments, and hasten the adoption of advanced technologies. Although concerns about rising costs and diminishing competition persist, thoughtful planning and community engagement will play a role in maintaining balance. When managed thoughtfully, consolidation can provide significant benefits to patients and communities while preserving affordability and choice.
Paula Ferrada, MD. Chair Department of Surgery Inova Fairfax Medical Campus; Division and System Chief of Trauma and Acute Care Surgery at Inova Healthcare System (Fairfax, Va.): Hospital consolidation in the coming years will only succeed if it moves beyond mergers of infrastructure to mergers of purpose. True progress happens when consolidation fosters collaboration — the new competition — uniting hospitals around shared values, transparency, and compassion. Financial alignment is essential, but numbers alone don’t sustain systems — shared vision does. The most resilient organizations will be those that balance fiscal responsibility with the moral imperative to care, invest in people, and keep the patient at the center of every decision.
At Inova, we’ve seen that sustainable growth depends on bringing clinicians into the decision-making process, ensuring that operational strategy and patient care remain inseparable. When collaboration guides consolidation, we don’t just build larger systems — we build stronger, more human communities of healing.
Faimy Vanleeuwen, RN, BSN. Regional Director of Quality at Baptist Health South Florida, North Region (Coral Gables, Fla.): As a regional quality director, I see hospital consolidation over the next 3-4 years as a significant opportunity to advance quality and patient safety. Integration allows for standardization of best practices, shared data, and consistent performance improvement framework across facilities within our system. It also enhances predictive analytics and strengthens accountability for patient outcomes across the continuum of care. However, consolidation must be carefully managed to preserve local culture, communication, and team engagement. 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.
Zafar Chaudry, MD. Senior Vice President, Chief Digital Officer and Chief AI and Chief Information Officer of Seattle Children’s: I fully expect the trend of consolidation to continue and likely accelerate, primarily driven by financial pressures and the high cost of digital transformation. Smaller, independent hospitals struggling with rising labor and supply expenses, coupled with the massive capital investment required for essential technologies like advanced analytics systems, robust cybersecurity, and AI platforms, will increasingly seek to merge with or be acquired by larger systems. This consolidation provides the necessary economies of scale, access to capital, and the pooled data required to optimize operations, move care to lower-cost outpatient settings, and ultimately deliver more efficient, integrated, and technology-enabled care to patients. However, we’ll see a mix of distress-driven mergers and strategic alliances, with increased regulatory scrutiny on the largest deals pushing organizations toward more creative partnership structures.
Quanna Batiste-Brown, DNP, RN. Vice President of Patient Care Services and Chief Nursing Officer at Touro Infirmary, LCMC Health (New Orleans): Over the next three to four years, I anticipate continued hospital consolidation across the United States, driven by economic pressures, workforce challenges, and the need for greater operational efficiency. Smaller hospitals and independent facilities may increasingly find it difficult to sustain operations amid rising costs, reimbursement constraints, and evolving regulatory requirements.
From a nursing leadership perspective, consolidation presents both opportunities and challenges. On the positive side, larger health systems can leverage shared resources, standardized clinical practices, and integrated technology platforms to enhance quality, safety, and patient outcomes. Consolidation also creates opportunities for nursing innovation, expanded professional development, and greater alignment of care delivery models across the continuum.
However, we must be mindful of potential downsides — such as loss of community identity, workforce disruption, and the risk of decision-making becoming too far removed from frontline caregivers. 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.
In short, consolidation is inevitable — but with intentional leadership, it can become a catalyst for stronger collaboration, greater equity, and more sustainable care models for our patients and staff alike.
Bashar Naser. Chief Financial and Operating Officer of CHRISTUS Southern New Mexico (Alamogordo): I believe we are going to continue to see more consolidation among healthcare systems to further enhance strategic position, improve quality outcomes, consolidate cost and overhead to preserve margins and market share. With new government cuts in reimbursement, hospitals will continue to look for opportunities to reduce cost, use AI to enhance operation and become more efficient.
Sean O’Grady. President of Acute and Ambulatory Care at Endeavor Health (Evanston, Ill.): It is clear that hospitals continue to play an important role in caring for the most acutely ill patients in our communities, but they haven’t been the center of the health delivery ecosystem for a very long time. I believe the next three to four years will be defined primarily by strategic partnerships that accelerate and improve care outside of the hospital setting or those that decrease administrative burden. Hospitals and health systems will accelerate their impact by aligning with traditional and non-traditional partners who can meaningfully advance clinical quality and patient experience while radically decreasing costs. Hospitals will remain trusted community assets but they will need to evolve as these relationships take foot and drive impact in the communities we are privileged to serve.
Deborah Visconi. President and CEO of Bergen New Bridge Medical Center (Paramus, N.J.): Hospital consolidation will continue, but I believe the conversation will shift from bigger is better to stronger together. The pressures of workforce shortages, reimbursement challenges, and infrastructure modernization will push organizations to align more closely — not just through mergers, but through strategic collaborations that expand access and stabilize care in their communities.
At Bergen New Bridge, we see consolidation less as an endpoint and more as an opportunity to create partnerships that preserve local care, strengthen safety nets, and integrate behavioral health, addiction treatment, and medical care in ways that reflect the real needs of the people we serve. The future won’t be defined by who owns what, but by who’s willing to innovate, share, and lead with purpose.
Peter D. Banko. President and CEO of Baystate Health (Springfield, Mass.): The Affordable Care Act drove a sharp rise in both hospital consolidation and physician employment by health systems. I fully expect the One Big Beautiful Bill Act to have an even more profound impact than the
ACA on mergers and partnerships over the next 3-4 years. For many health systems, there is just not enough population growth, market share movement, and cost transformation to overcome coverage losses in Medicaid and ACA contraction, utilization reduction due to Medicaid cost sharing, and state-directed Medicaid reimbursement reductions. We envision a future at Baystate that requires tripling the size of our health plan and doubling the size of our physician-hospital network through inorganic growth, and aggressively managing systemness and scale from that growth.
Perry M. Gee, PhD, RN. Enterprise Director of Nursing Research and Evidence-Based Practice, Nurse Scientist and Associate Professor of Research at Intermountain Health (Salt Lake City): As a nurse scientist and nurse leader, my outlook on hospital consolidation over the next three to four years is one of cautious optimism. Consolidation is likely to continue as health systems seek financial stability, workforce resilience, and broader access to value-based care models. From a nursing science perspective, this trend offers opportunities to standardize evidence-based practices, streamline care delivery, conduct multi-site research, and enhance data-driven decision-making across larger organizations.
However, it also presents challenges, particularly around maintaining community-centered care, preserving nursing autonomy, and ensuring that frontline voices remain integral to strategic planning. Nurse leaders must advocate for inclusive governance structures that prioritize patient outcomes and the professional development of nursing teams during these transitions. Ultimately, consolidation must be guided not only by operational efficiency but by a commitment to compassionate, evidence-based, high-quality care.
Ethel Hoffman.Vice President of Payor Contracting and Relationships at Tower Health (West Reading, Pa.): In my humble opinion, hospital consolidation will continue to accelerate over the next three to four years as a strategic imperative to keep pace with the growth among third party payer partnerships, mergers and acquisitions. With the advances in technology, this consolidation should reduce the care fragmentation the industry has seen evolve over the last couple of decades. One can only hope!
Deepti Pandita, MD. Vice President of Clinical Informatics and Chief Medical Information Officer at UCI Health (Orange, Calif.): Hospital consolidation will continue to accelerate over the next three to four years, driven by a combination of financial pressures, workforce shortages, and the strategic imperative to scale for value-based care. We’re seeing a shift from reactive mergers — where struggling systems seek lifelines — to proactive alliances among strong regional and national players. These consolidations are increasingly designed to optimize care delivery, expand geographic reach, and enhance negotiating power with payers.
Athena Minor, DNP, MSN, RN. Chief Nursing and Clinical Officer of Ohio County Healthcare (Hartford, Ky.): Hospital consolidation continues to be a discussion in healthcare circles, and like many other similar initiatives in the whole scheme of world dynamics, it looks like an efficient model on paper. In reality, merging hospital corporations to maximize resources only leads to minimizing the opportunity to meet patient’s needs. Our organization has been successful because we know our community, we know the unique challenges facing our people in this specific location of rural America.
The decisions we make are made locally and would not always be looked upon favorably by a larger organization but they are best for us and the needs of our people. When autonomy to make those types of decisions is removed because you are now a part of a larger organization, the decisions made will be best for the organization as a whole and not necessarily be specific to the needs of each community. While the business aspect of healthcare is necessary, it should be for the purpose of providing quality healthcare, we shouldn’t be providing healthcare because it is good for business. Business-minded success does not always translate to successful healthcare delivery.
Dorinda Mueller, MSN, RN. CEO of Aliso Ridge Behavioral Health (Aliso Viejo, Calif.): As a freestanding acute psychiatric hospital, hospital consolidation is definitely a consideration for strategic marketing over the next three to four years. As an acute psychiatric hospital with strong referral networks and high bed utilization, we will be viewed as a valuable asset to larger organizations seeking to contract for behavioral health services. Some of the operational challenges, i.e., clinical workforce gaps and rising costs, will make this idea much more attractive as seeking partnerships or mergers will help to stabilize operations. Changes in Medicare coverage limits and payment systems for inpatient psychiatric care will also influence strategic decisions over the next three to four years. As freestanding facilities face pressure to align with larger systems to navigate reimbursement complexities, I will be seeking creative programming opportunities to avoid being absorbed in this consolidation push.
Rebekah Fincher. Chief Administrative Officer of Conway Regional Health System (Ark.): The financial instability of rural hospitals is an underappreciated threat to both healthcare access and local economies. More than 700 rural hospitals nationwide are at risk of closure, with Arkansas being among the hardest-hit states. Without policy and funding solutions, communities risk losing their healthcare safety nets altogether. Healthcare being both complicated and complex, it is going to be a thoughtful and concerted effort to bring independent hospitals together and talk about right-sizing care and scaling services to insure communities have access to the right care, by the right provider, in the right place.
Brandi Fields, DNP, RN. Vice President of Clinical Services and Quality Improvement at UK King’s Daughters (Ashland, Ky.): In my experience, hospital consolidations 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. When executed thoughtfully, these integrations can drive performance outcomes across the continuum of care impacting quality and patient experience.
That said, it’s equally important to regularly assess whether these consolidations are truly delivering on their intended goals, not only from a financial standpoint, but perhaps more importantly, from a quality and patient outcome perspective. Maintaining agility with the ongoing complexities of healthcare will remain essential to ensuring sustainability and continued excellence in patient care. Be open to pivot structures if intended impact is not seen. I imagine that in the next three to four years nearly every community hospital will either be affiliated with an integrated healthcare system or will be in discussion to do so.
Gil Padula, MD. Chief Medical Officer and Market Medical Director of Case Management, St. Elizabeth Hospital and Youngstown Market at Bon Secours Mercy Health (Cincinnati): Looking to 2026 and beyond, I predict many more health systems will merge and form multi-state consortia and health delivery systems like we have not seen in the past. Declining reimbursement, inflation, and the need to develop more economies of scale will force our hand. Centralized IT, HR, and system-level board governance will continue to emerge. Local control of hospitals will continue to evolve and change.
Jay S. Grider, DO, PhD, MBA. Chief Quality Officer and CEO of Kentucky Medical Services Foundation at University of Kentucky (Lexington): We’ve all heard of the health systems that are at risk of destabilizing because of financial constraints and government payer changes because of recent legislation. These market forces will continue to drive health systems to seek consolidation. In Kentucky, we are attempting to take a little bit of an innovative approach in that we are attempting as an academic Medical Center to help support, where needed, underserved areas, and supply scarce clinical expertise to systems that are vulnerable. This initiative called Advancing Kentucky Together, seeks to stabilize and support rather than acquire and compete. It is our hope that through this work, we strengthen the infrastructure of healthcare across central and eastern Kentucky.
Wayne Gillis. President and CEO of Rehoboth McKinley Christian Health Care Services (Gallup, N.M.): Consolidation will continue over the next three to four years but become more strategic and targeted rather than driven by blockbuster megamergers.
Key drivers
- Financial pressure (rising labor, inflation, capital costs) pushes weaker hospitals toward scale or partnerships.
- Value-based care and payer risk contracts favor larger systems that can manage population health.
- Labor shortages incentivize centralized staffing and shared services.
- Tech costs (EMR, analytics, telehealth, AI) push smaller hospitals into networks or managed-service deals.
- Growth will focus on ambulatory/specialty (ASCs, oncology, cardiac, behavioral health).
- Regulatory and antitrust scrutiny will limit some large deals but often allow vertical or clinically justified integrations.
- Rural hospitals will see more closures, affiliations, leases, or creative partnerships.
Patterns to expect
- More bolt-on acquisitions, regional roll-ups, MSOs and joint ventures (including PE and payer partnerships).
- Specialty platform plays and care-at-home capabilities expand.
- Activity concentrated in distressed rural and fragmented markets; highly concentrated metros see fewer transactions.
Risks & signals to watch
- Credit markets and capital availability, CMS reimbursement changes, and antitrust enforcement.
- Watch bolt-on deal volume, rural affiliations/closures, payer-provider JVs, and PE activity in specialty services.
Bottom line: Expect steady, selective consolidation focused on scale, specialty platforms, tech enablement, and flexible partnership models — not a new wave of blockbuster mergers.
Robert Corona, DO. John B. Henry Professor of Pathology at SUNY Upstate Medical University; CEO of SUNY Upstate Medical University Hospital (Syracuse, N.Y.): My outlook is that hospital consolidation makes great sense for several reasons like spreading fixed operating costs and having scale to address rising labor costs and technology costs. Many of our regional standalone hospitals are struggling with negative margins and are reaching out to our AMC for help. We tried to consolidate with a large private teaching hospital located right next store which is connected to our hospital by a bridge. We ran into objections from the FTC and we couldn’t find a way to overcome their concerns despite the solid and sensible business plan. We spent approximately two years working on that deal.
Mark Whalen. Executive Vice President and Enterprise Chief Strategy and Transformation Officer of Jefferson Health (Philadelphia): Over the next three to four years, I expect hospital consolidation to continue, driven by a convergence of structural and strategic factors. Rising costs — particularly labor, pharmaceuticals and supply chain — are pushing systems to seek scale. At the same time, health systems are making significant investments in technology, especially AI, creating a need to spread the expenditures across larger networks. Finally, shifting demographics and the growing complexity of population health management make integrated, systemwide care models more attractive and sustainable.
Sandy Balwan, MD. Chief Medical Officer of Northwell Direct; Senior Vice President and Executive Director of Northwell Health IPA at Northwell Health (New Hyde Park, N.Y.): My outlook is that hospitals will continue to consolidate over the next several years for several reasons.
- Need to increase their share of the commercially insured market, especially given the aging population
- Efficiency- survival of financially stressed organizations may be buttressed by larger, more stable organizations who can provide MSO type services at a lower cost
- Power in numbers- stronger negotiating power with health insurance companies
Sarina Rodriques, FACHE. Associate Vice President of System Lab Operations at Rush University System for Health (Chicago): When it makes sense for hospitals to consolidate, it can bring together great minds who share common beliefs and values to deliver care using limited healthcare dollars and expertise in a highly scalable business model. In the Rush system, we are seeing immediate benefits of consolidation at a system level with our laboratories. We are developing best practice teams for all laboratory disciplines at all of our six laboratories testing locations. Sharing expertise in transfusion medicine, chemistry and pathology is affording us the benefits of removing duplication in effort to maintain six sets of policies, training documents and validation protocols. The BPT works together to support a OneRUSH OneRML methodology. I believe consolidation is necessary.
David Allen, DNP, RN. Division Chief Nursing Officer of Adult Services at OU Health (Oklahoma City): Hospital consolidation is progressing rapidly. Independent practices and community hospitals are frequently being acquired by larger health systems, while regional hospital networks are expanding across state lines to form more substantial healthcare organizations. Hospital systems are increasingly purchasing outpatient centers and merging with health plans, and private practices are combining resources to sustain operations. Insurance providers are also forming strategic partnerships to maintain competitiveness.
The consolidation of healthcare entities presents both benefits and challenges. Among the advantages, consolidation can enhance operational efficiency, improve patient care through the sharing of resources, and increase bargaining power with both suppliers and payers. Larger organizations may gain access to advanced technologies and standardized protocols, which have the potential to improve outcomes and reduce costs for patients.
Nevertheless, there are significant concerns associated with consolidation. The reduction in market competition may lead to increased service prices and fewer options for patients. Additionally, such changes can limit the autonomy of individual providers and diminish responsiveness to local community needs by centralizing decision-making within larger organizations. Critics further contend that consolidation may result in workforce reductions and negatively impact patient-provider relationships.
The healthcare industry is entering a pivotal period. As numerous organizations consider consolidation, it is essential to ensure that the potential advantages clearly surpass the associated risks as we move forward.
Barbara Martin. CEO of BJM Healthcare: Over the next three to four years consolidation within healthcare organizations is going to accelerate. We are seeing consolidation of hospital service lines within systems and the healthcare procedures shifted to the hospital which has the best contracted reimbursement.
There needs to also be enough volume to support the hospital service lines thus decreasing expenses and maximizing quality.
Hospitals will continue to close with very low volumes, and the patients will be treated at the larger hospitals thus driving profitability.
Overall consolidation will accelerate in the next several years.
Joy N. White, DNP, RN. Vice President and Chief Nursing Officer of Legacy Health Good Samaritan Medical Center (Portland, Ore.): 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. We’ll see more partnerships between hospitals, technology firms, and community organizations designed to expand access, share data, and strengthen care coordination.
I also hope to see systems move beyond transactional consolidation toward transformational integration — where organizations evaluate the entire continuum of care and maximize economies of scale to build sustainable, lifelong care models for their 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. 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.
Greg Sieg. Chief Information Security Officer of University of Michigan Health Regional Network (Ann Arbor): We’ve already seen a wave of healthcare consolidation, and with ongoing uncertainty around reimbursement models, I believe we’re on the cusp of another acceleration in the next few years. Organizations should keep their integration and risk playbooks handy.
Alyssa Livengood Waite, MHA, MSN, RN, FACHE. Associate Chief Nursing Officer of Penn Medicine Lancaster General Health: Hospital consolidation presents both challenges and promising opportunities for leadership. Consolidation of complex organizations is not ‘business as usual’, it will require adaptive leadership skills. Success will depend upon our ability to adapt–leading collaboratively across complex systems, embracing innovation, and maintaining the core values while adapting to a broader organizational framework. While consolidation can yield economies of scale, integrating disparate systems and technologies will introduce significant financial pressures. Nurse leaders must be equipped to advocate for investments that balance the clinical needs of their teams with fiscal responsibility. Learning to work differently within the multi-hospital context requires fostering a cohesive culture through collaboration to support the needs of all entities effectively knitting them together. Expanded career pathways, offering new opportunities for growth across the system, will support individual growth and corporate strength. Adaptive leadership demands emotional intelligence, enabling the leader to connect change initiatives with organizational values while aligning them to the individual purpose of the teams we serve.
Joseph Carr, RN, MBA. Vice President of Supply Chain at Akron Children’s (Ohio): Having started my career in banking, real estate, and private equity, the current state of healthcare reminds me of those industries during turbulent times and a strong outlook of M&A. Declining reimbursements and rising costs are putting tremendous pressure on hospitals, and for many, mergers and acquisitions have become a perceived lifeline. Yet in business schools, M&A is often studied as a what not to do case study especially when leaders fail to consider the long-term community impact.
To avoid becoming one of those cases, executives must explore all options before consolidating, including engaging clinicians in open fiscal dialogue to identify solutions that preserve both financial and clinical integrity. In physician-led models, this discipline tends to come naturally; in others, it must be intentionally built.
The hidden cost of consolidation is often borne by patients. When large adult systems acquire independent children’s hospitals, the result can be service reductions, redirection of capital to higher-margin adult lines, and erosion in pediatric care quality. During financial strain, children’s hospitals too often become “smoothing errors” in the broader system’s accounting.
This issue is personal for me. As the father of a child with a neurological condition, I’ve witnessed firsthand the superior quality and advocacy provided by independent children’s hospitals like Akron Children’s. From faster procedures to stronger insurance advocacy and child-centered care, these institutions consistently go beyond the expected.
As the industry faces mounting fiscal pressure, I urge leaders to resist the easy button of consolidation. Protecting independent pediatric systems isn’t just about financial stewardship, it’s about preserving access, quality, and the well-being of our future: the children.
David Marcozzi, MD. Chief Clinical Officer of University of Maryland Medical Center; Associate Dean of Clinical Affairs of University of Maryland School of Medicine (Baltimore): Over the next few years, hospitals will face even greater margin compression amid rising service demand and acuity. Thoughtful consolidation can improve payer negotiating position, align market-competitive salaries, and enable consistent standards of high-quality care through a unified EMR and automated clinical practice guidelines. Moving patients to the right setting at the right time and ensuring frictionless handoffs to outpatient care — ‘systemness’ could become an operating and financial advantage. The outcome, if successful: higher reliability at scale with lower unit cost.
Imran Qadeer, MD. President and CEO of Allegheny General Hospital (Pittsburgh): In this environment, financial sustainability requires greater scale or an extremely favorable patient mix, and the latter is difficult for hospitals to achieve in aging, slow-growth states like Pennsylvania. With patients shifting into government-sponsored insurance programs in ever-greater numbers and healthcare expenses continuing to grow, hospitals will continue to explore mergers and affiliations as a matter of survival. The kinds of technological, capital and personnel investments required to keep acute-care facilities afloat in a competitive healthcare landscape will be increasingly inaccessible for independent hospitals or small systems, especially as insurers themselves continue to consolidate and pursue value-based and risk-based contractual arrangements. Hospitals will also continue to eye strategic affiliations with regional and national health insurers — here in Pennsylvania, for example, Highmark Health and others have demonstrated that innovative relationships between payers and providers can benefit both parties.
Cody Walker. President of Baptist Health Medical Center – North Little Rock (Ark.): M&A will reach an all-time high. Independent hospitals and health systems alike will seek to enhance their ability to weather the cost-to-revenue mismatch. Consolidation with a focus on systemness can lead to new operational synergies and, in some cases, a more integrated approach to patient care and community needs.
Rural healthcare will be in the spotlight due to recent federal legislation. Successful systems will focus on leveraging these consolidations and will be experts at navigating the complexities of integration. At Baptist Health, serving smaller communities and ensuring their needs are met is integral to our culture and will remain a primary focus in the years to come.
Dani Hackner, MD, MBA. Senior Vice President and Chief Clinical and Academic Officer at Southcoast Health System (New Bedford, Mass.): At Southcoast Health, a health system not consolidated with large, national systems, we have seen the benefits of integration regionally. Bringing our system together under one medical staff and one medical executive committee with one board has reduced practice variation. Deploying system clinical and operational leadership supporting sites across the system from hospitals to cancer centers to urgent care to ambulatory care has enhanced continuity, consistency, and operational efficiency. With a robust information technology framework meeting Level 10 CHIME criteria and recognized analytics, we have been able to drive hardwired care and improved safety.
Sharing patients and care, working with academic and community systems, partnering with schools and colleges, or supporting chambers of commerce and local businesses does not require endless consolidation. Increasingly, at Southcoast Health, we are asking ourselves how we can work better with those who we serve as well as those who compete with us. It is a broader pie vision of health that goes beyond zero-sum gains. We recognize that consolidation has shown few signs of slowing and that in the coming 3-4 years some small systems will survive through consolidation. At Southcoast, our approach will be to sustain a journey of both integration and regional focus, a journey of affiliation and collaboration, and a journey to thrive and support communities across southeastern Massachusetts.
Chad Konchak. System Assistant Vice President of Data Analytics at Endeavor Health (Evanston, Ill.): Hospital consolidation will continue, although the focus and pace will evolve. Financial pressures and economies of scale, particularly as it relates to bargaining power with the increasingly strong payers, along with shifts in care delivery away from the hospital setting and regulatory and payment changes will all continue to drive fewer and larger health systems. The increasing investment required for advanced technologies, including AI, may present a significant financial hurdle for smaller, independent facilities, potentially making partnerships or integration more attractive. These new technologies could allow new entrants to shake up the healthcare market, accelerating the pace of consolidation, with larger health systems having the resources to invest in and implement these technologies at scale, ultimately enhancing the quality and efficiency of care delivery for their patients.
Airica Powell-Steed, MBA, RN. Interim Executive Vice President and Chief Operating Officer of Loretto Hospital Network (Chicago): Over the next three to four years, I definitely see hospital consolidation continuing, but the real question will be why organizations choose to come together. The future is not about getting bigger, it’s about getting better and more connected to the people we serve. As we shift toward keeping communities well and out of the hospital, the demand for inpatient beds will continue to decline, while the need for innovative, comprehensive ambulatory and community-based care models will rise. This evolution will push leaders to pursue more strategic, mission-aligned consolidations and partnerships that extend beyond traditional brick-and-mortar systems. The organizations that thrive will be those that choose to strategically integrate with purpose while aligning scale, health equity, and innovation to truly transform outcomes and create healthy communities.
Molly Biwer. Chief Marketing Officer of Emory Healthcare (Atlanta): The next few years will bring continued transformation across healthcare — whether that takes the form of consolidation, collaboration, or new delivery models. But at Emory Healthcare, our perspective is clear: the conversation begins and ends with the patient. Every strategic decision we make is rooted in how it will improve the experience, access, and outcomes for those we serve.
While market dynamics may drive integration, our focus is on purpose — not size. We will pursue relationships that create meaningful value for patients, caregivers, and communities — whether through shared innovation, expanded access, or the seamless coordination of care. Ultimately, our growth is defined not by how many hospitals we have, but by how effectively we meet the needs of every patient who entrusts us with their health.
Darrell Bodnar. CIO of North Country Healthcare (Flagstaff, Ariz.): Over the next three to four years, I believe hospital consolidation will accelerate, driven largely by the financial and regulatory ripple effects of leadership changes in Washington. The policy shifts we’re seeing, combined with tightening reimbursement models, inflationary pressures, and mounting compliance costs, are creating a level of financial headwind that many standalone hospitals, particularly rural and community-based systems will struggle to sustain. As these pressures intensify, we’ll see not only more hospital mergers but also the absorption of smaller clinics and FQHCs into larger health systems as a survival strategy.
Mary Martin. COO of Duke University Hospital (Durham, N.C.): Given the current financial headwinds, hospital consolidation will continue over the next few years. Additionally, I believe healthcare systems will expand partnerships and ownership of retail pharmacies, AI companies, and other healthcare-adjacent industries to diversify revenue streams. Providing efficient care while lowering cost will be the primary focus of all healthcare service providers for the foreseeable future. We must not, however, sacrifice the quality of this care nor divest in the critical funding of research to advance medical science.
Michele Szkolnicki, RN. Senior Vice President and Chief Nursing Officer of Penn State Health Milton S. Hershey Medical Center: As a hospital nursing executive in a health system that is early in its “systemization” journey, I find that the shift toward systematization is more than operational; it’s deeply cultural. The challenge isn’t just aligning processes or standardizing care models, but also about navigating the human side of change. Nurses, leaders, and frontline teams are being asked to think beyond their individual sites and embrace a broader identity, one that prioritizes shared goals over local traditions. That’s a significant mindset shift, and it doesn’t happen overnight.
One of the most tangible opportunities my organization has to support this shift is our current journey to convert our EHR to Epic. That transition is forcing us to take a hard look at how we do things across our hospital. We are examining our policies, workflows, and documentation standards; and asking what needs to be consistent across the board. In planning that system, we’re implementing technology as well as streamlining and aligning practice. It’s a catalyst for change that supports the broader goal of becoming a more cohesive, high-functioning system. But even with that momentum, the real work lies in how we lead this transition through clear communication, thoughtful engagement, and a steady hand through the discomfort of transformation.
It has been reported that hospital consolidations are expected to accelerate over the next three to four years, driven by financial pressures, workforce challenges, and the need for greater operational efficiency. In response to the question, “What’s your outlook on hospital consolidation over the next three to four years?” I believe we’ll see a continued trend toward mergers and strategic affiliations, particularly among smaller hospitals seeking stability and access to broader resources. However, this consolidation must be approached thoughtfully to preserve community access, maintain quality of care, and ensure that nursing leadership remains deeply involved in decision-making during these transitions.
Nariman Heshmati, MD. Chief Physician and Operations Executive at Lee Physician Group (Fort Myers, Fla.): I believe we will see more and more regional hospital consolidation in the next three to four years. Reimbursement continues to be challenging and the economies of scale in regional systems allow resource allocation in a sustainable manner for success. Complex IT systems are needed for quality reporting and value-based care, more AI enabled technologies are available to improve care delivery but at a cost, and adequate scale is important to be successful. All of this is difficult to accomplish in a stand-alone hospital but more feasible with regional consolidation of several hospitals so I believe the market dynamics will continue to favor that consolidation. On the other hand, perhaps because of the continued regional nuances of healthcare delivery, national consolidation approaches have been less successful and may not advance as much as regional consolidation.
D. Richelle Heldwein. Chief Risk and Compliance Officer of St Johns Health (Jackson, Wyo.): St. John’s Health is an independent community hospital with local governance, and we have worked hard to maintain that status over the years. As a community hospital facing strong financial headwinds, we are working to ensure that our strategic plan focuses on our core services and our continued financial viability. The quality of care that we provide is critical for maintaining community support. That community support is also key to maintaining our independent status moving forward.
Our hospital CEO Jeff Sollis has renewed our commitment to keeping our quality healthcare mission focused on local community needs. This is a timely topic for Becker’s to address, and it was addressed by our CEO in our local paper recently as well. See local article here: Jackson Hole News and Guide-Keep It Local
James Mladucky. Vice President of Design and Construction at Indiana University Health (Indianapolis): The economic realities of healthcare will continue to drive consolidation as health systems face shrinking margins, rising costs, and workforce challenges that make it harder to sustain operations independently. Consolidation allows hospitals to achieve the scale needed to operate efficiently, share resources, and deliver high-quality, affordable care through value-based care models. Looking ahead, smaller and rural hospitals may join larger systems, gaining critical financial stability, access to resources, and support for maintaining local services – helping communities continue to receive care close to home. Academic health centers will remain uniquely positioned, leveraging patient care, education, and research to drive innovation and long-term efficiencies.
Damon Blankenbaker. Workplace Violence and Public Safety Manager of Integris Health (Oklahoma City): My time in healthcare has been relatively short compared to my 30 years in law enforcement and behavioral threat assessment, but it’s been long enough to see how consolidation creates both opportunity and risk to our patients and caregivers. When I joined Integris Health in 2021, the system had already begun expanding and consolidating hospitals across Oklahoma. Since then, we’ve continued to grow, by adding two more rural hospitals.
That expansion and consolidation have brought real challenges, especially around violence prevention, caregiver safety, and behavioral risk management. Every merger has brought with it challenges by introducing new cultures and expectations.
I believe hospital consolidation will continue, but at a much slower pace over the next few years. That’s not necessarily a bad thing. A period of stability could help systems standardize not only patient care but also caregiver safety programs, which should bring consistency to threat management, de-escalation training, and post-incident review processes.
One challenge I’ve seen since entering healthcare is that workplace violence prevention still doesn’t receive the emphasis it deserves, even though caregivers are statistically five times more likely to experience serious workplace assaults than workers in other sectors. As we continue to build and improve our workplace violence prevention program it is hard to find other healthcare systems who seem to have this figured out. It took OSHA, The Joint Commission, and CMS to establish clear expectations and guardrails for healthcare systems. It took IAHSS to advocate for and help produce recommendations for healthcare security leaders to point to.
I’m not usually an advocate for regulation, but in this case, healthcare needed that external push to prioritize violence prevention and build sustainable safety infrastructure.
In my view, the next wave of consolidation should be about stabilizing cultures, protecting caregivers, and embedding behavioral risk management as a core operational standard. Growth is important, but how we protect our people during and after that growth will define whether these consolidations truly succeed.
Melinda Hancock. Executive Vice President and CFO of Sentara Health (Norfolk, Va.): Given what we know to be true today, there will be enormous financial pressure building year by year on care delivery. The ability to scale the work needed to think differently about workflows and processes through AI and automation, coupled with the variation of balance sheet strengths, will fuel more consolidation. Our Sentara care delivery, health plan, and administrative support are diligently forging innovative ideas and ways of thinking about healthcare. Sentara has set targets for growth and efficiencies for the next 3 years to ensure the continuance of delivering our mission of improving health every day.
Vi-Anne Antrum. Senior Vice President and Chief Nursing Officer of Cone Health (Greensboro, N.C.): As the reimbursement and expense environment continues to escalate, I believe hospital consolidation will continue. At the same time, it will be important to preserve the philosophy that healthcare is local. The larger entities that will be most successful will understand and preserve this while consolidating IT platforms and connectivity to ensure alignment across markets. There will be gains in expense reduction in places like supply chain and back office. Smart growth will continue in places like pharmacy, ambulatory, and virtual care to support access, affordability, and convenience. We will continue to see innovation in delivery of services in the home setting and a reimagined post-acute care network as part of the larger ecosystem. Coordinated, connected, personalized care that ensures all needs are met will be at the heart of the health systems that win in the coming years!
Theresa McDonnell, RN. Senior Vice President and Chief Nursing Executive of Duke University Health System (Durham, N.C.): Over the next three to four years, hospital consolidation in the U.S. will continue, but with a more selective and strategic focus. Financial pressures, especially for smaller rural hospitals, will drive acquisitions and affiliations, while larger systems pursue scale and integrated networks. This comes at a time when heightened regulatory scrutiny and capital constraints will temper the pace, making partnerships and targeted deals more common than broad roll-ups.
JohnRich R. Levine, MSN. Chief Nursing Officer of Reeves Regional Health (Pecos, Texas): Over the next three to four years, I am seeing that consolidation will continue to evolve from large-scale acquisitions into coordinated alliances built around shared capability. Health systems will place greater emphasis on operational integration such as connecting technology platforms, specialty services, workforce strategies, and patient pathways, into cohesive networks. Community and rural hospitals will remain essential anchors in this model, operating with local leadership while benefiting from regional support. That direction calls for leaders who can protect identity and trust while expanding reach and capability, and it is the approach guiding our work at Reeves Regional Health.
Healthcare is moving toward a model that brings services closer, responds faster, and meets people where they are. Teams that understand local needs and collaborate across facilities will expand access to advanced care that once required larger institutions. Partnerships built on shared knowledge, coordinated transfers, integrated technology, and workforce collaboration will define success.
At Reeves Regional Health, that reality is shaping how our care is delivered. Coordinated emergency and critical care programs move high-acuity patients quickly and keep treatment continuous. Maternal and neonatal collaborations provide specialized services to families within their own regions. Workforce partnerships strengthen bedside care and improve recruitment and retention. Each initiative reduces barriers and builds a system that places care within reach when it matters most.
Consolidation now reflects a broader mission of building capacity while preserving identity. It strengthens care while keeping it grounded in the communities that depend on it. For the populations we serve, this approach delivers access, reliability, and trust, which are our lifeline.
Michael Antoniades. President of UChicago Medicine Ingalls Memorial Hospital: I expect healthcare systems to continue expanding their geographic reach through consolidation with other systems or independent hospitals. Given the uncertainties facing the healthcare industry in both the short and long term, consolidation can be a strategic approach that leverages existing infrastructure to support operations across broad regions. This helps hospitals maintain or improve care delivery and financial stability, enabling them to fulfill their community missions.
For academic health systems in particular, consolidation offers smaller community hospitals and their patients greater access to academic excellence — such as clinical trials, tertiary and quaternary care, specialty services and more — that might otherwise be out of reach. That said, consolidation also requires thoughtful integration to ensure that local communities’ voices and needs remain a priority.
Timothy Carrigan, PhD, RN. Regional Chief Nursing Officer of Illinois and Indiana at Trinity Health (Livonia, Mich.): Healthcare has to change and innovate care delivery; the system cannot remain status quo while absorbing dramatic cuts to Medicaid. Hospital consolidation will continue, including mergers, acquisitions, and site of care reductions. I also think health systems will look closely at consolidating or shrinking specific programs, which impacts access to specialized care. Instead of offering labor and delivery at every hospital in a system, hospitals may be forced to consolidate into one site offering labor and delivery services instead. There will likely be an impact on high-resource centers of specialized care, like cardiac or neurosciences, too.
Right now, healthcare consumers are used to accessing a variety of healthcare services close to home. As these changes unfold, all patients – not just those on Medicaid or government insurance – will likely see a change to where they receive their care and what services are offered in their communities.
While it seems concerning to hear about healthcare closure or consolidation, there is an opportunity for better programs to be created through consolidation. In healthcare, there are usually improved patient outcomes in higher volume centers.
Christopher Douglas, EdD. Houston Market CEO of Advanced Diagnostics Healthcare System (Houston): Over the next three to four years, our consolidation strategy will focus on selectively partnering with high-demand specialties such as cardiology, urology, endocrinology, and rheumatology to strengthen our comprehensive one-stop care model. By pursuing untapped payor sources, enhancing referral alignment, and expanding access through integrated mobile and onsite services at feeder practices, we aim to drive sustainable growth, broaden patient reach, and deliver more coordinated, value-driven care across our network.
Roy E. Alston, PhD. Vice President of Security and Public Safety at Christus Health (Irving, Texas): The outlook for hospital security over the next three to four years is expected to focus on increasing sophistication and integration of cyber and physical security measures. This includes the adoption of advanced surveillance systems, real-time threat detection, and access control technologies to enhance safety for patients, staff, and visitors.
Evolving threats — such as active shooter incidents, cyberattacks, and workplace violence — will drive hospitals to invest even more in both physical and cybersecurity in a manner that results in a convergence of the two.
Financial threats, such as rising operational costs, reduced reimbursements from Medicare and Medicaid, and labor shortages, will drive hospitals to improve revenue cycle management while making very tough decisions regarding service lines and security.
Overall, security in healthcare settings will become more proactive, more integrated, and more technologically driven to address both physical and digital threats effectively.
Wayne Lipson, MD. Senior Vice President and Chief Medical Officer of Methodist Le Bonheur (Memphis, Tenn.): We expect that service consolidations will be more frequent over the three to four years. Within Methodist Le Bonheur Healthcare, for example, we regularly assess the services that we offer to the communities that our five adult hospitals and children’s hospitals serve. For example, we made the decision to consolidate our maternity and obstetrics services across the system to better serve our patient population in the Mid-South. Our obstetrics services previously were offered in three locations: Methodist South, Methodist Olive Branch, and Methodist Le Bonheur Germantown.
The decision to consolidate was driven by data from the hospitals which provided maternity and obstetrics services, which showed that the volume of deliveries had decreased significantly at Methodist South, where the service area community is aging.
Consolidations and regular service line volume reviews are critical in ensuring that we continue to provide the highest-quality care to our patients and the communities we serve in an effective and efficient manner.
We continue to work closely with providers to ensure continuity of care for Methodist South maternity patients.
Kaleem Qazi. Vice President of Operations at Insight Hospital and Medical Center Chicago: Safety net hospitals will struggle in the years to come, most are already struggling but it is predicted to worsen with deficiencies and an increase in uninsured patients. This will end up leading to safety nets being absorbed by bigger hospitals. This can risk care being taken away from patients that are in need.
Nirmit Kothari, MD, MPH. Associate Chief Medical Officer of Baptist Memorial Hospital – Memphis (Tenn.): I expect hospital consolidation to continue accelerating as a strategic response to several persistent challenges: stagnant or declining reimbursement rates, rising costs of care delivery, and ongoing difficulties in securing adequate physician coverage. Previous consolidations have often led to reduced access for rural communities, forcing patients to travel farther for care. However, with the growing adoption of telemedicine and virtual care, health systems now have the tools to expand their reach without compromising accessibility. I am optimistic that the future consolidations could result in more integrated networks that deliver high-quality care across broader geographies — potentially improving outcomes and patient experience.
Christopher Burks, MS, MBA. Vice President of Laboratory and Support Services at Brown University Health (Providence, R.I.): I believe, overall, that hospital consolidation is expected to continue over the next three to four years. In particular, at my institution, Brown University Health, we are driven by continuing financial pressures from private payers along with Medicaid funding from the state of Rhode Island. With these growing concerns and the recent acquisition of former Steward inpatient and outpatient facilities, Brown Health is moving to establish a broader ambulatory presence in Massachusetts.
Deesha K. Brown, JD. Senior Director of Community Clinics Network Operations at UCLA Health (Los Angeles): Winning in healthcare often requires balance – achieving the dual aims of exceptional patient experience and financial sustainability. Over the past five to six years, the healthcare landscape has experienced seismic shifts: workforce shortages, rapid technological changes, evolving payer mixes and declining reimbursement rates. These factors often require many organizations to rethink how they operate and for many this means exploring consolidation. The strategy of consolidation can be compared to a game of sports – position matters. In the league of mergers and acquisitions, you are either the acquirer or the acquired. Yet, regardless of the position the ultimate goal is the same: to create a winning strategy that creates value for both teams. For one it may mean creating greater access and an enhanced patient population; and for the other, financial relief, operational stability and long-term viability.
A recent example is UCLA Health’s March 28th acquisition of the 260-bed West Hills Hospital and Medical Center including seven operating rooms and a free-standing ambulatory surgery center in the west San Fernando Valley, 21 miles northwest of UCLA’s main campus in the Westwood area of Los Angeles. The expansion demonstrates how a thoughtful strategy can advance mission, reach and resilience.
If long term financial stability is the goal, the lesson is clear: find the right partner, align on purpose and build a solution where everyone wins.
Tiffany Love, PhD. Associate Vice President of Nursing at Greater Lawrence Family Health Center (Lawrence, Mass.): The “One Big Beautiful Bill Act” is projected to result in substantial cuts to Medicaid spending, directly impacting hospitals that rely heavily on this funding. These reductions could force hospitals to scale back staff and essential services or consider consolidation. Additionally, if other health subsidies and coverage options are also reduced, hospitals may see a rise in uninsured patients, further straining their resources.
In this challenging financial climate, more hospitals may feel pressured to merge into larger healthcare systems in order to survive. However, this trend toward consolidation poses serious risks. 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 concentrates power among a few large entities, enabling them to set prices and restrict options — often without delivering meaningful improvements in outcomes. The result is a healthcare system that imposes greater financial burdens on families and delivers poorer health outcomes overall.
Jake Stover. Vice President of Finance at UK HealthCare (Lexington, Ky.): The future outlook on consolidations is a complex one. Most colleagues I have had a chance to speak with are referencing risks from historical times before the ACA when bad debt levels were a significant challenge, especially for smaller and rural hospitals. Based on what we see in the future landscape, organizations are anticipating pressure in the uninsured levels rising again, putting strain on the healthcare ecosystem. Because of that, I would anticipate an increasing conversation on consolidated facilities and services out of fiscal necessity. This could mean a real pressure point for patients and their ability to access much needed services in the future.
Matthew Boebel, MBA, FACHE. Associate Vice President of Clinical Services at Silver Cross Hospital (New Lenox, Ill.): The outlook for hospital consolidation among independent organizations, like Silver Cross, over the next three to four years will depend on several external factors, including rising labor and wage pressures, state and federal site-neutral payment reforms, market expansion by large health systems, ongoing operating margin compression, and significant internal capital demands. Silver Cross is positioned well to remain independent during this period due to its stable financial health, strategic partnerships, and steady growth. Our service area’s steady population growth and favorable payer mix continue to support service demand and revenue stability. While consolidation pressures will persist, for Silver Cross to sustain this position, our organization must continue emphasizing operational efficiency, leveraging key affiliations, and remaining nimble in responding to financial and market pressures.
Sophia G. Holder. Executive Vice President and CFO of Children’s Hospital of Philadelphia (Pa.): Over the next three to five years, hospital consolidation will remain a defining force, though the pace will be shaped more by strategy than scale alone. Rising labor costs, persistent reimbursement pressures, and the capital intensity of digital health and research investments will push organizations to evaluate partnerships that create durable, system-level value. Regulatory scrutiny will require that consolidations demonstrate measurable improvements in affordability, access, and outcomes, not simply market share.
For pediatric providers, the calculus is even more nuanced: integration offers the promise of broader access to subspecialty expertise and research capabilities, but must also preserve the agility and mission focus that children’s care demands. We are likely to see a shift toward more innovative models of affiliation – network-based partnerships – that allow systems to share risk and resources without full mergers. The organizations that will thrive are those that approach consolidation not as an end in itself, but as a lever to advance strategic differentiation, clinical excellence, and long-term resilience.
Edward Kim, MD, MBA. Vice Physician-in-Chief of City of Hope (Duarte, Calif.); Physician-in-Chief of City of Hope Orange County: Consolidation of health systems is a double-edged sword. While we all understand the importance of making healthcare more efficient, it shouldn’t come at the price of limiting access to quality care. This is especially important in cancer care. Unfortunately, most Americans don’t receive cancer treatment at an NCI-designated cancer center. This lack of access can make a lifesaving difference, as it means fewer opportunities to provide advanced treatments and clinical trials — often the most promising therapies, particularly for complex cases. Also, some of these cases become even more complicated because diagnosis is delayed by access barriers.
At City of Hope, we are taking a different approach, looking at ways to bring our unique model of academic medicine, research breakthroughs and whole-person care to more communities. In the coming weeks, we will open our cancer specialty hospital in Irvine, California, completing the delivery of a full continuum of advanced cancer care and research to the community. That means more – not fewer – leading-edge treatments and discoveries within reach for patients who need them.
Marsha Sinanan, DNP, MBA, RN. Vice President of Patient Care Services and Chief Nursing Officer at Mount Sinai Morningside/West/Behavioral Health Center (New York City): Healthcare in the U.S. is seeing more and more mergers and acquisitions, and the future short term outlook in this area could mean higher costs, lower quality and strained access due to less competition. While consolidation might make providers more efficient or help struggling ones, it often leads to higher prices and fewer choices for patients, especially in local markets.
Dionne Dixon, PhD. Regional Executive Director of NW at CommonSpirit Health (Chicago): Over the next 3 years health systems will likely continue consolidations to focus on access to care, logistical efficiencies and workforce shortages.
While the financial gains will remain the key driver, building and strengthening mobility pathways and ecosystems to support the work will be key. This includes not just platforms, but also how we effectively integrate people and new roles into and through Healthcare.
