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Health Systems - Hospitals
Market Trends...
  • Focusing on better outcomes at lower cost (reimbursement depends on it), investing in IT / IoT / IoHT
  • Developing new business models and IDNs; more effectively engaging commercial / government payers, ongoing consolidation nationwide driven by reimbursement challenges
  • Health systems acquiring practice groups and other provider entities to fortify marketing strategy based on the length and depth of their continuum of care


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Health systems (also known as "hospital systems", "integrated delivery networks", "IDNs") are undergoing significant changes. They are trying to improve their competitive position, more effectively engage healthcare reform and grow income despite more stringent reimbursement guidelines by managed care and government payers:

  • Acquiring physician specialty practices
  • Forming accountable care organizations (ACOs)
  • Acquiring additional hospitals or merging with other healthcare systems 
  • Developing additional care venues like home infusion services and assisted living or nursing home facilities
  • Fortifying advanced billing/recordkeeping capabilities to improve accuracy of billing and patient care data while accelerating payment cycles for more consistent, ongoing cash flow 
  • Investing in advanced surgical and other care technology to provide more specialized care within select facilities

Several key strategies are emerging in the health system sector.  Mergers between health systems in certain metropolitan markets have been frequent but also trigger concern by consumers / patients and regulators in terms of reduction in provider competition.  As that comes into play, the merger strategy is set aside and health systems concentrate on buying or organically establishing physician group practices, clinics and specialty treatment centers (dialysis, outpatient surgery, physical therapy, infusion sites, etc.).  Another approach is for the merger / acquisition strategy to expand across state and regional borders; multiple hospitals in several metropolitan areas and states are operated by a single ownership entity.  Key examples of this are HCA and Tenet -with Steward Health Care a new contender with an added variable as it is a private equity venture under Cerebus.

Essential operating goals are to lower cost while improving levels of care -challenging propositions.  The consolidation strategy being taken reduces administrative redundancies, increases leverage against payers and healthcare product manufacturers.  Organic and acquisition-based expansion of care services enables them to extend their reach in the continuum of care and increase the likelihood of retaining a greater number and variety of patients.

​Long Term Acute Care hospitals, known as "LTACS", are a highly specialized segment. They bridge the gap between hospitals and adjoining healthcare service providers such as rehabilitative care and/or nursing facilities. Patients are typically transferred to an LTAC from the intensive care unit of a traditional hospital because they no longer require advanced procedures, diagnostic services or the other deep resources offered by a full scale hospital facility but still require advanced levels of care.

LTACs focus on patients with serious medical issues requiring intense, special treatment for an extended period of time, perhaps 20 to 30 days. LTACs offer more individualized support than a skilled nursing facility, nursing home or acute rehabilitation facility. Depending on the patient, after completing the care regimen at an LTAC, they may be discharged to go home or may be transferred to a rehabilitative facility to complete their recovery. In other cases, patient stays in LTACs are extended based on recovery status and required care.

Some hospital/healthcare systems provide LTAC services by operating their own LTAC facilities. There are also several sizable, well-established companies dedicated to the extended care market which operate a number of LTACs as well as rehabilitative centers and other extended care service facilities. Some of the leaders are :

  • Kindred Healthcare*
  • Landmark Hospitals
  • SelectMedical
  • Vibra

*​Kindred has begun to exit the LTAC sector by selling some of its LTAC facilities to better focus on other portions of its business...
... This is a list of leading Health Systems, Hospitals, Integrated Delivery Networks (IDNs); scroll down page for presentations and current market trends ...
... Health Systems are a complex sector with increasingly diversified business models; these presentations cover business entities and topics within the sector ...
<img src="sb10069454x-001.jpg" alt="registered nurse in meeting with hospital staff about changes in their health system">
... Find State, Regional, Metropolitan Hospital Associations With This Resource Link ...
...In late August, 2017, a new hospital / healthcare system mega merger was announced. Through Adventist Healthcare and Ascension Healthcare's joint partnership, AMITA, Presence Healthcare would be acquired and integrated into the AMITA Health System. The deal would primarily impact the greater Chicago and surrounding suburban area; it is still subject to Federal regulatory approval...
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...In mid-December, 2017; two major hospital systems were in merger discussions which would create a new leader in U.S. hospital ownership totaling 191 hospitals.  Non-profit Ascension and non-profit Providence St. Joseph Health would create a new mega hospital entity comprised of 191 hospitals across 27 states; its annual revenue is estimated at $44.8 billion.  Its next largest competitor would be HCA.  Presently, HCA owns 177 hospitals which generate roughly $41.5 billion in annual revenue...

...In early December, 2017, a new hospital / healthcare system mega merger was announced. Illinois-based Advocate Health Care and Wisconsin-based Aurora Health Care announced their plans to merge.  The deal is subject to Federal regulatory approval; the combined entities would be a formidable healthcare provider / competitor with multiple hospitals, outpatient clinics and an impressive array of physician specialty groups.  There patient service coverage would have extensive reach in and around the great Chicago and Milwaukee metro markets plus outer areas including rural sectors...
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