Hospital system acquisitions and mergers: Nonprofits lead the way

This post is the second in a series exploring the Tracking Hospital Ownership and Consolidation dataset, released by the Lown Institute in June 2026. The dataset includes approximately 4,500 acute care and critical access hospitals. 

Our previous blog highlighting the ten largest hospital systems in the U.S. showed that most of these systems reduced the number of hospitals they own in recent years. This post focuses on the systems that are growing. The big takeaway? Almost all of them are nonprofits.

Nearly half of hospital systems experienced some kind of change from 2020-2025. Among 357 hospital systems active in 2025, 43 systems were created within the past five years and 129 others gained or lost at least one hospital. Including both new systems and systems with hospital acquisitions or losses, 48% of systems experienced a change. 

Nonprofit systems show largest hospital gains, while for-profits shed hospitals

Of systems that operated under the same name and ownership from 2020-2025, 12 systems acquired at least five hospitals. All of these systems are nonprofits (ten private and two public). 

Of the seven systems that dropped five or more hospitals from 2020-2025, six are for-profit systems (Ascension is the exception). The following chart includes only systems that operated under the same name and ownership across all six years. Five of these systems shed ten or more hospitals. 

Nonprofits dominated merger activity 

Along with systems acquiring hospitals and growing, we also saw several new systems created through mergers or joint ventures. Leading the pack was Advocate Health, created in 2022 from Advocate Aurora in the midwest and Atrium in the south. This joint venture is notable not only for the size of the resulting system (making it one of the top 10 in the nation), but for its geographic reach across Georgia, North Carolina, Illinois, Wisconsin, and Alabama.

The following systems of five or more hospitals were created through mergers of existing systems between 2021 and 2025. All of these are nonprofits; Advocate is a joint venture between a nonprofit and public system.

• Advocate Health (43 hospitals in 2025) – Merger between Advocate Aurora and Atrium Health in 2022
• Corewell Health (18) – Merger between Beaumont Health and Spectrum Health in 2022
• Froedtert ThedaCare Health (13) – Merger between Froedtert & Medical College of Wisconsin and ThedaCare in 2024
• Jefferson LVHN (13) – Merger between Jefferson Health and Lehigh Valley Health Network in 2024
• Vandalia Health (11) – Merger between Mon Health and Charleston Area Medical Center in 2022, Davis Health System joined in 2023
• Emplify Health (9) – Merger between Gundersen Health and Bellin Health in 2022
• Independence Health System (5) – Merger between Excela Health and Butler Health in 2023

There were also new systems created from bankruptcies, hospital sales, or new buildings rather than mergers. Of the following newly created systems with at least five hospitals, all but Risant are for-profits. 

• ScionHealth (13 hospitals) – Spinoff from Lifepoint system in 2021
• Risant Health (9) – Created by Kaiser Foundation Hospitals, acquired Geisinger Health in 2023 and Cone Health in 2024
• Healthcare Systems of America (7) – Bought Steward hospitals after bankruptcy in 2024
• Exceptional Healthcare (5) – Built their second community hospital in 2024 and have continued to build.

Why nonprofit system growth matters

Why do nonprofit systems appear to be growing while some for-profits are shrinking? As we pointed out in our previous blog, some large for-profit systems are divesting from hospital facilities and turning toward ambulatory surgery centers and other outpatient growth. Hospitals’ ability to keep their costs down and add facility fees make some outpatient services very lucrative.   

The proliferation of nonprofit mergers also reflects the deep divide between the “haves and have nots” in this sector. Nonprofit hospitals have had stable operating margins overall the past few years (4.4% in 2023 and 5.9% in 2024, according to MedPAC). But experts note high variability, with smaller and rural hospitals struggling to recover from the financial shocks of COVID-19 and high labor costs. This inequality sets up an environment ripe for mergers, with wealthier hospitals able to buy out poorer ones and increase market share, further improving their financial standing. With Medicaid work requirements and other H.R.1 policy changes on the horizon, we’re likely to see more nonprofit hospital acquisitions to come. 

The growth of nonprofit systems gives policymakers and patients an opportunity to improve accountability and community partnership. Since these hospitals benefit immensely from their nonprofit status through tax breaks and 340B payments, stakeholders can use this leverage to encourage affordability and community investment. 

Next time: Hospital consolidation by state