Transaction momentum continued to build in 2023. Here are our thoughts on the five most interesting hospital and health system transactions from the past year.

Watch Kaufman Hall managing directors Dan Clarin and Sarah Wiley for insights from our latest State of the Healthcare Consumer Report. The team explores the current state of health system growth and performance measurement.

Some colleges are pursuing athletic program expansion to boost enrollment and tuition revenue. The key question is whether this strategy will boost the institution’s financial performance as well.

There was a general improvement in operating margins over the course of 2023, and it is possible that we have reached a point of stability. But with margins still well below pre-pandemic levels, will that level of stability provide sustainability?

The past year saw a material increase in downgrades over 2022 while the number of upgrades declined from the prior year. Here are five key takeaways from rating activity in 2023.

Financial distress emerged as a key factor in hospital and health system M&A in 2023, with 28% of announced transactions involving a financially distressed partner. This is almost double the percentage of transactions in which financial distress was cited as a factor in 2022.

The Health Insurance Exchange (HIX) or Marketplace segment can be considered the largest growth market in the payer sector after Medicare Advantage (MA). From a relative low of 11.4 million members in 2020, the HIX market grew to 16.4 million members in 2023.

Hospital performance in November signals continued stabilization and growth as operating margins improve. The median Kaufman Hall Calendar Year-To-Date Operating Margin Index reflecting actual margins was 2.0% in November.

The hospital leadership issues that really matter right now center around the ability of hospital executives to possess and demonstrate an authentic emotional IQ to lead a diverse workforce in difficult circumstances.

This past year in higher education has been fraught with challenges, both new and chronic. A focus on objective assessment, planning, and preparation will be vitally necessary to survive the ever-changing weather of higher education.

Artificial intelligence is developing rapidly and relentlessly pushing into business practice generally, and healthcare specifically. Healthcare leaders must learn how the endless potential applications of AI might affect their organizations in the very near future.

At the 2023 Kaufman Hall Healthcare Leadership Conference, a panel of investors shared their insights on current market conditions, disclosure considerations, the impact of credit ratings on investment decisions, and ESG and the political environment.