Advancing Healthcare Missions with Disciplined Spending

The new tax bill passed by Congress and signed into law in early July will have a financial impact on all healthcare systems and may require funds to be pulled from systems’ long-term investment pools (LTIPs). The recent federal Medicaid funding cuts will create financial challenges for healthcare systems, particularly those with high Medicaid exposure. […]

August 2025

How Much Return Do We Need? Aligning the Investment Strategy with the Mission for Healthcare Systems

Over the last few decades, many not-for-profit healthcare systems have enjoyed strong margins driven by favorable demographic trends, inexpensive debt, and improved cost structures through mergers & acquisitions. As a result, many of those systems have been able to amass significant investable reserves. However, in many cases the purpose of the investment portfolio is often […]

March 2025

Inverted World: The Attractiveness of Short-Term Tiers for Healthcare Systems

A healthcare system’s investment structure is intentionally aligned to match varying enterprise needs over the short, intermediate, and long term. Most have gravitated toward the use of tiers—pools of capital delineated as available immediately (operating cash), within the next few years (short-duration bonds), or strategically over time (long-term investment pools). However, the need for capital […]

March 2023

Healthcare System Investments: Play Defense Before Offense

The COVID-19 pandemic financially shocked healthcare system enterprises and investment portfolios, but those shocks were short lived and the recovery was swift. In fact, by the time 2021 ended, many hospitals were in a stronger financial position after the positive impact of stimulus funding, stabilizing operational results, and substantial investment gains. But challenges still exist. […]

July 2022

An Investment Perspective on Healthcare System Mergers

During the past decade, nonprofit healthcare providers have undergone a wave of accelerating consolidation. When systems combine, the new entity created will have new financial health metrics. A fresh review of how a transaction will impact the newly combined long-term investment pool (LTIP) is crucial. This paper examines key variables to assess and specific examples of how a LTIP might restructure post-merger.

April 2021

Healthcare Systems: Recalibrating for 2021 and Beyond

Healthcare systems appear to have navigated the most severe financial impact of the pandemic. We believe the present time provides an opportunity to reset investment strategy and recalibrate portfolios as necessary.

January 2021

Reshaping Industry Audio Series: Hospital Liquidity

In this segment, Jeff speaks about the importance of liquidity for healthcare systems in the wake of the COVID-19 pandemic and how he guided clients during the market downturn in March and April. He goes on to discuss the present state of the industry and what he believes will be the long-term implications of the crisis.

September 2020

Hospitals Seek Liquidity to Get Through Crisis

Before COVID-19 most hospitals generated liquidity from their operating model. In our May 2020 survey of 27 hospital systems, we learned that COVID-19 has driven hospitals to search for liquidity from multiple sources, including, for some, the investment portfolio.

June 2020