News & Events

Bridging Health Inequity — government hospitals enter the M&A market

An interesting trend has emerged in our health system M&A advisory work over the past several years. Across the country, hospitals sponsored by local governments are expressing renewed interest in business combination transactions. A principal aim of these partnerships is to bridge health inequity within their markets.

Economic inequality today can be seen directly impacting patient access to high-quality, affordable medical care. The breadth and availability of specialty services are closely tied to the strength of regional demographics.

Local governments that contain both affluent and poor communities are at crossroads. Officials are confronted with how best to configure care for all constituencies. Many are choosing to explore the merits of consolidation to form more integrated delivery networks across diverse populations to better serve communities in need.

Our team has advised public hospitals from Alaska to Florida to assess strategic options. This experience represents all public ownership forms: Authority, Borough, City, County, District, Parish, State, etc.

Two recent examples stand out: Monterey County in CA and Indian River Health District in FL. Monterey County contains Carmel and Pebble Beach, with a median home value of ~$3,900,000. It also includes communities like Salinas inland with a base

November 23rd, 2021|News & Events|

Post-Pandemic Provider Realignment 2.0: If the Past Year Taught Us Anything

Click image for pdf of article

By Jordan Shields, Partner, Juniper Advisory, and Brian Fuller, Principal, PYA

Calling 2020 a challenging year for the country as a whole and for providers in particular would be a vast understatement. Disruption reigned across global, national, and local industries.

The healthcare industry found itself at ground zero of the disruption. Extended elective service moratoria, patient reticence to seek treatment, capacity and equipment shortages, staff facing crushing demand and unprecedented risk, and a flood of federal relief funding are but a few of the major, previously unthinkable, products of the pandemic. As we look back, providers have much to be proud of in their resilience and response.

As the pandemic entered the summer of 2020, we authored an article for BoardRoom Press that offered predictions on COVID-19’s effects on provider consolidation.1 Now, nearing 12 months and a seeming lifetime of change later, we believe we are approaching the cusp of the post-pandemic era in U.S. healthcare. As such, it is an appropriate time to revisit those initial predictions, gauge their prescience, and reassess where the industry is and where it is likely going from here.

What Was Right, What Was Wrong, and

May 21st, 2021|News & Events|

Adventist Announces Behavioral Health Transaction with Acadia

Adventist Health signed a definitive agreement to sell their behavioral health hospital in Vallejo to Acadia Healthcare (NASDAQ: ACHC) to strengthen behavioral health services in Solano County and the northern California region. Juniper proudly advised Adventist on this transaction.

Health systems are continually exploring new ways to deliver better healthcare. When it comes to some service lines, particularly behavioral health and ancillary care, this increasingly entails bringing in a focused operator partner. Such a transaction can enhance access and care quality, and also lower financial risk while keeping the business closely integrated with other offerings.

Adventist Health Vallejo, is a 61-bed psychiatric hospital that offers inpatient and outpatient care. Its services include short-term psychiatric care for children, adolescents and adults as well as partial hospitalization services for adults who are experiencing psychiatric problems or a substance abuse disorder. Adventist’s regional tertiary hospital in St. Helena will continue to support the acute care needs of the Vallejo facility.

“Behavioral health and well-being are central to Adventist Health’s mission, and we are committed to taking actions that meet the needs of our communities,” said Steven Herber, MD, president of Adventist Health services in Vallejo and St. Helena, in a press release. “Acadia has the national

March 23rd, 2021|News & Events|

Hospital Partnerships, Mergers & Acquisitions—We Wrote the Book

A Healthcare Leader's Guide to Successful Mergers & AcquisitionsNavigating a hospital M&A process can be complex and daunting.

Juniper can help.

Our new book for hospital Boards and executives offers a start-to-finish look at what it takes to successfully complete a healthcare partnership.



The book includes articles from Juniper and leading partners in the field about partnership evaluations, transaction structures, legal considerations, communications and more.

For more than 30 years, the team at Juniper Advisory has had one singular focus: hospital partnerships. With our niche concentration and no competing service lines, we provide unparalleled guidance for hospitals seeking to assess their independence, find the right partner, or grow.

As more hospitals seek stability and growth through partnerships in a post-pandemic landscape, we hope you will find this book to be a valuable resource.

The book is available for purchase on Amazon. To download a free copy of the e-book, please fill out the form here.

February 17th, 2021|News & Events, News-Home|

Universities to Merge, Expand Health and Science Education

The University of the Sciences in Philadelphia, the nation’s oldest pharmacy and allied health school, has announced a non-binding Letter of Intent to merge with St. Joseph’s University, a neighboring liberal arts institution.

The proposed partnership is unique in the highly-fragmented higher education landscape where affiliations between universities are far less common than in other fields.  Juniper is proud to advise the University of the Sciences on this transaction.

“There’s not a playbook for this,” Dr. Paul Katz, President, University of the Sciences, told the Philadelphia Inquirer. “Hopefully, we and St. Joe’s are creating the playbook. One of the things that we’re very confident of is there will be others who consider similar pathways.”

Together, the University of the Sciences and St. Joseph’s University hope to expand and enhance their academic offerings as well as achieve the benefits of scale and financial sustainability necessary to support further growth.

“Those numbers in terms of the scale … are relevant,” said Mark C. Reed, President, St. Joseph’s University. “It gives us a lot of runway, a lot of potential.”

With high demand nationally for a skilled healthcare workforce, St. Joseph’s sees a partnership with the University of the Sciences

February 12th, 2021|News & Events, News-Home|

Neighboring Hospitals Combine to Enhance Service to Community

On January 1, 2020, Illinois Valley Community Hospital (IVCH) in Peru, IL joined St. Margaret’s Health in Spring Valley, IL, a member of SMP Health System. The hospitals, which are located just 4 miles from each other, have both served communities in the Illinois River Valley for more than 100 years. This combination represents a multi-year process by IVCH to evaluate its future and strategic options. Juniper proudly represented IVCH on this transaction.

The partnership between IVCH and St. Margaret’s can serve as a model for other rural standalone hospitals seeking economies of scale while preserving local autonomy and clinical services.

IVCH and St. Margaret’s share a vision for efficiently delivering high-quality healthcare in the region. Together they intend to create a sustainable regional health network that will be able to meet the needs of their communities long into the future.

A key priority for the IVCH Board of Directors and executive team was to expand access to care locally and provide services to patients close to home.

“We knew that survival in the future would

January 7th, 2021|News & Events, News-Home|

In the News: State AGs Ramp Up Hospital Transaction Reviews

Conditions placed on the merger that formed the Boston area’s second-largest health system—Beth Israel Lahey Health—are the latest in a series of strict state oversight actions that will shape large regional health system deals for years to come.

State attorneys general have placed stringent conditions on recent transactions that significantly consolidated healthcare services to try to level the competitive playing field. Pricing, access and quality guardrails imposed by state authorities, coupled with state legislation, are expected to ratchet up regulation of these regional tie-ups.

“As the healthcare industry matures and hospital companies continue to get larger and become more important components of their communities, the attention from attorneys general and state authorities has continued to increase,” said Jordan Shields, partner at Juniper Advisory. “These enforcement actions build on themselves.”

Read more. 

December 18th, 2020|News & Events, News-Home|

The Looming Deadline: Repayment of COVID-19 AAP Loans

CMS’ Accelerated and Advance Payment (AAP) Program has been a lifeline for healthcare providers during the COVID-19 pandemic which loaned hospitals and others $100B.  Repayment of these loans begins August 1, 2020 – compounding the financial stress for many hospitals still grappling with the pandemic response.

In Waller’s latest episode of their podcast PointByPoint, Jordan Shields, a Managing Director with Juniper Advisory, joins Denise Burke, a partner in Waller’s healthcare compliance and operations group who advises hospitals and other healthcare clients across the country, to discuss the legal, financial and strategic implications for hospitals that received AAP loans.

Listen or read the transcript here. 



Evaluating Opportunities for Government-Sponsored Hospitals

The COVID-19 pandemic is straining hospital and governmental resources. It is also serving as a catalyst for a major evolution of our nation’s healthcare delivery system, the likes of which we have never before seen. With this confluence of factors, local governments and the hospitals they support are presented with a unique chance to evaluate the sustainability of their relationship.

For some government health systems, this may mean exploring opportunities to grow their footprint, often by supporting less-resourced 501(c)3 hospitals within or adjacent to the municipality they serve. For others, it means assessing the long-term durability of their governmental status and, in some cases, considering a conversion to an independent, non-profit entity.

Understanding the impact of government sponsorship on the hospital’s ability to meet its objectives is critical.  Our latest article highlights several key issues hospital leaders and elected officials should take into consideration when evaluating governmental sponsorship and common advantages and drawbacks to each.

Read more.