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. 

Dealmaking in the Sunlight: Navigating Public Hospital M&A

Public hospitals have a uniquely open relationship to the communities they serve, which invites a level of transparency as they consider potential mergers and acquisitions. So what kind of M&A deal activity options are out there for public hospitals dealing with financial pressures, and how can parties navigate regulatory, financial and public opinion to get the deal done?

In this two-part Collaborative Transformation podcast series, Rex Burgdorfer, Partner, Juniper Advisory joins Megan Rooney, Partner, McDermott Will & Emery, to discuss important considerations related to government-sponsored hospital partnerships.



Part I 

  • The major trends driving public hospital M&A
  • How M&A can strengthen hospitals financially and the regulatory and external challenges contributing to financial pressures
  • Unique regulatory and financial challenges faced by public hospitals
  • Benefits of privatization in the hospital industry
  • The role public sentiment can play in public hospital transactions

Click here to listen to the podcast. 

Part II 

  • Key issues that hospital boards, senior leaders and partners must address to secure transaction approval
  • Strategies for identifying and educating stakeholders about the proposed transaction, including competitive benefits and tax and political implications
  • Choosing a deal structure that will work for all

Assessing Hospital Preparedness for COVID-19 by Affiliation Status


System hospitals tend to have more ICU beds, higher case mix indices and are more likely to be a part of physician integration networks compared to like-sized standalone hospitals. These attributes are particularly important findings during the COVID-19 pandemic, where ICU beds are at a premium; experience managing complex cases is essential; and the ability to care for patients in appropriate settings is of utmost importance.

We reached these conclusions by analyzing CMS Medicare Cost Report data, the most comprehensive set of financial and clinical data available for comparisons of U.S. hospitals. We used this data set to create regression models which can be found here. These regressions allow us to assess the impact of independence on ICU beds, CMI and ACO/CIN membership. We performed this analysis on a subset of all hospitals, namely those with 80 or fewer ICU beds. Intuitively, facilities with more than 80 ICU beds tend to be ‘hub’ facilities and there are almost no independent hospitals with greater than 80 ICU beds. Further, by excluding these ‘hub’ facilities, we review a data set where both system and standalone hospitals are well distributed and lower the

Provider Realignment Post-Pandemic

The COVID-19 crisis exposed the high cost of fragmentation within the healthcare industry and will serve as the seminal event that ushers in an era of greater provider integration and concentration. COVID-19 will accelerate U.S. healthcare’s transformation toward a future characterized by the blurring of traditional lines between care delivery and financing. There will be no going back to the industry as it existed, only a going through to a stronger, more hardened, and, in some cases and in some geographies, a materially scaled healthcare system.

Three phases are anticipated as the industry moves forward:

  • A turbulent restart through the remainder of 2020, marked by initially sluggish M&A activity as at-risk providers seek the shelter of cautious buyers.
  • A shake-out will follow over the next couple of years, characterized by strong regional systems, insurers, and private equity-backed disruptors seizing the opportunity to drive performance and efficiency through scale.
  • In a final phase, rise of the titans, national mega-systems will emerge, dwarfing today’s largest systems. These behemoths will compete directly with scaled, non-traditional, ambulatory-centric networks (e.g., integrated insurance companies) a marketplace that no longer adheres to traditional delivery vs. financing distinctions. These organizations will

COVID-19 Impact on Healthcare M&A

The COVID-19 pandemic has upended our nation and our healthcare delivery system. The extreme pressure being put on hospitals during this crisis will permanently change the way healthcare is sought and provided. In addition to the sweeping changes we can expect in clinical standards and care delivery models, we will also see changes in how hospitals approach partnerships. Following are seven observations on the impact the pandemic will have on the healthcare merger and acquisition market:

  • We are entering a buyers’ market. Hospitals and health systems are experiencing financial strain during the pandemic. The loss of revenue from non-urgent procedures along with the increase in supply and workforce costs is dramatic. The burden is being felt most acutely by hospitals that were near or in financial distress pre-pandemic. Stressed hospitals are already seeking infusions of cash and other support to keep their doors open. In the aggregate, there will be more sellers than buyers in the market post-pandemic. As a result, sellers will need to be more flexible as the composition of transaction consideration will change. Hospitals that seek relationships with academic medical centers should also be aware of the anticipated