Ascension is a leading, nonprofit Catholic health system operating across 19 states and the District of Columbia. The organization, formed through the 1999 merger of the Daughters of Charity National Health System and Sisters of St. Joseph Health System, currently operates 90 hospitals and 30 senior living facilities. Beyond direct patient care, Ascension engages in diverse financial activities, including investment management, venture capital, and insurance holdings. Recent events have highlighted both the system’s operational shifts and vulnerabilities, notably a significant cybersecurity incident in May 2024.
Historical Development and Restructuring
Ascension underwent a significant restructuring and rebranding in 2012, dropping the “Health” moniker and unifying its subsidiaries under a national umbrella. This rebranding included renaming all hospitals to incorporate the “Ascension” name, intended to improve client recognition of the system. In 2018, the organization announced a strategic shift away from a hospital-centric model towards prioritizing outpatient care and telemedicine, responding to decreased government reimbursements, reduced profit margins, and rising care costs. The system’s history also includes instances of hospital closures, such as the attempted closure of the Providence Health System hospital in Washington D.C. in 2018, which prompted legal action from the District of Columbia’s Attorney General. The suit was ultimately withdrawn after reviewing the hospital’s closure plans.
Financial Operations and Investments
Ascension’s financial structure extends beyond traditional healthcare operations. The organization operates Ascension Investment Management, Ascension Care Management, an insurance holdings company, and Ascension Technologies, a healthcare information technology services company. A notable aspect of its financial activities is the operation of Ascension Ventures, a for-profit venture capital subsidiary that invests in medical startups. In 2021, reports surfaced regarding a multi-billion-dollar private equity fund operated by Ascension in partnership with TowerBrook Capital Partners. This fund, established in 2015, drew scrutiny due to its similarity to Wall Street-style investment operations, despite the organization’s stated mission of serving the poor. Concerns were raised regarding the alignment of these investment returns with Ascension’s charitable mission.
Further controversy arose from shareholder lawsuits in 2021 and 2023 involving the medical revenue cycle management company R1 RCM, alleging improper financial dealings between Ascension and TowerBrook. These lawsuits resulted in a $45.4 million settlement, with Ascension and TowerBrook bearing the majority of the cost. Wisconsin Senator Tammy Baldwin issued a statement questioning whether Ascension’s for-profit investment activities aligned with its tax-exempt status and charitable obligations. A professor of accounting and health policy at Johns Hopkins University described the fund’s operation as “aggressive and controversial.”
Operational Changes and Joint Ventures
In 2021, Ascension opened a national pharmacy hub in Austin, Texas, capable of filling 5,000 prescriptions per shift. This hub also includes a “patient engagement center” designed to assist patients with medication management, with the goal of reducing hospitalizations. Later that year, in October 2021, Ascension and AdventHealth announced the planned dissolution of their joint venture, AMITA Health, in 2022, with each system retaining the hospitals they originally contributed to the partnership.
Recent Cybersecurity Incident
On May 8, 2024, Ascension experienced a significant cyberattack that disrupted access to patient records. The organization engaged Mandiant to investigate the incident, which was attributed to the Russian ransomware operator Black Basta (also known as "Conti"). The attack resulted in over a month of inaccessibility to patient medical records, leading to delayed appointments and potential risks to patient health. Class-action lawsuits were filed against Ascension, alleging that the attack was “foreseeable and preventable.” Patient medical records were restored by June 11, 2024. Reports indicate the attack originated from a worker mistakenly downloading a malicious file, and the extent of data compromised remains unclear.
Hospital Recognition and Services
As of 2025, Ascension operates 90 hospitals. Several of these hospitals have received recognition for their quality of care, including cardiovascular care by Fortune magazine and maternity care by Newsweek. Specifically mentioned are Ascension St. Vincent in Indianapolis and Ascension Sacred Heart Hospital in Pensacola. In addition to hospitals, Ascension operates a pharmacy and drug delivery system called AscensionRx.
Organizational Structure and Sponsorship
The organizational structure of Ascension has evolved over time. In 2010, the Catholic congregations that previously sponsored Ascension transitioned to a sponsoring group comprised of both religious and lay persons, the identities of whom Ascension has chosen not to disclose. The system currently has approximately 95 wholly owned or consolidated hospitals and 30 senior living facilities. Ascension emphasizes collaboration across its network of hospitals, medical practices, and healthcare innovators, sharing best practices and knowledge across its operating states.
Conclusion
Ascension is a large and complex healthcare system undergoing continuous evolution. While committed to its nonprofit mission of serving vulnerable populations, the organization engages in substantial for-profit investment activities that have drawn scrutiny. Recent events, including a major cybersecurity incident, underscore the challenges facing large healthcare systems in maintaining both operational efficiency and data security. The system’s ongoing restructuring and strategic shifts reflect the broader changes occurring within the healthcare industry.