A majority of the nation's largest health systems and payers have filed their fourth quarter earnings reports. Becker's has compiled their year-end net profits and losses to examine where the healthcare financial landscape stands among the largest players as of Dec. 31, 2022.
It's a tale of two cities as for-profit health systems continued to report profits last year while nonprofit systems revealed heavy losses. While the six systems highlighted are among the largest systems in the country, all showed a decline in income from 2021 comparables.
Whether a for-profit entity or a nonprofit, no system was exempt from the sustained inflationary pressures causing higher staffing expenses and supply costs. For nonprofit systems specifically, there was a significant decline overall in their investment performance for much of 2022.
Notably, there were signs of improvement for some of the systems in the final quarter of 2022 as investments recovered and as contract labor expenses began to dip.
1. HCA Healthcare: $5.64 billion profit
The nation's largest for-profit hospital system reported net income of $5.64 billion in 2022, along with $60.23 billion in revenue, down nearly 19 percent compared to 2021. The system had $2.08 billion net income in the fourth quarter, up from $1.81 billion over the same period last year.
2. Tenet Healthcare: $410 million profit
The Dallas-based for-profit health system reported $410 million in 2022 net income. Net income in the fourth quarter totaled $102 million. Those figures compare with $250 million and $915 million net income in 2021 for the quarter and full year, respectively.
3. Community Health Systems: $179 million profit
Franklin, Tenn.-based Community Health Systems, a for-profit health system, reported $179 million net income in 2022, a 51.4 percent drop from the $368 million net income reported the year prior. Net income in the final three months of the year totaled $446 million, compared with $223 million in the same period in 2021.
4. Trinity Health: operating loss of $298 million
Note: operating loss only reflects second half of 2022
Livonia, Mich.-based Trinity, one of the largest nonprofit health systems in the country, reported an operating loss of approximately $298 million for the six months ending Dec. 31.
5. CommonSpirit Health: net loss of $213 million
Note: net loss only reflects second half of 2022
The Chicago-based health system reported a $213 million loss for the six-month period ending Dec. 3, and an operating loss of $451 million compared with a loss of $47 million year over year. Overall income for the 2022 period included a gain of $200 million in the final quarter as investment returns improved.
6. AdventHealth: net loss of $837.9 million
AdventHealth recorded a $837.9 million net loss in 2022 on revenues of over $15 billion as investments slumped. The 49-hospital system reported a decline of nearly $1.2 billion in its investment return in 2022 compared with a $524.9 million gain the prior year. However, there were signs of improvement in the fourth quarter as AdventHealth reported an operating gain of $269.3 million and an overall profit of $489.4 million.
7. Kaiser Permanente: net loss of $4.5 billion
Oakland, Calif.-based Kaiser Permanente reported a net loss of $4.5 billion in 2022, significantly down from a net income of $8.1 billion in 2021. For the 12 months ended Dec. 31, Kaiser — an integrated payer-provider with 39 hospitals — recorded an operating revenue of $95.4 billion, up 2.4 percent from $93.1 billion in 2021, but also experienced higher expenses which rose 4.5 percent from $92.5 billion to $96.7 billion in 2022.
While no large insurer posted losses for the full year, certain markets have become increasingly challenging to operate in. Perhaps most notably, Humana said Feb. 23 it is exiting the commercial group business over the next 18 to 24 months as it places more focus on its government-funded and specialty plans, along with its healthcare delivery business.
Most of the largest insurers are diversified healthcare service and delivery businesses, meaning profits are partly derived from other areas of business beyond health benefits.
1. UnitedHealth Group: $20.6 billion profit
Total net earnings in 2022 were $20.6 billion, up 16.4 percent year over year. In the fourth quarter, net earnings attributable to shareholders were $4.76 billion. UnitedHealthcare's total earnings from operations in 2022 were $14.4 billion, up 20 percent year over year.
2. Cigna: $6.7 billion profit
Total net income in 2022 was nearly $6.7 billion, up 24 percent year over year. In the fourth quarter, net earnings were $1.2 billion.
3. Elevance Health: $6 billion profit
Total net income in 2022 was over $6 billion, down 1.3 percent from 2021. In the fourth quarter, net income was $949 million, down 16.5 percent from the same period last year.
4. CVS Health (Aetna): $4.2 billion profit
Total net income in 2022 was $4.2 billion, down from $7.9 billion in 2021. Fourth quarter net income was $2.3 billion, up from $1.3 billion over the same period last year. The health benefits segment reported nearly $6 billion in adjusted operating income for 2022.
5. Humana: $2.8 billion profit
Total net earnings in 2022 were $2.8 billion, down 4.3 percent year over year. In the fourth quarter, the company posted a net loss of $15 million.
6. Centene: $1.2 billion profit
Total net earnings in 2022 were $1.2 billion, down 10.8 percent year over year. In the fourth quarter, the company posted a net loss of $213 million, down from a net income of $599 million year over year.