Academic health systems in the U.S. are increasingly acquiring rural and community hospitals to address financial challenges and maintain care access. Strategic partnerships offer smaller organizations sustainability while benefiting academic systems’ goals. MyMichigan Health, for example, recently acquired three hospitals from Ascension. CEO Lydia Watson emphasizes cultural alignment and strategic growth over scale, considering factors like clinical quality, financial stability, community benefits, and leadership fit. UCSF Health similarly acquired two hospitals from Dignity Health for $100 million, with CEO Suresh Gunasekaran highlighting vision alignment, academic mission, and workforce commitment as crucial factors in partnerships. Both health systems focus on strategic acquisitions to enhance care quality and community services.