Ardent Health executives said Wednesday the for-profit health system’s recent ambulatory acquisitions are finding early success and that more growth for the company is anticipated through a combination of ambulatory surgery center openings, organic inpatient demand growth and new joint venture opportunities stemming from shifts in federal policy.

The system is a relative newcomer to the public markets, having debuted on the New York Stock Exchange last summer hoping to raise funds for “complementary” acquisitions and other strategic goals.

Some of that plan has already moved forward, with Ardent purchasing nine urgent care clinics in east Texas and Topeka, Kansas, in 2024 plus another 18 in New Mexico and Oklahoma right at the top of 2025.

“We’re seeing the pull-through of those patients—as we get those clinics that we bought on Epic [electronic health record platform] and we have visibility into the operating system, we can see those first six centers we bought in Texas last year are producing about 45% new patients that we hadn’t seen,” CEO Marty Bonick said Wednesday morning during a KeyBanc Capital Markets Healthcare Forum fireside chat.

“It goes to that consumer strategy of patient access, getting more people into the funnel and then having the connectivity. A lot of people that come into those urgent care centers, about 15% of them, within 30 days are needing follow-up services, they need a specialist appointment, they need a scan, they need a procedure done. So we’re seeing that pull-through come,” he said.

Ambulatory surgery centers are the next focus area for Ardent, Bonick continued, though these will probably be “more heavily tilted towards de novo” openings rather than acquisitions.

That’s not for lack of opportunity, “but given the training multiples of those centers, we think that we’re going to be able to build those more efficiently and then partner with our physicians to make sure that we can operate them,” he said.

Ardent currently operates 30 acute care hospitals and more than 280 sites of care across eight markets, in each of which the company has said it controls the most or second-most market share.

It reported $1.61 billion in total revenue, $183 million adjusted EBITDA and $114 million of net income attributable to the company during its most recently closed quarter and is targeting $6.2 billion to $6.45 billion total revenue and $575 million to $615 million adjusted EBITDA across 2025. As of Dec. 31, its balance sheet included more than $550 million cash and a lease-adjusted net leverage ratio of 2.9 times.

Though historically more of a “hospital-centric company,” Bonick said Ardent acknowledges that more care is being delivered outside of the hospital due to a combination of procedure advancements and other trends like value-based care. As such, the company has worked to make itself into a “comprehensive healthcare system,” expanding high-acuity inpatient services for its hospitals and introducing more ambulatory access points throughout the rest of its markets.

“The good news is we’ve got demand for that inpatient [care] to backfill those services that are moving out,” he said. “We’ll be building into other things that will help our value-based care strategies, like imaging centers, physical therapy, freestanding emergency rooms where we’ve got these growing markets, growing parts of the community that may not be ready for a new hospital yet but need that access point, need those emergency services.”

Of note, Ardent is unique from its public for-profit peers for its joint venture model, under which 18 of its hospitals are operated in partnership with major nonprofit systems or academic medical centers like UT Health East Texas, Hackensack Meridian Health medical centers or Ascension. These partners bring their strong brand names and access to clinical specialists while Ardent provides best practices around community hospital operations the nonprofits may lack, per Ardent’s IPO filing and statements from its executives.

Citing financial headwinds and likely detrimental policy shifts for nonprofit health systems, executives said they are “encouraged by the opportunity” to expand Ardent’s existing joint venture partnerships and potentially strike up some new deals this year.

“About 40% of hospitals are losing money , and with some of the impending potential changes in regulatory policy , that could exacerbate that situation for a lot of nonprofit hospitals,” Chief Financial Officer Alfred Lumsdaine said during the session. “We think we have a proven track record … working with academics and the needs that they may have. There’s already been some cuts to [National Institutes of Health] funding, they’re going to have to reprioritize where they spend their capital. We think we’re going to be a great opportunity for systems like that.”

Ardent has “a number of conversations with academics … whether it’s about a proposed transaction or just exploratory looking for opportunities as they arise,” Bonick said. The company has already passed on some opportunities that “didn’t meet our financial criteria,” with Lumsdaine pointing to an interest in keeping Ardent below a lease-adjusted net basis of three times its leverage.

“Now that’s not to say we wouldn’t go up,” Lumsdaine said. “I would view four times as sort of a ceiling for us, and we would need to see a path towards delivering on any transaction we do within the first … 18 to 24 months.

“I would think the sweet spot from a deal size perspective would be, top-line, call it half a billion to a billion and a half," he continued, while noting an interest in markets with growing populations and economic engines, he said.

The CEO added that Ardent would prefer joint venture deals with multihospital systems with footprints that still have room for outpatient expansion. That said, “if the opportunity was there and mutually made sense, we will look for outright acquisitions as well,” Bonick said.