BlackRock’s dedicated healthcare practice stands ready to meet the complex - and interconnected - investing challenges of hospital and healthcare systems. Our team works with healthcare CFOs, CIOs, Treasurers, 403b plan sponsors and pension managers to create customized solutions across asset classes.

How we serve healthcare and hospital systems

BlackRock takes a collaborative approach with each client, fully committed to helping solve their unique investing challenges:

• Cash and liquidity solutions
• Strategic investing of balance sheet assets
• Pension strategy and solutions
• Innovative retirement solutions
• Insurance investing expertise
• Proactive risk management
• DEI and sustainability expertise

Healthcare Peer Risk Study

Quick Convos – Healthcare Peer Risk Insights

Calvin: Hi Anne Marie – I have a question about Healthcare investing, could we catch up over coffee?

Anne Marie:  Absolutely  

Calvin: I hear you just launched your fiscal year 2021 peer risk study for healthcare balance sheets.  Can you give me a quick overview of what it is?  

Anne Marie:  Sure Calvin!  I actually have a recent presentation with me, let me pull it up

Our peer risk study aims to spark dialog around how hospital systems are investing - how they are allocated, how much risk and the types of risk they are taking, and how those choices may perform under stress scenarios and growth scenarios. 

We take an enterprise view, leveraging data from public financial statements of 50 US hospitals to provide an in-depth analysis for each system.  We can also customize the peer group and add systems on an ad-hoc basis too.

Calvin:  Cool.  So what asset allocation trends are you seeing in the latest study?  

Anne Marie:  Calvin, the most notable and understandable shifts have been changes in cash and short-term liquidity.

In fiscal year 2019, a 10% average enterprise allocation to cash was typical relative to balanced exposures across fixed income, equities, and alternatives.

In fiscal year 2020, cash levels swelled as hospitals built up defensive liquidity from CARES grants, Medicare Advances, and issued debt and opened lines of credit. 

In fiscal year 2021, cash and fixed income levels started to come back down as both operations and markets stabilized, and Medicare Advances began to be repaid.   We also see combined exposure to risk assets like equity and alternatives edging up as valuations rose in 2021.

However, 2022 is shaping up to be a significant challenge.  With expenses up 15-20% for many systems, it's been difficult for operating cash flows to keep pace.   We could see cash levels lower.  And with this year’s market sell off, we would expect lower public allocations but higher private allocations as those valuation changes lag.

Calvin:  Yeah, with this year’s historic market drawdown, I’d imagine how much risk and the type of risks you’re taking really mattered.  So what does the risk profile of a hospital systems look like?

Anne Marie:  The 50-60% allocations to equity and alternatives drives nearly all the risk for most hospital portfolios.  Fixed income – which is interest rate risk and spread risk - has been providing very little downside protection.  Some hospitals who diversify their fixed income exposure in both public and private credit benefit from spread risk diversification. 

On the flip side, alternatives can be a good source of diversification, especially hedge funds, private credit, and infrastructure, which are among the most risk efficient asset classes in our capital markets framework. 

When we compare system level expected risk vs. expected return, we do generally see those more diversified systems generating more return for the risk taken relative to peers.

Calvin:  So I understand investments are really important to the financial strength of hospitals.  So how do hospital system portfolios perform under stress?

Anne Marie:  That’s an important question Calvin.  

Anne Marie:  We see that in historical scenarios, like the Crash of 2008 or the Covid drawdowns in 2020, the instantaneous drawdown ranges from the mid-teens to the mid-twenties percentages. 

Unfortunately, that also sounds a lot like the current period.

So the risk appetite of a lot of systems is being tested right now when you look at the impact on key financial strength metrics, like Days Cash on Hand or Cash to Long Term Debt.  Debt covenants are a near term concern for some, and balance sheets may be tested by both prolonged market and operating pressure. 

Calvin: It sounds like a dialog about maximizing returns for a hospital’s preferred level of risk is really important right now.   
So thanks for this chat!  A lot of hospital systems have been asking about this topic, so let’s set up meetings to take them through a customized peer study!

Anne Marie:  That sounds great Calvin!


Clients provide data to BlackRock regarding their existing portfolios. The case study and screenshots in this material are for illustrative purposes only and are intended to describe BlackRock’s capabilities. Actual account outcomes may vary.


Opinions and estimates offered constitute our judgment and are subject to change without notice, as are statements of financial market trends, which are based on current market conditions. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, accounting, legal or tax advice. You should consult your tax or legal advisor regarding such matters.

This material may contain “forward-looking” information that is not purely historical in nature. Such information may include, among other things, projections, forecasts, estimates of yields or returns, and proposed or expected portfolio composition. No representation is made that the performance presented will be achieved by any asset allocation or investment, or that every assumption made in achieving, calculating or presenting either the forward-looking information or the historical performance information herein has been considered or stated in preparing this material. Any changes to assumptions that may have been made in preparing this material could have a material impact on the investment returns that are presented herein by way of example.

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The portfolio risks hospitals are taking to pursue growth that can outpace inflation has taken on more significance as mounting operating and economic pressures begins to weigh on some balance sheets.

Our peer risk study aims to spark dialogue around how hospital systems are investing - allocation choices, risk tolerance and how those decisions may perform under stress and growth scenarios.

We take an enterprise view, leveraging data from public financial statements of 50 U.S. hospitals to provide an in-depth analysis for each system.

Investing strategies for healthcare and hospital systems

With access to BlackRock’s extensive suite of investment strategies across asset classes, our dedicated healthcare team creates a tailored client experience built to address each client's unique objectives.

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Fixed income

Healthcare investors aiming for a reliable income stream and lower risk compared to other asset classes are integrating more diversified fixed income strategies within their portfolios.

With Rick Rieder as BlackRock’s Chief Investment Officer of Global Fixed Income, BlackRock helps healthcare and hospital systems navigate the entire fixed income spectrum - from active & index, public to private, fundamental & systematic - to help deliver better outcomes, convenience, value and transparency for our clients.

Cash and liquidity solutions

Healthcare systems require robust cash and liquidity solutions that address immediate operating expense and long-term financial commitments, such as capital expenditures and unexpected liquidity events. Balancing these needs with an eye for enhancing yields can offer a framework that fosters resilience, while carefully mitigating risk.

BlackRock offers custom investment strategies and vehicles such as money market accounts (MMAs), short duration strategies, ETFs and separately managed accounts (SMAs) to deliver on client’s individual liquidity needs.

Outsourced Chief Investment Officer (OCIO)

BlackRock’s OCIO team aligns the firm’s investment expertise, robust research platform and advanced technology to help healthcare clients achieve their investment goals.

The pandemic underscored the importance of healthcare and hospital systems to our communities, but at the same time significantly disrupted their operating models. Our continued partnership with healthcare providers allows us to understand their liquidity needs and manage costs.

BlackRock’s OCIO services for healthcare help providers across their varied asset pools:

  • Develop an investment playbook that includes liquidity needs and risk profiles
  • Improve investments returns during a time of rising operating and labor costs
  • Make strategic investments across public and alternative markets
Dedicated CIO model
Our CIOs are aligned with specific client segments, helping them solve specific challenges.
Broad investment toolkit
Investing in today’s markets requires a full toolkit of investment capabilities, from active, index, factor to alternative—all of which BlackRock can provide.
Daily monitoring
We help clients make timely investment decisions and use our Aladdin® technology to model risks in portfolios.
Cost-effective partnership
We serve as an extension of a client’s staff to help free up their time to focus on what’s important.

Diversified alternatives

As healthcare investors look to expand beyond traditional allocations in search of alpha generation, such as stable cash flows and uncorrelated income streams, alternative strategies are playing an increasingly critical role in their portfolios.

At BlackRock we believe that the need for an approach to alternative investing that is scalable, disciplined, integrated, technology-enabled and transparent has never been greater. BlackRock's alternatives platform is designed to deliver healthcare and hospital systems outperformance across a range of investment solutions such as private credit, private equity, infrastructure and hedge funds.


Healthcare and hospital systems seeking resilient long-term capital appreciation and/or a hedge against inflation often look for investment opportunities across BlackRock’s extensive equity platform.

Our fundamental and systematic equity strategies offer healthcare investors curated access to global markets as well as key investment insights. BlackRock’s equity investors and researchers combine company-specific research, innovative proprietary modeling and industry analysis to provide clients with insights that aim to deliver consistent, differentiated outperformance.

Our fundamental active equity investment strategies leverage BlackRock’s resources in efforts to meet client demands for higher alpha and outcome-oriented strategies.
BlackRock’s systematic investment platform combines cutting-edge technology, scientific research and human insight in the relentless pursuit of investment performance.
Index investing strategies, including ETFs and direct index customization, can help reduce portfolio volatility, create liquidity sleeves and reduce costs.

Index investing

For over 50 years, we have developed a wide array of index strategies across sectors, qualities and geographic regions to meet client needs. We partner with healthcare clients to deliver customized beta exposures and invest in technology, such as Aladdin, to continually enhance and improve our index replication process.

Employing index investing strategies in institutional portfolios can help achieve a variety of goals including reducing portfolio volatility, creating liquidity sleeves and reducing plan investment costs. Index exposure is available to institutional investors through separate accounts, pooled funds and exchange-traded funds (ETFs).

Managing liquidity
Whether used as a permanent liquidity sleeve or a temporary way to access markets, ETFs can bring liquidity and low trading costs.
Enhancing cash
Institutions can incrementally increase yield by stepping out of cash across a spectrum of short duration offerings and respective risk levels.
Adjusting tactical and strategic allocations
Immediate, low-cost strategic exposure to sectors where active management may be insufficient or unnecessary.

Our healthcare team

Anne Marie Schultz
Head of U.S. and Canada Healthcare, Americas Institutional Business
Anne Marie Schultz, Managing Director, is Head of the Healthcare practice within BlackRock's Americas Institutional Business. In this role, she manages relationships with many of BlackRock's healthcare clients and is responsible for providing industry insight, investment solutions and risk advisory for hospitals and health systems.
Joe Tavarez
Director, U.S. and Canada Healthcare
Joe Tavarez, Director, is a member of the Healthcare team within BlackRock's Americas Institutional Business. Joe is responsible for developing and maintaining relationships with hospitals and healthcare systems, while delivering industry insights, investment solutions and risk advisory.

Contact our dedicated healthcare team

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Commons questions

  • BlackRock is a fiduciary to healthcare clients. Our team offers institutionally-scaled investment services that range from single mandates to multi-asset solutions, tailored portfolio analytics leveraging Aladdin technology and market insights provided through research reports and investment forums. The Client Insight Unit (CIU) provides institutional investors with multi-asset portfolio construction expertise, focusing on solutions comprising both public and private markets.

  • Yes, the BlackRock Educational Academy was launched in 2013 with the objective of facilitating the training needs of BlackRock’s institutional clients. Learn more about the BlackRock Educational Academy.

  • We offer a variety of events – including calls, workshops, forums and conferences – that allow healthcare investors to engage in debate around topical issues and to make better informed investment decisions. Contact us to learn about events for healthcare and hospital systems.

  • BlackRock’s scale is its key competitive advantage - it allows access to a plethora of information and insights that enable unrivaled risk management. Our Aladdin® platform combines sophisticated risk analytics with comprehensive portfolio management, trading and operations tools to power informed decision-making and effective risk management.

  • We have an extensive, US$326B alternatives platform (as of December 2022) that seeks to deliver outperformance with true partnership. We offer healthcare and hospital systems clients access to high-quality opportunities across real estate, infrastructure, private equity, credit, hedge funds and multi-alternative solutions. Global reach across private and public markets powers our sourcing, and industry-leading technology delivers improved transparency on investments.

Contact our institutional team

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