If there’s one trend that has had staying power in American health care, it’s been the rise of the system. Today, roughly two-thirds of American hospitals belong to a health system, up from 10% in 1970, and those systems have inevitably become larger and increasingly diversified providers of care—with some owning physician specialty groups, surgical centers, and home care services among other business.

In this spirit, the PINC AI Top 15 Health Systems study crunches the numbers on this increasingly dominant landscape to identify the nation’s best performers and provide a benchmark for others. In its 15th year, the study relies on Medicare data and considers clinical outcomes, operational efficiency, and patient experience at 361 U.S. health systems to determine standout organizations. The list honors five systems per size category—small, medium, and large—though due to a tie, this year includes six medium-sized systems.

The difference between these top organizations and their peers is not trivial. According to PINC AI’s analysis, if all health systems operated as this year’s winners, more than 207,000 patient lives would be saved and 432,000 patients would be spared in-hospital complications each year. Inpatient mortality was 20.8% lower for winning systems compared to their non-winning peers, and health care-acquired infections were 20.7% lower for the group. Hospital stays were also shorter at the Top 15 systems. (This year 16 made the list due to a tie.)

One of America’s oldest and most storied health systems, the Mayo Clinic, topped the large system category and made its 11th appearance on the ranking. Health systems do not apply for the 15 Top Health Systems selection process, and winners do not pay to market their honor.

5 Top Large Health Systems

1. Mayo Clinic

Location: Rochester, Minn.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 11
Website

2. HCA Continental Division

Location: Denver
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★
Patient experience: ★★★
Total number of years on 100 Top list: 3
Website

3. Intermountain Health

Location: Salt Lake City
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 1
Website

4. Houston Methodist

Location: Houston
Clinical outcomes: ★★★★★
Operation efficiency: ★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 1
Website

5. Baylor Scott & White Health

Location: Dallas
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 3
Website

6 Top Medium Health Systems*

1. HCA Mountain Division

Location: Cottonwood Heights, Utah
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★
Total number of years on 100 Top list: 2
Website

1. Scripps Health

Location: San Diego
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 7
Website

3. Bronson Healthcare

Location: Kalamazoo, Mich.
Clinical outcomes: ★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 1
Website

4. Edward-Elmhurst Health

Location: Naperville, Ill.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 5
Website

5. CHI Saint Joseph Health

Location: Lexington, Ky.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★
Patient experience: ★★
Total number of years on 100 Top list: 1
Website

5. Munson Healthcare

Location: Traverse City, Mich.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★
Total number of years on 100 Top list: 1
Website

*Two companies are tied for No. 1 and two companies are tied for No. 5 in this category.

5 Top Small Health Systems

1. CHI Memorial

Location: Chattanooga, Tenn.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★★★
Total number of years on 100 Top list: 2
Website

2. Franciscan Sisters of Christian Charity Sponsored Ministries

Location: Manitowoc, Wis.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★
Total number of years on 100 Top list: 2
Website

3. AdventHealth-Great Lakes Region

Location: Chicago
Clinical outcomes: ★★★★★
Operation efficiency: ★★★
Patient experience: ★★★★
Total number of years on 100 Top list: 1
Website

4. Saint Joseph Health System

Location: Mishawaka, Ind.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★★
Total number of years on 100 Top list: 4
Website

5. Excela Health

Location: Greensburg, Pa.
Clinical outcomes: ★★★★★
Operation efficiency: ★★★★★
Patient experience: ★★
Total number of years on 100 Top list: 1
Website

Fortune partnered with PINC AI on the 2023 ranking of the 100 Top Hospitals and the 15 Top Health Systems in the U.S. Learn more about the lists and see which community and teaching hospitals ranked high among their peers below.

PREMIER, PINC AI, 100 TOP HOSPITALS, 15 TOP HEALTH SYSTEMS, and 50 TOP CARDIOVASCULAR HOSPITALS are registered/unregistered trademarks of Premier Healthcare Alliance, L.P. in the United States.

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Original: Fortune | FORTUNE: Fortune/PINC AI Top 15 Health Systems 2023