--- title: Legacy Health · Strategic Market Overview · BPD --- BPD Healthcare: A STRATEGIC GROWTH PARTNER Legacy Health · Market Overview · May 2026 Legacy Health *·* Market Overview - [Snapshot](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#snapshot) - [Claims](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#claims) - [Map](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#patient-map) - [Service Lines](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#service-lines) - [Trends](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#trends) - [Competitors](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#competitors) - [Advantage](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#differentiators) - [Headwinds](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#headwinds) # Legacy Health: *Market Overview* Executive summary ## Legacy Health holds a *strong market position*, but is facing market and competitive pressure. Legacy Health is the largest system in the Portland-Vancouver-Hillsboro by claims, with **26.11%** of the 724,102-procedure market captured[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). Legacy Health is the leader, ahead of OHSU Partners, Kaiser Permanente, and PeaceHealth. That share advantage sits alongside financial pressure: an estimated CY2025 net loss of **$71M**, a Moody's downgrade to A2/negative, and a need to focus capital against the places where Legacy's scale is defensible[B](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). Legacy Health should sharpen its role as the region's premier **community-rooted, multi-site, high-acuity area system**: locally trusted, clinically differentiated in trauma, pediatrics, and focused specialties. Claims Market Share 26.11% 2025 system parent share Market Size 724.1K 2025 procedure claims Operating Revenue $2.6B FY total operating Net Loss −$71M CY2025 estimated Days Cash 182 on hand Direct Debt ~$700M Moody's, Aug 2025 Moody's Rating A2 Negative outlook Clinics 70+ OR & WA ambulatory **Sources** Legacy Health Strategic Overview[A](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) · Moody's Investors Service (Aug 27, 2025)[B](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) · BPD Volume Procedure Claims, Legacy Health 2025 Claims Market Share[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) · The Bond Buyer (Aug 29, 2025)[B](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). BPD Proprietary Claims · Portland Area 2025[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) ## Legacy Health has a *strong market share* at the system level but is distributed across sites. Market Size · 2025 724.1K ### Total procedure claims in the updated market-share view System Parent Share · 2025 26.11% ### Legacy Health is the largest health system parent by procedure claims, ahead of OHSU Partners, Kaiser, and PeaceHealth Patient Origin · 2025 1.27M ### Unique patients in Legacy Health's footprint (OR & WA) ### Portland metro · system parent share % of 724,102 procedure claims[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) Legacy Health 26.11% OHSU Partners 14.53% Kaiser Permanente 14.41% PeaceHealth 13.42% Providence St. Joseph Health 5.78% LifePoint Health 5.30% Adventist Health 4.76% Shriners Hospitals for Children 3.84% Unknown / NA 3.13% Universal Health Services 2.56% ### Location-level share leaders top locations by share of 724,102 procedures[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) PeaceHealth Southwest Medical Center 13.19% Kaiser Sunnyside Medical Center 9.88% OHSU Hospital · Marquam Hill 9.11% Legacy Emanuel Medical Center 6.46% Legacy Salmon Creek Medical Center 5.81% Legacy Good Samaritan Medical Center 5.76% Kaiser Permanente Westside Medical Center 4.49% Legacy Meridian Park Medical Center 4.22% **Strategic takeaway:**Legacy Health system lead is distributed across multiple campuses rather than concentrated in a single site. PeaceHealth Southwest and Kaiser Sunnyside remain the largest individual location-share competitors. ### Patient Count by Hospital 1.27M unique patients · 1.99M claims[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) Salmon Creek 329.6K Emanuel 257.5K Good Samaritan 233.9K Meridian Park 206.5K Mount Hood 129.0K Health Physicians 57.1K Silverton 55.1K **Strategic takeaway:** Salmon Creek is Legacy Health's largest patient-origin facility, bigger than Emanuel. The Clark County / PeaceHealth battle is more material than inner-Portland narrative implies. ### Top service lines · patient count where Legacy Health's 1.99M claims concentrate[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) Office visit, established 330K Emergency room visit 239.7K Anesthesia 98.9K Chemistry & hematology 75.0K Addiction services 46.2K Office visit, new 42.2K Behavioral evaluation 23.6K **The story** E&M + ED  dominate. The conversion question is downstream specialty retention, keeping these patients in-system instead of leaking to Providence and OHSU. PATIENT Origin · Geographic View · 2025[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) ## Legacy Health owns *cross-state* behavior patterns. Total Patients 1.27M Across 476 ZIP codes (468 mapped) · 2025 BPD origin data Oregon 212 ZIPs Metro core + Willamette Valley Washington 264 ZIPs Clark County + SW WA + outliers Top 10 ZIPs 50.8% of total patient volume #### Top 10 ZIPs by Volume #### Patient Volume Scale 1 100 1K 10K 100K+ Map Reference Legacy Health hospital ZIP polygon (hoverable) **Read:** The two largest concentrations, 98664 (Vancouver, WA) and 97210 (NW Portland), map directly to Salmon Creek and Good Samaritan, respectively. The strong Vancouver/SW Washington presence confirms Salmon Creek's strategic weight: a meaningful share of Legacy Health's demand sits inside PeaceHealth Southwest's home territory. Clinical Service Lines: 2026 Patients [H](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) ## Legacy Health's growth opportunity is *high-acuity, repeat-care patients.* A view of Legacy Health's 2026 patient base by clinical service line, patient counts indicate where the system's clinical footprint is the largest, and claims-per-patient indicate which areas involve the most ongoing care episodes per patient. These are the service lines where strategic opportunity matters. Service Line Unique Patients (volume bar) Patients Claims / Patient Respiratory / Pulmonology 2,361 10.6 Cardiovascular 3,152 9.89 General Medicine / Symptoms 5,739 8.48 Trauma / Emergency 3,768 8.40 Urology / Nephrology 3,349 8.08 Obstetrics / Maternity 1,770 7.87 Oncology 2,010 7.82 Gastroenterology 3,987 6.82 Orthopedics / Musculoskeletal 3,791 6.51 Other 7,420 5.54 What this means Cardiovascular and Respiratory care show the highest claims-per-patient ratios in Legacy Health's 2026 patient panel[H](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references), consistent with the system's role as a tertiary destination. Trauma/Emergency at 3,768 patients with 8.4 claims each validates Emanuel's Level I trauma capabilities. Oncology and Obstetrics deserve strategic focus, given high repeat-encounter rates at relatively modest patient counts. ### Patient demographics Legacy Health 2026 patient panel · 34,708 unique patients[H](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) Age Distribution 65+ 40.6% 14,102 35–49 16.6% 5,753 50–64 16.5% 5,712 18–34 14.8% 5,142 0–17 11.5% 3,999 Gender Female 58.6% Male 41.4% **Read:**At 40.6%, Legacy's share of patients 65+ runs more than double the metro average of 17.4%[F](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). The system is Medicare-skewed by structure, not by accident, and the strategy has to start there. ### Payer mix Legacy Health 2026 patient panel · % of unique patients[H](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references) 37,766 claims-payer total Commercial 30.4% Other (incl. Medicaid) 27.3% Medicare 23.3% Unknown / Unspecified 19.0% Section 1 · Competitor Positioning ## Four established competitors. Four diverse risks. OHSU Partners (14.53%), Kaiser Permanente (14.41%), and PeaceHealth (13.42%) are the closest scaled competitors; Providence St. Joseph Health is lower in this view at 5.78%[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). Legacy Health has the largest market share, but each competitor attacks a different part of the portfolio. Inpatient Incumbent ### Providence 5.78% system share Providence St. Joseph Health ranks influence remains strategically important because it is Oregon's largest hospital operator and a familiar premium inpatient brand, but the claims-share baseline no longer supports treating Providence as Legacy Health's closest all-payer procedure rival. **What it means** Counter-position on access, continuity, and employer-friendly network design rather than assuming Providence has superior metro procedure scale. Academic Destination ### OHSU 14.53% system share OHSU is Oregon's only academic health center remains the strongest specialty and complex-care referral competitor, even after the OHSU-Legacy Health transaction was cancelled. **What it means** Competition for complex oncology, specialist recruitment, research-adjacent reputation, and tertiary referrals remains the main OHSU threat. Closed-Network Payer-Provider ### Kaiser NW 14.41% system share Kaiser Permanente is effectively tied with OHSU Partners remains the strongest payer-provider model in the market. Its threat is not broad leakage; it is employer capture, closed-network retention, and digital access expectations. **What it means** Legacy Health needs a credible access and convenience story for employers and commercially insured patients that does not require becoming Kaiser. Cross-River Anchor ### PeaceHealth 13.42% system share At the location level, PeaceHealth Southwest Medical Center is the largest single facility in the market at 13.19% share and 95,489 procedures[C](https://insights.bpdhealthcare.com/legacy-health-market-assessment-opportunities#references). That puts the Clark County / Salmon Creek corridor back at the center of the strategic focus. **What it means** This remains the competitive area that matters most geographically: Legacy Health's Salmon Creek position has to defend against the market's largest individual facility-share anchor. Section 3 · Key Differentiators ## Legacy Health's Structural *Advantage.* Six structural advantages most Portland health systems can't replicate. What's missing isn't the capability. It's the story Legacy Health tells. 01 ### Trauma & Burn at Emanuel One of two Level I trauma centers in Oregon. The only burn center between Seattle and Sacramento. A regional referral engine and recruitment magnet. 02 ### Randall Children's Hospital Full-service pediatric capability co-located on the Emanuel campus, an adult/pediatric/acuity cluster Providence cannot match geographically. 03 ### Unity Center for Behavioral Health 4-system collaboration with Adventist, Kaiser, OHSU. 85 adult + 22 adolescent beds; Bridge Clinics serving 360+ patients. Platform for crisis stabilization. 04 ### Legacy Health Partners (CIN) 2,100+ providers. A decade of clinical integration: 29% ED utilization decline per 1,000 since 2015, 7.2% increase in cervical screening, doubled childhood immunizations. 05 ### Legacy Research Institute Inpatient and outpatient clinical trial infrastructure. Leading to better clinical practices and better health for the community and provides Legacy Health a credible base for industry-sponsored research. 06 ### PacificSource 50% Ownership Unique payer-provider arrangement for an Oregon-owned system. PacificSource is a meaningful Medicare/Medicaid insurer across OR, WA, ID, MT. Optionality to deepen integration or monetize a stake. Section 4 · Market Headwinds ## The pressure is real. 01 Financial ### The margin problem is not cyclical Operating losses narrowed from $172M (FY23) to a projected $38M (FY25), with an estimated CY2025 net loss of $71M. Operating expense growth was 47% from 2021–2025. Hospital Association of Oregon: nearly half of Oregon hospitals lost money in 2024. −$71M est. CY25 net loss · A2 negative outlook 02 Workforce ### Wage benchmarks reset by competitor strikes HB 2697 enforcement carries civil penalties and 2,400+ complaints. Providence experienced Oregon's largest healthcare strike in 2025; Kaiser faced a multi-state strike. Every dispute resets system-wide wage expectations. 2,400+ HB 2697 complaints filed 03 Capital & Commercial Leverage ### Competitors invest through the cycle OHSU merger terminated May 2025. Providence expanded ED capacity, OHSU is opening Vista Pavilion, and Kaiser is building Oregon's first fully-electric hospital. The April 2026 Regence contract dispute (a 28% rate-hike ask against Regence's counter) showed how thin Legacy Health's commercial leverage really is. The contract was restored in May 2026, but the underlying dynamic is still structurally adverse. ~$700M direct debt · Regence renegotiated May 2026 04 Regulatory & Payer ### Cost caps + Medicaid pressure are structural Oregon cost growth target (3.4% → 3.75%) constrains pricing. HR1/OBBBA's ~$1T Medicaid cuts plus 6-month redeterminations put ~100K Oregonians at coverage risk. Government payers cover ~66% of Legacy Health's patient volume. ~66% government payer mix · OBBBA in force ## References & Sources Citations for every data point in this briefing, grouped by source type. ### A · Legacy Health Official - Legacy Health Strategic Landscape Briefing (May 2026, 23-page deck prepared for Dr. Susan Huang): canonical internal source for financials, headwinds, signature differentiators, and competitor positioning. - Legacy Health News Releases *(legacyhealth.org)*: Susan Huang CEO announcement (Mar 31, 2026); Beacon Gold Award (Feb 24, 2026); STAND Grant (Jan 30, 2026); Unity expansion (May 2026); S&P 'A' affirmation (April 2025); service changes (Oct 2025). - Legacy Health Partners Newsletters: Jan/Jul/Aug/Oct/Dec 2025; Jan 2026. - Legacy Health Financial Summary & OHA Hospital and Health System Finance Snapshot *(oregon.gov/oha)*. - Legacy Health system overview pages: services, hospitals, institutes, telehealth, behavioral health, eye care. ### B · Bond Agencies & Financial Press - Moody's Investors Service: Legacy Health A2 downgrade with negative outlook (Aug 27, 2025). - S&P Global Ratings: Legacy Health A rating, stable outlook (April 2025). - The Bond Buyer: Oregon healthcare downgrade coverage (Aug 29, 2025). - Fierce Healthcare: OHSU/Legacy merger termination (May 6, 2025). - HealthLeaders Media: Operations tightening coverage (Oct 24, 2025). - Becker's Hospital Review: FYQ1 financials, CEO appointment, service-line closures coverage (2024–2026). ### C · BPD Proprietary Claims · 2025 - *Legacy Health 2025 Claims Market Share.PNG*: BPD Volume Procedure Claims dashboard, MAT v0.1, Portland-Vancouver-Hillsboro CBSA; 724,102 procedure claims; system-parent, network/division, and location-level market-share metrics. - BPD Consumer Origin Volume Procedure · Legacy Health · 1.99M claims · 1.27M unique patients · OR & WA. - BPD Consumer Origin · ZIP-level patient counts · Legacy Health 2025 (476 ZIPs · 1.27M patients): geographic basis for the interactive choropleth heat map. - BPD MAT v0.1: service-line classification, payer mix, age cohort, ZIP-level patient origin analytics. - OpenStreetMap contributors: interactive map base tile layer *(openstreetmap.org)*. - ZIP polygon boundaries: *OpenDataDE State-zip-code-GeoJSON* (2010 U.S. Census ZCTA5 boundaries), full-resolution polygons filtered to 468 Legacy Health patient ZIPs. Conceptually equivalent to the *opendatasoft "georef-united-states-of-america-zcta5"* dataset. ### D · Local Journalism · OR & WA - The Lund Report: financial downgrade, CEO search, new CEO selection, nurse staffing law, GoHealth closures (2025–2026). - OPB / Oregon Public Broadcasting: OHSU/Legacy merger called off (May 2025). - Willamette Week: OHSU calls off Legacy purchase (May 5, 2025). - KOIN / KGW / KATU: Regence contract termination & restoration; service-line closures (Oct 2025–May 2026). - The Columbian: Regence/Legacy contract termination (April 2, 2026). - Salem Reporter, Hoodline, Axios Portland: Providence Health Plans sale; Hoodline citing The Oregonian on CY25 operating loss (April 3, 2026); CEO selection (2026). ### E · Industry Research & Federal Policy - Definitive Healthcare: Largest IDNs in Oregon; Top Hospitals by Net Patient Revenue. - Kaufman Hall: National Hospital Flash Report. - Vizient: Strategy Spotlight on ambulatory-focused strategy (Nov 2025). - Advisory Board: Ambulatory Strategy 2025; Chartis Group outpatient analysis (June 2024). - RAND Corporation: State-Level Impacts of OBBBA Medicaid Provisions (2026). - Hooper Lundy & Bookman: OBBBA Health Care Impact (July 8, 2025). - AMA: OBBBA Medicaid/ACA tracker; Stateline: OBBBA state affordability coverage (Dec 2025). - Premier Inc.: 7 Healthcare Trends for 2026; AI integration benchmarks. - Cigna: Top Health Care Trends for 2026; value-based payment penetration. ### F · Government & Demographics - Oregon Office of Economic Analysis: Population & Demographic Outlook (FY 2025–35). - Oregon Health Authority (OHA): HCMO program; OHSU/Legacy submissions; nurse staffing law data; Hospital Financial Snapshot. - Oregon Office of Rural Health: 2025 County Profiles (Multnomah, Clackamas, Washington, Marion). - Oregon Nurses Association: HB 2697 walkthrough; 2025 Legislative Updates. - Oregon Health News Blog: HR1/OBBBA OHP impact (March 2026). - U.S. Census Bureau ACS 5-Year Estimates; World Population Review; Oregon-Demographics.com. ### G · Competitor & Recognition - Providence Health *(providence.org)*: Dr. Susan Huang leadership profile (chief physician executive, CEO Providence Clinical Network, CivicaRx board). - OHSU News *(news.ohsu.edu)*: Tarek Salaway CEO (Nov 24, 2025); Doernbecher; OHSU/Legacy transaction docs. - Kaiser Permanente NW facility & program pages *(kp.org)*. - PeaceHealth Southwest 2025 Community Health Needs Assessment. - U.S. News & World Report: Best Hospitals Portland 2026. - American Association of Critical-Care Nurses: Beacon Gold (Salmon Creek ICU). - Healthgrades: 2026 Outstanding Patient Experience (Good Samaritan). ### H · DocNexus IDN Intelligence - DocNexus SuperAgent: Medical & Pharmacy Claims Intelligence Analysis Reports (May 21, 2026). - DocNexus 2026 Patient Demographics · Legacy Health IDN 14804103208846070575: age, gender, payer mix breakdowns. - DocNexus 2026 Service Line Patient Volume: Cardiovascular, Oncology, Trauma/Emergency, Respiratory, Orthopedics, GI, Urology, OB, GenMed. - DocNexus Strategic Overview of Legacy Health IDN (Portland): market dynamics, technology adoption, regulatory environment, competitor benchmarks, performance metrics. - DocNexus 2026 Healthcare Trends Report *(docnexus.ai)*. 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