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WHAT IS GROWTH? AND IS IT ALWAYS GOOD?

To unleash your organization, forge a growth strategy that helps you become better, not just bigger.

Most administrative assistants don’t go on to become CEO of Fortune 500 companies, but my trailblazing friend Beth Mooney did. After talking her way into a management training program in 1979, she began a meteoric rise in the banking industry, taking on leadership roles at a number of American financial institutions. In 2006, she joined Cleveland, Ohio–based KeyCorp, the country’s fifteenth largest bank, and was tasked with overseeing the bank’s 1,000 local branches.¹ She succeeded yet again, and in 2011 the institution named her its chairman and CEO, making her the first woman to lead a top 20 American bank.²

But Mooney was just getting started. KeyCorp and the banking industry were then still recovering from the Great Recession. Mooney’s job was to stabilize KeyCorp and lay the foundation for future growth. She spent her first couple of years regaining the confidence of investors, building trust with regulators, and restoring its base of capital.³ She also refocused KeyCorp’s culture on its purpose and values. In her view, the financial crisis had taken hold because the banking industry had abandoned its social purpose, with leaders making risky and ultimately disastrous investments. “People lost sight of the fundamentals,” Mooney says, which included a service orientation, building strong relationships with clients, and investing in ways that would enhance communities. KeyCorp had to go back to basics and pursue what Mooney described as “sound, profitable growth.”

By the mid-2010s, as the bank began to acquire other firms, Mooney remained focused on achieving the right kind of growth. Corporate decisions to merge typically reflect hard-boiled strategic considerations. A firm might have a business line that an acquiring company wants, or resources that will allow an acquiring company to enhance its own offerings. It might have a set of loyal customers that an acquiring company can claim as its own. Mooney and her team considered such factors, but they also asked another set of questions: Is there a culture match? Does a firm they’re thinking of acquiring do business in the elevated, mission-focused way to which KeyCorp aspired? If so, KeyCorp would consider doing a deal. If not, it would pass. Decisions to buy other companies had to contribute to “sound, profitable growth” just like decisions the firm might make to expand its existing businesses.

By 2020, the year of Mooney’s retirement, KeyCorp had made a number of acquisitions, most notably its 2015 purchase of First Niagara, a Buffalo, New York–based bank with $39 billion in assets.⁴ At the time, the deal was the largest acquisition in the banking industry since the Great Recession.⁵ All told, KeyCorp’s assets under management nearly doubled during Mooney’s tenure, rising from $89 billion to $170 billion.⁶ Shareholders did well: the bank’s stock price nearly doubled during that period.⁷ KeyCorp also made massive investments in the community, lending and investing more than $18 billion over a four-year period to increase economic opportunity among low- or middle-income customers (via small business loans, financing for affordable housing projects, and so on). In addition, the company committed $4 billion in financing for renewable energy projects. Had Mooney found a path to sound, profitable growth? I think so.

Almost every business wants to grow. But too many leaders focus on profits, not purpose; on financial success, not service. Most health-care organizations that decide they want to enter a new market opt to simply buy an existing hospital, hire specialists to work in that hospital, compete head-to-head with other local hospitals, and try to get as many patients in their hospital beds as possible to drive revenue. That’s great for the healthcare system, not so great for patients and communities. The more specialists exist in a local area, the more likely it is people will be referred for the services of these specialists. Beyond a point, the mere presence of specialists can mean that people receive expensive treatment they may not need. Further, you’re only treating people once they’re sick, not preventing them from getting sick in the first place.

Drawing inspiration from leaders like Mooney, we can take a more deliberate and creative approach. Keeping our missions foremost in our minds, we can craft deals that over the long term benefit patients, caregivers, communities, and society—what Harvard Business School’s Michael Porter has termed “creating shared value.”⁸ To drive progress, we must aim for such “good growth” and reject out of hand opportunities that don’t advance our organization’s mission, even if they might prove financially lucrative. Expanding businesses at all costs might create financial opportunities for investors, but only good, mission-focused growth can galvanize organizations, transforming them and their people into powerful engines of progress.

A MIDDLE PATH LESS TRAVELED

In March 2019, I took my family to Colorado for a quick and much-needed ski getaway. I was on the top of the mountain preparing for a run when my phone started buzzing. I ignored it, but it buzzed again. And then again. Seeing that it was our chief strategy officer Dan Liljenquist, I picked up, a bit annoyed that he would call me on a rare day off. “Hey Marc,” he said, “do we want to buy HealthCare Partners Nevada?”

All of a sudden, I wasn’t annoyed anymore. I was thrilled. Healthcare Partners Nevada was a sizable group of 340 physicians and other caregivers that, although operating as part of a for-profit company, had adopted a population health model to keep people well. They offered exceptionally high-quality care and were especially adept at serving seniors, keeping them well through a network of nearly two dozen local clinics.⁹ They were also a well-managed and financially solid organization, generating $1 billion in revenue each year, and their Las Vegas–area market was growing fast. About a year earlier, we had entered into negotiations to buy them, but the purchase price had been too high, so we reluctantly walked away.

For a variety of reasons, we now had a chance to buy them at a much more favorable price. In the weeks that followed, Dan and other members of our team worked hard to get a deal done quickly. They succeeded, and in June 2019 we announced our acquisition of HealthCare Partners Nevada.¹⁰ Although members of my team were elated, others in our organization harbored their doubts. It wasn’t that people didn’t like or respect HealthCare Partners Nevada or that they second-guessed the specifics of our deal. It was that they were leery of the very idea of growing into new markets.

Early in its history, Intermountain had grown aggressively in accordance with its charge to be a model health system and its vision to provide better health services to more people. During the 1970s, 1980s, and 1990s, we expanded beyond our original hospital footprint in Utah, Idaho, and Wyoming, adding smaller health ventures in several other states. We entered into an entirely new line of business by starting a health insurance plan and also built out a medical group.

During the 2000s and 2010s, however, we turned away from growth outside of Utah and Idaho. Although some inside our organization did want to expand, others worried about losing what they proudly thought of as “the old Intermountain.” They loved what we’d accomplished as an organization and didn’t want to risk diluting our culture of quality and service by acquiring other organizations. Instead of growing, they thought it would be better to focus on continuing to improve our quality. Let’s perfect our own ways of delivering care, they said. Then we can grow.

Such fears about growth had a certain logic to them. As some have noted, pursuing growth poses potential pitfalls. It can damage the brand of a business, leading to a coarsening of its culture and what formerly made a company successful.¹¹ I see it differently, and during my first few years at Intermountain, I challenged those with an antigrowth sentiment. If companies weren’t striving to grow, I argued, they were decaying. I challenged people to name a single great organization in the history of business that shrunk its way to success. Moreover, it was becoming increasingly difficult for midsized players in our industry to compete. The largest health systems were growing more quickly than midsized ones, and as they continued to grow, their size would afford them all kinds of competitive advantages. Right now, we weren’t feeling the impact of this dynamic, but we couldn’t afford to wait around and let the big guys bully us with their size. We had to act preemptively by growing.

As we soon found, the threat of being pushed around by bigger players wasn’t theoretical. In 2020, the second largest health insurance company in Utah, United Healthcare, called us with some bad news. Although we had been the exclusive provider to their customers in the state, they had just inked a national deal with a much bigger healthcare system with facilities in Utah and would no longer work exclusively with us. Clearly, we didn’t have the pull we used to—bigger players with a larger geographic reach were overshadowing us. “This was a real wake-up call,” our chief operating officer Rob Allen says. “It brought home the idea that our influence level will diminish if we don’t grow.”¹² It wasn’t just a question of economic or geographic heft, but also policy influence. We have long enjoyed a seat at the table in national debates about healthcare. If we didn’t continue to grow, we risked losing the ability to exercise meaningful industry influence.

Competitive considerations were one thing, but I also felt that we had a moral imperative to grow. If we really believed in our mission and in our emphasis on keeping people well—if we really thought that this approach allowed us to provide better quality and safety and more access at lower cost—didn’t we have a duty to operate in more communities and spread our model to serve as many patients as possible? Likewise, if the largest healthcare systems were gobbling up the industry, didn’t we have an obligation to ensure that we were the ones doing the gobbling rather than another company without our strong mission focus? Weren’t we obliged to promote our ideas about health-care and be a force on the national stage? We were already moving fast to transform healthcare. But if force equals mass times acceleration, it was high time Intermountain picked up some mass.

We had another reason to grow: to return more value to the community. As a nonprofit system dedicated to increasing access to healthcare, we pride ourselves on taking care of people regardless of their ability to pay. But doing that costs money, and strong growth would provide us with the financial resources we needed to subsidize it. Growth also would allow us to maintain our large, traditional hospitals even as we managed to keep more people well. As an example, if our existing patients would need 25 percent fewer heart procedures because we’re keeping them healthier, our high-quality, hospital-based cardiac programs might soon become unsustainable. But expanding our telehealth services to more non-Intermountain hospitals would help us to build trusting relationships in those local communities by supporting local care for patients when possible. If people there did need to come to a major hospital for a heart procedure, they’d more likely come to us, offsetting the loss and keeping our cardiac programs economically viable.

We didn’t want to try to grow at all costs, including in ways that didn’t benefit patients and the wider community. That’s the kind of growth that could get us in trouble. But staying at our present size wouldn’t serve our mission either. What I was arguing for—and what I continue to champion today—was meaningful, mission-focused growth. We would expand in a way that allowed us to continue to improve safety, quality, patient experience, equity, access to care, and stewardship to the communities we serve. We would expand in a way that allowed us to enhance our commitment to population health and value-based care and that wasn’t focused on simply boosting revenues.

Over time, our organization came to welcome growth, especially as we began acquiring companies and showing that we could succeed. Each acquisition or merger we’ve completed—there have been four major ones, with a number in the pipeline—has served our mission of helping people live the healthiest lives possible by enhancing our ability to deliver on population health.

Take Healthcare Partners Nevada. As I’ve suggested, most health systems buy or merge with other players to acquire hospitals or profitable services and then fill their beds and technologies with patients. The very presence of these facilities encourages people to seek more treatments once they get sick rather than stay well. It would have been easy for us to go to Las Vegas, build a hospital, and compete with existing players for patients. We’d make money, but we’d only be exacerbating the problems of a health system built around sick-care.

We took a different approach, making an acquisition that wasn’t focused on brick-and-mortar assets. We saw an opportunity to join forces with a like-minded organization and expand the population of people we were keeping well. Although Healthcare Partners Nevada was a sizable business, they couldn’t expand as quickly as they might have liked because they couldn’t afford big investments in areas like digital innovation, marketing, and communications. Given our larger size, we could provide these resources and help them care for more patients in their market.

Although our integration of Healthcare Partners Nevada is ongoing, the deal so far has been a success. In 2020, our operations in Nevada grew 10 percent year over year, achieving the highest patient experience scores ever in the history of Healthcare Partners Nevada, with strong caregiver engagement.¹³ Patients and the local community are benefiting because we’re keeping people healthier by preventing illness rather than only treating them when they are sick, an approach that in turn lowers costs. We’re also proving that we can keep people well and lower costs not just in places like Utah, which has a relatively healthy population overall, but in places like Nevada, which historically has had relatively poor health outcomes.

If you’ve been pondering whether and how to expand your organization, don’t listen to those who say you must grow at any cost. Ignore, too, those who want to avoid growth altogether. Aim for a middle path. Growth doesn’t just have to be a cold, calculated business strategy. It can also be a higher calling. You’re not growing for its own sake, solely to line investors’ pockets or for the ego boost of being number one in your industry. You’re doing it to allow the maximum number of people to benefit from the good work your organization does.

SUBSTANCE, NOT JUST SIZE

Not long ago, a frail woman in her eighties—I’ll call her Irene— came to one of our primary care facilities in Utah complaining of shortness of breath and feeling unwell. We asked if she wanted to go to the emergency room, and she said she preferred to come into the clinic because she was familiar with it and trusted the caregivers there. When our team examined her, they found her quite sick. The oxygen levels in her blood were low, and she was struggling to breathe. Other signs indicated that one of her preexisting conditions—congestive heart failure—had worsened.

If a patient in Irene’s condition arrived at one of our emergency departments, we would have admitted her to the hospital and probably to the intensive care unit (ICU). But that’s not what our clinic did. They provided oxygen to Irene and consulted with her cardiologist remotely via telemedicine. They gave her some medication to help her body release fluid from her system (a consequence of congestive heart failure), which helped her feel better. A couple of hours later, our clinic sent her home, but continued to monitor her closely. Irene recuperated and was able to resume her normal activities without ever being admitted to the hospital.

This episode might sound mundane, but it’s actually quite remarkable. Caring for patients in ICUs costs a lot—we’re talking thousands of dollars per day. Caring for Irene at a local clinic might cost only about 5 percent of that, representing a massive savings. And the outcome for patients is better. Because we were well prepared to manage the care of a patient like Irene, we could send her home knowing that we could quickly intervene if her condition deteriorated.

Meanwhile, Irene never had to subject herself to any of the risks associated with hospitals. For elderly people, a hospital stay can feel scary, even traumatic. Deprived of their usual setting and caregivers, they can become disoriented and delirious. They can fall and sustain serious injuries because they’re staying in an unfamiliar room and don’t know how to get to the bathroom. Irene avoided all of this because we had become much more adept at the complex challenge of caring for people like her outside of the hospital.

How had we gained that know-how? Part of it we’d developed on our own, thanks to our yearslong effort to advance population health, but we’d also learned a great deal from Healthcare Partners Nevada. When we entered Nevada, we didn’t simply impose our own ways of operating on our new employees, assuming that we knew everything and our new workforce in Nevada would now do things the Intermountain way. After all, growth is more than simply getting bigger; it’s about listening and evolving. While we certainly sought to integrate Healthcare Partners Nevada into our system by sharing our processes and practices, we also paid close attention to what they could teach us.

HealthCare Partners Nevada had extensive experience keeping elderly people well and out of the hospital. They used an innovative, team-based approach to care similar to one we were already deploying at some of our primary care facilities in Utah and were seeking to scale up. They had great processes in place for collaborating to keep track of patients’ conditions and determine which patients to see proactively, before their health worsened. They also had systems in place for compensating healthcare providers in ways that incented them to keep people well and also worked economically.¹⁴ These elements sound simple, but the details get hairy pretty quickly. Our new Nevada colleagues taught us some of their best practices, which we could quickly spread to our existing facilities to provide better, less costly care to patients like Irene.

Proponents of growth often emphasize the benefits that come by virtue of an organization’s size. If you serve more customers, you can often operate more efficiently and profitably, for instance, by using your volume to negotiate lower prices from your suppliers. That in turn might allow you to sell your products and services more inexpensively, so that you can attract still more customers.

But good growth doesn’t benefit companies by simply making them bigger. It should help them become better at what they do, improving their ability to compete and to deliver on their broader social mission. By allowing our missions to lead us, and by staying true to them when seeking out and evaluating potential opportunities, we can sustain and deepen the cultures that make us special and position our organizations to thrive in tough, competitive environments. We can also provide investors with a fair return or, in our case, use margin to lower the cost of healthcare, improve the value we provide, and return value to the community.

Other deals we’ve made have allowed us to improve our ability to keep people well instead of just caring for them when they’re sick. In 2021, we announced that we were purchasing Classic Air Medical, an air transport system aimed at serving rural communities across the Intermountain West. Classic Air had a long history of providing extremely safe transport for patients at low cost and a service footprint that overlapped with Life Flight, our existing air transport service, but that also allowed us to reach new areas of the Intermountain West. With Classic Air, we’d be able to integrate rural areas more fully into our network. As we treat patients remotely via telemedicine, we’d now have a greater ability to move them from local areas into our major hospitals, should they need more significant care.

But that’s not the only reason Classic Air would be a boon for Intermountain. Because Life Flight specializes in moving extremely sick patients over long distances, it is a relatively high-cost service. We use expensive helicopters and staff them with sophisticated crews providing world-class care that patients with specific conditions require. Classic Air has made its mark by providing basic transport service at a much lower cost. They fly less expensive helicopters, staff their crews with paramedics as opposed to highly trained medical specialists, and source their operations with lower-cost vendors. They really understand how to work with local fire and police departments to provide great care. By acquiring Classic Air, we are learning how to run a bread-and-butter transport service, using some of that knowledge as appropriate to improve Life Flight and other services at Intermountain.

In addition to operational knowledge, acquisitions enhance our ability to deliver on population health and value-based care by improving our base of talent. Our acquisitions so far have added many thousands of people to our workforce, including talented senior leaders whom we’re able to either keep in place or elevate to other roles within Intermountain. Our mission-based acquisitions also allow us to become a magnet for top talent and to retain up-andcoming talent in our own ranks. Marti Lolli, a seasoned, growth-oriented executive with an impressive track record of success, came onboard in 2021 as CEO of our SelectHealth insurance plan. She never would have come if we hadn’t put ourselves on a growth trajectory. With smart, ambitious leaders like her in our ranks, we’re much better positioned to move forward as an organization and deliver on our strategy.

Acquisitions can also improve our ability to deliver on our mission by opening up new business relations, sometimes in unexpected ways. Classic Air, for instance, has longstanding relationships with many rural hospitals in our service area. Our deal to acquire them already has created opportunities for collaboration and potential acquisitions. These hospitals trust Classic Air, and now more of them feel they can trust Intermountain.

Ultimately, good growth helps organizations better deliver on their missions by rendering them more adaptive. Expansion into new businesses and geographic territories gives companies the capacities and talent they need to evolve, in addition to more financial heft and industry influence. Bert Zimmerli, our chief financial officer, tells young people that they should redo their résumés every year or two and see how many new items they’re adding. If they have hardly anything new to add, they should be worried—they’re not keeping up with a changing world. Something similar holds true for organizations. The world is changing fast. Good growth helps organizations to change with it.

SEEK THE GREATEST GOOD

Do you remember all those stimulating conferences I go to that expose me to new opportunities for innovation? A gathering of CEOs I attended in 2018 unfortunately wasn’t one of them. Although I’d arrived eager to engage, the conversation seemed fixed on a single topic: money. Leaders were going on and on, complaining about the tremendous financial challenges they faced and discussing how best to remedy them. They weren’t exploring deeper questions related to their social purpose, such as how to serve patients better and at lower cost.

There was one exception: Lydia Jumonville, the CEO of SCL Health, a Catholic nonprofit healthcare company operating in Montana, Colorado, and Kansas. She spoke not about money but about her organization’s commitment to providing charity care to the vulnerable. I hadn’t met Jumonville before, but her passion and enthusiasm made a big impression. Indulging the rebel in me, I spoke up and chastised our group for how intellectually uninteresting and self-serving our conversation had been. I didn’t win many friends that day, as you can imagine, but I felt that I said what needed to be said.

One friend I did make was Jumonville. After the session, we got to know each other and learned that we shared a board member in common and that our organizations were culturally quite similar. Jumonville suggested that our leadership teams meet to discuss possible areas of collaboration, so they did. Over the next couple of years, we partnered on a number of projects; in one case, Intermountain provided telemedicine services to an SCL Health hospital in Colorado. In early 2021, after a high-profile merger we were pursuing fell apart, Jumonville called us and asked if we might be interested in merging with them instead. After months of analysis and negotiation, we were quite interested. In December 2021, Intermountain and SCL Health formally announced our decision to merge, creating an integrated healthcare organization operating in seven Western states.

SCL Health was economically strong and had a great deal of cash on hand. Other companies had approached SCL Health, seeking to acquire or merge with them, but Jumonville and her team refused. They sensed that these other firms didn’t care much about their culture or mission but were only after their cash. My team approached the deal from a much different lens, one that aligned well with SCL Health’s mission. We liked that SCL Health was strong organizationally, delivering excellent clinical quality. We also liked that SCL Health’s geographic area was complementary to but distinct from ours, so a merger would increase our footprint. But what mattered most to us was the opportunity we saw to expand the number of people we were keeping well.

Although SCL Health provided its services largely on a fee-forservice basis, its leaders wanted to move toward keeping people well through value-based care, with all the important social and economic benefits that would provide. Here, then, was the chance to take a healthcare company that was already great at providing high-quality, low-cost care to people who were sick and help them shift toward keeping people well. As in Nevada, we wanted to prove to the world that keeping people well really is a better way of doing health-care. If we could succeed with a population health approach in states like Montana, Colorado, and Kansas, then we would further disprove all those naysayers who thought we could only focus on wellness for populations in Utah that were generally healthy.

In addition, merging with SCL Health, a company with $3 billion in annual revenues, would form the nation’s eleventh biggest nonprofit health system, with combined revenues of about $14 billion. That kind of size would allow us to make even bigger bets in digital technology and other innovations, further enhancing our ability to deliver on our mission of keeping people well.

With the SCL Health deal, we didn’t merely allow our mission to inspire us. We used it as a tool for systematically vetting and analyzing the deal. As we’ve found, using the mission as a filter—and being transparent about that with our board—is vital for ensuring that the deals we pursue truly represent good growth. As our chief strategy officer Dan Liljenquist puts it, “We committed to our board that the value focus lens is the number one filter we go through” in vetting potential mergers and acquisitions. “If we can’t see how a deal leads to better health outcomes and better value for the communities we might enter, then we don’t have a good case for going forward.”¹⁵

We’re hardly the only organization that employs this kind of discipline around mergers and acquisitions. We’ve seen that KeyCorp applied a mission orientation as a filter when vetting potential deals. Another firm that does this is the pharmaceuticals giant Amgen. As CEO Bob Bradway explains, everyone in the company “can draw a direct line” between their daily work and the company’s basic mission of saving patients’ lives and restoring them to health. He himself joined Amgen in hopes of “making a difference in the lives of individuals who were suffering from challenging conditions, diseases, and disorders.” Such mindfulness of the mission applies to the company’s merger and acquisition activities as well. “When we look at acquisitions, the first question we have to ask ourselves is, How does it align with our mission? How is it embodied in our strategy? How is it embraced in the boundaries of our strategy?”¹⁶

To illustrate the use of mission as a filter when analyzing acquisitions, Bradway cites the company’s 2021 deal to buy the biotech company Five Prime Therapeutics for $1.9 billion.¹⁷ Five Prime had developed an exciting, first-of-its-kind treatment to help fight gastric cancer, one of the deadliest forms of the disease globally. Few treatments exist to help patients with late-stage illness, and Five Prime’s new therapy performed well in early clinical trials. As the only treatment of its kind, Five Prime’s technology clearly supported Amgen’s mission. From there, Bradway and his team assessed whether Amgen’s own resources and capacities in manufacturing and marketing would allow it to bring the technology to market better than its current owners, benefitting shareholders as well as patients. Only when they determined that Amgen could be a better steward of that technology did they consider acquiring it.

Using the mission as a filter becomes especially powerful as firms proceed in their growth journeys. As we’ve found, becoming more active in mergers and acquisitions has led to an increased number of potential deals coming our way, more than we could possibly undertake. Focusing on our mission allows us to dismiss a large number of these opportunities out of hand. “We turn down at least four deals for every one we really look at,” Dan Liljenquist says, “and for the remaining deals, it’s a coin toss if we do them. We try to be very selective.” We aim, of course, to fix healthcare everywhere, but we have a limited amount of attention and energy. If we can apply that energy carefully to notch some great early successes, we’ll establish that keeping patients well really is a better way of delivering healthcare. Others will join us, and together we’ll change the entire industry.

To be more precise about how our mission-oriented filter actually works, we know that in any new locale we might enter, we must put three key components in place to truly keep people well. We need primary care doctors and other providers, hospitals for patients to use when they get sick, and a way to get paid that rewards us for keeping people well. No deal we make will allow us to put all three of these elements in place in a given location all at once—we know that. What we’re looking to understand is whether we can see a way to put all three of those elements in place eventually, starting with the deal at hand.

As Liljenquist says, “We’re looking for a pathway to value, understanding that the beachhead in each place might be a little different. We’re asking: How might we take full clinical and financial accountability for people’s health?”¹⁸ With our Nevada deal and our 2020 acquisition of Idaho-based Saltzer Health, we started with the primary care provider piece. With SCL Health, we moved on to hospitals and primary care. And with Classic Aviation, we added an ancillary service that allowed our existing system to penetrate more completely into rural geographies.

Although using mission as a filter facilitates the task of selection, landing on the right opportunities is never perfectly straightforward. With limited resources, we often must decide between multiple opportunities that would each serve our mission, although to varying degrees. “You have to try to think through where the greatest good is,” Amgen’s Bob Bradway says, “where we can create the biggest return from a societal public health standpoint for our investment.” As Bradway notes, leaders also must balance the interests of various stakeholders, recognizing that some deals will benefit them unevenly or benefit some while hurting others. “We don’t often find ourselves in this position,” Bradway says, “but what we try to do is keep patients as our North Star. We try to say, ‘Gosh, let’s try to make every decision with the patient in mind. What makes the most sense from that standpoint?’”¹⁹

Many leaders talk about serving the greatest good, only to see their priorities shift when it comes to mergers and acquisitions. Don’t let this be you. Revenue matters. Being competitive matters. But social impact matters more. Maximizing that impact while also running a strong, sustainable business will lead, over time, to attractive returns. It has for us. Between 2016 and 2021 our revenue grew from $6.6 billion to $10.8 billion, fueled by our ongoing shift to the population health model. Meanwhile, our financial ratings from Moody’s were the best in healthcare. And we were able to return over $1 billion during that period to the community via our charitable foundation.

I deeply believe that the best kind of growth originates from within, reflecting our abiding passion to make a difference in the world. This good growth arises when we seek not to steal someone else’s market share but to realize our highest, most altruistic aspirations. I invite you to think more deeply about growth and commit to making a positive difference. The world’s problems are dire. In many industries, including healthcare, progress is slow. We must move faster—and we can. Take the good you already do via your core commercial activities, and do more of it. Your stakeholders—all of them—will thank you.