It's Diversify or Else, Says Commonfund to Healthcare Nonprofits

(February 13, 2013) – Endowments do it; pension funds do it; even insurance companies do it, and a white paper says it’s time healthcare providers did it, too. 

Diversify their portfolios, that is. 

Small- and mid-sized nonprofit healthcare organizations lag behind their larger counterparts with respect to investing, argued William Jarvis, managing director at the Commonfund Institute, in his latest white paper. According to Jarvis, the time has come for these organizations to modernize their cash- and bond-heavy portfolios. 

“The healthcare business model is changing,” Jarvis said in a statement. “Larger healthcare organizations and networks already have substantial endowments and possess the scale to manage costs efficiently. But,” he continued, “small and mid-size healthcare providers that lack scale will have to obtain greater investment income” by adopting the diversified models used by higher education and other nonprofits, and “reducing their reliance on fixed income investments.” 

Jarvis’ whitepaper, titled “Assessing the State of Healthcare,” compares the median operating margins for healthcare organizations large and small. The results show economies of scale and portfolio diversification at work. In 2011, providers with investible assets over $1 billion had a 4.9% margin, whereas those with between $251 million and $500 million operated with a median margin of 3.6%. That figure has been rising for large organizations, as well—climbing from 4.2% in 2006 to 4.9%—while it’s just inched up 0.2% over six years for smaller providers. 

Healthcare organizations of all sizes tend to hold more liquid assets than do university endowments and other institutional investors, because they rely on bond issuances to fund facility and infrastructure improvements. More liquid portfolios generally impress the ratings agencies who grade those bonds. However, Jarvis argued that dedicating so much of a portfolio to ultra-low yield assets like cash and long-term US Treasury bills hamstrings providers’ potential investment income. 

“Rating agencies, bondholders and healthcare organizations have a common interest in seeing that the sector is able not only to survive the coming period of stress and transition but to thrive beyond it,” he wrote “To that end, a renegotiation of the strictures on asset allocation and liquidity will be necessary.” 

Moreover, improving diversification could have financial benefits beyond just investment returns, Jarvis points out. “Organizations that have demonstrated an ability to maintain the real value of their endowment while fulfilling mission goals are more likely to receive endowed gifts; those that have not will receive gifts for current use or none at all.”