
In Huntsville back in 1895, a group of women, concerned about health care access in the city, founded Huntsville Infirmary.
Today, the hospital, renamed Huntsville Hospital, is the flagship for the Huntsville Hospital Health System, a not-for-profit entity that provides patient care across north Alabama and part of southern Tennessee. The system administers health care through a network of clinics and 14 community-based hospitals, including Decatur Morgan Hospital, Helen Keller Hospital, Red Bay Hospital, Highlands Medical Center and DeKalb Regional Medical Center.
“It’s very hard these days to be an independent, stand-alone hospital,” says Jeff Samz, CEO of the Huntsville Hospital Health System. “You simply don’t have the scale to negotiate with payers, to buy things at a discount, to purchase the expensive capital items and training programs you need to be successful.”
In fact, these days, fewer single, stand-alone hospitals exist than in the past.
According to the American Hospital Association, in FY 2022, 68% of community hospitals were “system affiliated” while only 32% were independent.
Furthermore, the association reports that mergers and acquisitions are ways health systems are endeavoring to keep financially strapped hospitals open. Such transactions allow hospitals to provide more services, increase patient access to medical specialists and provide scale to lower the costs of obtaining medical services and even prescription drugs, the AHA says.
In 1994, Huntsville Hospital acquired another Huntsville institution, Medical Center Hospital.
But in the late 2000s, Huntsville Hospital launched a plan to acquire more small hospitals, medical systems and specialty clinics in the region.
“The regional hospitals in North Alabama started approaching us about being partners, and we tried to help them,” Samz says.
In 2007, Athens-Limestone Hospital joined the Huntsville Hospital Health System. Then the system acquired Decatur Morgan Hospital, followed by Helen Keller Hospital and Red Bay Hospital in 2014, Marshall Medical Centers in 2018 and Scottsboro’s Highlands Medical Center in 2021.
In 2022, the system acquired Lincoln Health System, its first facility in Tennessee.
The system’s most recent acquisition was the DeKalb Medical Center in 2024.
“Today, we have 14 across North Alabama, one in southern Tennessee, and we all are now working on connecting those hospitals and making them function as an integrated health system and taking full advantage of the scale that we have,” he says.
Being part of the Huntsville Hospital Health System comes with many benefits for the smaller hospitals, Samz says.
“The biggest thing they gain is they come on our balance sheet and they’re part of our company,” says Samz. “So, they go from being an independent hospital that doesn’t have the resources to replace their capital and keep the hospital up to date to joining our health system, where we will help fund their capital. We’re fully responsible. The hospitals in Scottsboro and DeKalb and Decatur are just as much part of our health system as the big hospital,” Samz says.
Under the Huntsville Hospital Health System, for example, physician recruitment is a joint effort throughout the system, he says.
“We’re trying to recruit well trained physicians to rural communities. We do that together, so we’re not competing for the same candidates,” Samz says.
And at system-affiliated hospitals, patients in the region can have access to specialty services such as labor and delivery, Samz says.
One of the facilities that benefits from the system is Helen Keller Hospital in Sheffield. The hospital struggled financially prior to its acquisition, says its president, Kyle Buchanan. At the time, Buchanan was vice president of business development.
“Our trajectory as a small hospital was concerning. We were struggling to see, in the town our size with multiple hospitals in this area, enough patients just to make ends meet,” Buchanan says.
“And there were lots of projects that we knew we needed to take on, with getting new equipment, renovations in our hospital, keeping up with being competitive with compensation for our staff,” he says.
So, in 2010, Helen Keller entered a management agreement with Huntsville Hospital Health before officially joining the system in 2014.
Buchanan says one major way his hospital has benefitted from being part of the Huntsville Hospital Health System is through Huntsville’s electronic medical records system, which gives patients in small towns like Sheffield access to various specialists.
“Just last February, we rolled out a new electronic medical record, which was a multi-million-dollar investment in our information systems, which allows us to better document, to better track and to better care for our patients,” Buchanan says.
Soon after the rollout, Buchanan says, a patient arrived at Red Bay Hospital’s emergency room with a gynecologic ailment. There were no gynecologists in that community, so the ER physician in Red Bay called Helen Keller Hospital to consult with the gynecologist on call. After the consultation, the gynecologist suspected the patient was in danger, he says.
“Our gynecologist here in Sheffield contacted a gynecologic oncologist in Huntsville, and the three physicians in Red Bay, Sheffield and Huntsville were able to look into the medical record together on the phone and agreed that the patient needed to be transferred to Huntsville Hospital as soon as possible because her life was in danger,” Buchanan says.
Without the medical records system, what took just minutes might have taken three or four days for the doctors to reach that conclusion, Buchanan says.
Samz says, “We do everything together, from supporting them with staffing and training programs and trying to support them with government affairs and a whole host of other things.”

For example, the hospital system recently negotiated a new contract with the insurer UnitedHealthcare.
“When we do those negotiations, we’re doing it on behalf of all 14 hospitals in our system, and that gives additional leverage to those small hospitals that they would not have if they were trying to do that on their own,” Samz says.
Buchanan says that prior to joining the health system, Helen Keller Hospital had little leverage over the big insurance companies.
“Often, there was no negotiation. There was no discussion. Big nationwide Fortune 100 companies would present us with a contract that we knew wouldn’t fulfill the needs of our community, but we had very little leverage to work with them to get a better contract, to better cover the services in this county,” Buchanan says.
“In our current health system, we have a lot more success having this very real negotiation and making sure we work together to get the resources to our community that our folks need,” Buchanan says.
Though the 14 hospitals and clinics are part of the Huntsville Hospital Health System, Samz says each maintains its own identity within its community.
In fact, the system is governed by the Health Care Authority of the City of Huntsville, a volunteer board whose members, all from Huntsville and other communities the system serves, provide advice and counsel, Samz says.
“We’re all part of the hospital health system, but health care is inherently a local thing,” Samz says. “It’s their community hospital. People who live in that community work there. So, we’re very intentional about trying to maintain the local identity of the hospital.”
“In my opinion, you’re fully a member of the system, and you have our brand and our logo, and you are part of us, and we all do it together, but you’re also part of your local community.”
Gail Allyn Short and Dennis Keim are freelance contributors to Business Alabama. She is based in Birmingham and he in Huntsville.
This article appears in the January 2025 issue of Business Alabama.