Why Capital Campaigns Are Healthcare’s New Frontier

The scale of capital campaigns is shifting, with campaign fundraising becoming a foundational driver of health system growth.

Campaigns that once topped out in the tens of millions are now reaching into the hundreds of millions and beyond. In North Carolina, Duke Health and UNC Health have joined forces to raise $1 billion in private funding to build the state’s first freestanding children’s hospital. Michigan’s Henry Ford Health is already halfway to raising $750 million for a system-wide expansion.

In fact, about half of nonprofit health systems are in a capital campaign at any given time, with median goals around $60 million and top-end campaigns extending far beyond that.

And it’s not just confined to academic medical centers or big metropolitan areas. In Maine, the 25-bed Mount Desert Island Hospital is raising $55 million to expand its emergency, surgical, and diagnostic capabilities. A longtime resident recently made a $10 million lead gift.

The Numbers That Signal a New Era

Healthcare organizations received 64 gifts of $10 million or more in 2024, totaling $2.35 billion, the third-highest annual total since 2015. The number of both gifts and donors grew by 60% compared to 2023, though total dollars increased by just 3%, according to Marts & Lundy’s 2025 $10M+ Gifts Report.  

That activity is part of a sustained shift. Average annual $10 million-plus giving to healthcare during 2021–2024 was roughly 150% higher than the 2017–2020 average, according to the report.

Taken together, these numbers point to a change in how philanthropy is leveraged, with campaigns structured to support multiyear system expansion, to fund services that reimbursement can’t cover, and to position organizations competitively within their regions.

This shift is also expanding what campaigns are designed to fund. Philanthropy is increasingly supporting areas that lack clear reimbursement pathways, including community health initiatives, behavioral health, and programs addressing social drivers of health.

The scale of the gifts, the size of the projects, and the speed of fundraising indicate that donors are being asked to support long-term institutional change at a system level.

What’s Driving the Shift

Three forces are reshaping how healthcare organizations now approach capital, growth, and long-term sustainability.

Financial Pressure Is Reshaping Capital Strategy

Compressed operating margins have deferred capital priorities at organizations of every size, from community hospitals to regional systems and academic medical centers alike.

Philanthropy offers a way to fund major projects without adding debt, particularly as traditional financing becomes harder to justify in a low-margin environment.

At PeaceHealth, which has raised $192 million over the past four years, philanthropy has “evolved into a strategic powerhouse, steering resources toward the most vital patient and community-centric priorities,” said Michael Dwyer, EVP of strategy and community health.

Across the sector, philanthropy is increasingly being used to fund capital priorities that might otherwise be delayed or scaled back, particularly in areas where reimbursement does not cover the full cost of care. As those patterns take hold, philanthropic dollars are being evaluated alongside traditional financing options and incorporated more directly into capital planning decisions.

Donors Are Deploying Capital at Scale

Philanthropists are giving to healthcare at transformational levels. Since 2021, healthcare organizations have received at least 20% of all mega-gift dollars annually, holding that position for four consecutive years alongside higher education, according to the Marts & Lundy report. 

Some, like Dan and Jennifer Gilbert, are grateful patients or their families. The couple committed $154 million to Henry Ford Health after Dan’s stroke recovery and the loss of their son Nick to neurofibromatosis.

Others, like Nike founder Phil Knight, are civic leaders who view healthcare infrastructure as essential to regional growth. Phil and his wife Penny Knight’s $2 billion pledge to the Knight Cancer Institute at Oregon Health & Science University is the largest gift ever made to an academic medical center.

Corporate donors are also making capital-scale commitments. Coca-Cola Consolidated committed $25 million to NC Children’s to anchor a behavioral health center within the health system’s new $1 billion children’s hospital campus.

These gifts establish a new ceiling for what healthcare organizations can raise.

Philanthropy Has Become a Strategic Discipline

Campaigns approaching the $1 billion level require infrastructure capable of treating philanthropy as a strategic imperative. Foundations that were once event shops have become finance-literate operations with board oversight, disciplined project selection, and multiyear revenue targets.

In leading organizations, where philanthropic performance is tracked with enough precision to treat it as a predictable revenue stream, foundation teams work alongside CFOs, strategy leaders, and hospital presidents to align donor funding with the highest-priority investments and ensure those dollars are deployed effectively.

Organizations are also becoming more selective in how philanthropic dollars are deployed. When funding is directed toward lower-priority or unvetted initiatives, it limits both impact and donor engagement. High-performing systems focus philanthropic investment on projects that directly support approved strategic priorities.

Because these teams are in constant contact with donors and community stakeholders, they bring real-time insight into which priorities will resonate and attract support, influencing which initiatives move forward and how they are financed.

Supporting this level of coordination requires a technology backbone built for complexity. Running an eight- or nine-figure campaign means tracking thousands of donor relationships, managing restricted funds across multiple project codes, and reporting on pledge fulfillment to boards, auditors, and lead donors.

The organizations raising transformational gifts are the ones that already have done the work of integrating philanthropy into how the health system plans, budgets, and governs.

What Comes Next

Capital campaigns have always been about bold vision. What has changed in healthcare is who is setting that vision, and what they are willing to ask donors to help them achieve.

Community hospitals are setting campaign goals once reserved for academic medical centers. Regional health systems are building the philanthropic infrastructure to compete for transformational gifts. The donors are there.

What separates the organizations that succeed at this level? Preparation.

The infrastructure required to manage a campaign at this scale—fund accounting, multiyear gift tracking, and reporting frameworks that satisfy both major donors and health system leadership—is becoming a defining factor in whether organizations can execute on that ambition.