AI search favors academic hospitals over big health systems across states

Academic medical centers are outranking the biggest health systems in AI answers, and the split is wider than a branding quirk. In the 5W Healthcare volume of the AI Trust Map of America, 46 of 50 states named an academic medical center first, while HCA Healthcare landed the dominant recommendation in zero states. Across ChatGPT, Claude, Perplexity, Gemini and Google AI Overviews, the names that kept rising were Mayo Clinic, Cleveland Clinic, Johns Hopkins, Mass General, NYU Langone and MD Anderson.

The study was released June 17 from Miami and used five engines, 50 states, 3,000 data points and 12 buyer-intent prompts per state. That structure matters because it measures how AI systems respond when a user asks for the best hospital in a state or city, not just which hospital buys the most media. Across the broader five-part AI Trust Map of America series, which also covered grocery, restaurants, banking and hotels, 5W said the country’s largest chains took the dominant AI recommendation in only 7 of 250 state-level answers.

The state winners help explain the pattern. Mayo Clinic said it has clinics and hospitals in Arizona, Florida, Minnesota and the upper Midwest, and it led the 2025-2026 U.S. News Best Hospitals rankings for the 36th time. Cleveland Clinic, which describes itself as a nonprofit multispecialty academic medical center integrating clinical and hospital care with research and education, said it has been named to the U.S. News Best Hospitals Honor Roll for 35 consecutive years. U.S. News said its latest Best Hospitals edition evaluated nearly 4,500 hospitals and only 20 made the national Honor Roll, a reminder that prestige signals remain highly concentrated.

HCA’s scale did not translate into the same AI visibility. The company said in its 2025 annual report that it operated 190 hospitals as of Dec. 31, 2024, and its Impact Report said it has about 2,400 sites of care in 20 states and the U.K. Even so, the report found no state where HCA held the dominant AI recommendation. That gap points to the local trust thesis at the center of the study: AI systems appear to favor academic affiliation, peer-reviewed research, named physicians and other retrievable proof points over bed count or network size.

For hospital marketers, that changes the brief. Reputation architecture now has to stretch beyond SEO into academic, clinical and earned-media signals that models can surface quickly and summarize cleanly. The AAMC says academic medicine includes more than 150 medical schools, about 400 academic health systems and hospitals and nearly 80 academic societies. The AHA says academic medical centers and teaching hospitals educate future medical professionals, conduct research, care for the poor and uninsured, and deliver highly specialized care. In AI search, those are the attributes that look like authority, and they are increasingly shaping who patients see first.