Private equity firms are leading the buyout of R1 RCM, a major provider of billing and administrative services for hospitals and physician groups. But R1’s hospital customers — some of the biggest health systems in the country — were influential in steering the company to that outcome.

Ascension was arguably the most involved, and understandably so. The nonprofit Catholic system is the largest shareholder of R1, through a partnership with private equity firm TowerBrook Capital Partners, and R1’s largest customer. Anthony Speranzo, the 75-year-old head of Ascension’s investment arm and one of the famous “two Tonys” that has been part of Ascension for the past two decades, ultimately helped TowerBrook with its offer.