The system consists of hospitals, primary and specialty physician practices, pharmacies, health clubs and other complementary services.

Carilion has more than 13,200 employees with 737 physicians covering more than 70 specialties at 225 practice sites,[1] making it the largest employer in the Roanoke Valley.

The deal took several years to complete because of anti-trust concerns by the United States Department of Justice that two of the three major hospitals in the Roanoke Valley would now be under the same ownership.

In 2019, Carilion announced plans to spend $300 million expanding services at Roanoke Memorial Hospital.

[4] In 2006, Carilion's management warned that trends in the health care sector threatened to undermine the organization's financial position.

In response, Carilion announced plans for a significant business restructuring in which it would shift its focus from operating hospitals to hiring more physicians in more medical specialties, with the main objective of improving patient care coordination and placing a focus on medical education and research.

[5] The vision for moving Carilion toward the "clinic" model was spearheaded by CEO Ed Murphy, who left Carilion in 2011 to work with a New York and London based firm in order to help develop ways to better manage and coordinate physicians and services provided by hospitals.

The 11 accredited fellowship programs are adult joint reconstruction, cardiovascular disease, child and adolescent psychiatry, emergency medical services, gastroenterology, Geriatric medicine, Geriatric psychiatry, hospice and palliative care, infectious disease, interventional cardiology, and pulmonary critical care.

[10] Carilion Clinic operates seven hospitals located in the Southwestern region:[11] Located in Rocky Mount, Virginia, Carilion Franklin is a 37 licensed bed hospital that provides 24-hour emergency, general medical/surgical care, and outpatient services.

Located in Pearisburg, Virginia, Carilion Giles is a 25 licensed bed critical access facility that provides 24-hour emergency care.

Located in Roanoke, Virginia, Carilion Roanoke Community Hospital is a magnet-designated, 34 licensed bed hospital home to outpatient services such as community care, wound care, occupational medicine, inpatient rehabilitation and pediatric dental.

Located in Lexington, Virginia, Carilion Rockbridge Community Hospital is a 25 licensed bed critical access facility.

The center provides access to more than 50 specialists including cardiology, obstetrics and gynecology and vascular surgery.