[8] In February 2003, Rochester General Health System (then called ViaHealth) and Unity Health System opened merger discussions, but the discussions ended in April 2004, when Rochester General's board of directors voted unanimously to reject the merger.

[9] The disagreement was partly due to the differences in ViaHealth wanting to merge its medical and dental staff, and Unity Health System the opposite.

Merger discussions began again in April 2013,[10] in response to incentives built by the Federal Affordable Care Act, but also New York State regulations and increasing pressure for better outcomes and lower costs from business and commercial insurers.

[14] The hospitals joined due to the difficulty for small-town rural health clinics to be financially viable and to attract and retain adequate medical staff.

The new 312,000 square foot facility was built to help deliver better care to an aging population in the region, as well as future generations to come.

[17] Due to the facilities design, it allowed Rochester Regional to better manage the COVID-19 pandemic fall and winter surges and influx of patients needing critical care.

[19] As a result, the nurses at Rochester General Hospital voted to unionize in July 2022, hoping for better pay, staffing, and consistent retention.

[25] Clifton Springs Hospital & Clinic, The 262-bed Clifton Springs Hospital & Clinic provides acute care, primary care, cancer treatment and behavioral health and addiction recovery programs in the central Finger Lakes region.

[21] UMMC joined the Rochester Regional Health family of hospitals in late 2016, but still kept its original name, and manages its own board of directors.

[33] In 2019, as they were beginning their Massena takeover, they obtained funding for "patient-centered" training[34] and grants "providing low-income St. Lawrence County residents free rides to non-medical destinations like pharmacies, grocery stores, farmer’s markets, self-help classes and other places that could improve their health.

The affiliation aims to strengthen the care that is delivered in the North Country communities served by St. Lawrence Health System.

[38] On October 20, 2017, Rochester Regional Health announced one of the most aggressive healthcare sustainability project in the United States.

[40] By the end of 2025 the company anticipates it will spend $1.5 Million less in electricity needs throughout the entire health system than it does today.