About a month after Sioux Falls, S.D.-based Sanford Health and Robbinsdale, Minn.-based North Memorial Health signed a definitive agreement to combine, the organizations’ CEOs told Becker’s the timing reflects a broader reality facing healthcare: For many regional systems, long-term sustainability can depend on finding partners that can help expand access, fund major investments and preserve mission-driven care.
The deal, announced in May and expected to close later in 2026 pending regulatory approvals, would bring together Sanford — the nation’s largest rural health system, with 58 hospitals — and North Memorial, a two-hospital system that serves as a safety-net provider and operates a level 1 trauma center and one of Minnesota’s largest integrated air and ground ambulance networks.
Bill Gassen, president and CEO of Sanford Health, and Trevor Sawallish, CEO of North Memorial Health, told Becker’s their proposed partnership is less about scale for its own sake and more about creating the financial strength and operational capabilities needed to invest in trauma care, specialty services, virtual care and future growth across Minnesota.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Both organizations have emphasized this partnership is about building a stronger, more sustainable model for the future, not simply getting bigger. Looking five to 10 years ahead, what capabilities, investments or outcomes do you believe the combined system will achieve that would have been difficult independently?
Trevor Sawallish: From our perspective, this partnership allows us to grow and adapt to what patients and communities will need in the future, not simply sustain what exists today.
North Memorial Health serves an essential role in Minnesota and across the region. Our system includes clinics, two hospitals, including a level 1 trauma center, and one of the state’s largest integrated air and ground ambulance networks. Together, these services provide critical care, emergency response and access to healthcare for communities throughout Minnesota and beyond.
We are not sustainable in our current, independent model, however. In Robbinsdale, roughly 75% of the care we provide either goes unreimbursed or is reimbursed through government programs that often do not cover the full cost of care. At the same time, demand for care continues to grow while workforce shortages, inflation, reimbursement uncertainty and rising operating costs make it increasingly challenging to maintain access and invest for the future.
We have a responsibility to address those challenges proactively, not only for our organization, but for the patients, families and communities who rely on us.
That is where this partnership matters. Sanford shares our commitment to patients and the communities they serve and they bring the scale, financial strength, new competencies, and operational and clinical expertise that can help us continue serving a high-need patient population while also making the investments required for the future.
Together, we will be better positioned to modernize facilities, invest in technology, strengthen and grow services, support our workforce and improve access to care across Minnesota.
Over the next five to 10 years, success means preserving North Memorial Health’s mission and role in the community while ensuring we have the resources, capabilities and long-term stability to meet growing patient needs for generations to come.
Bill Gassen: What excites us most about this partnership is that we’ve seen firsthand what’s possible when strong local leadership is paired with the capabilities and long-term investment of our integrated health system.
Sanford Health is who we are today because of partnerships with like-minded organizations that share our mission, values and commitment to locally driven care. Time and again, we’ve seen those partnerships strengthen access, expand services and create new opportunities for patients and communities.
Bemidji, Minn., is a great example. Fifteen years ago, many patients traveled hours for specialty and advanced care. Today, patients and families have access to cardiology, oncology, behavioral health services, clinical trials and advanced therapies close to home. After combining with North Country Health Services in 2011, Sanford originally committed to investing $75 million in the region over 10 years. Fifteen years later, we have invested $170 million.
That same philosophy will guide this partnership. Our focus will be on strengthening Robbinsdale Hospital, doubling the size of Maple Grove Hospital, expanding access to specialty and behavioral health services, leveraging virtual care and innovation and creating a more coordinated and seamless care experience for patients.
Five to 10 years from now, I believe Minnesotans will benefit from bringing together North’s strengths in trauma care, emergency medicine and specialty services with Sanford’s experience serving communities across greater Minnesota. Together, we have an opportunity to better connect care across rural and urban communities, making it easier for patients to access the expertise, services and support they need, regardless of where they live. Success will be measured by sustained investment, improved outcomes and healthcare that remains accessible and affordable for future generations.
Q: Health systems across the country, particularly in Minnesota, are facing pressures around reimbursement, workforce shortages, capital demands and the shift toward outpatient and digital care. What does this transaction signal about the future viability of standalone regional health systems?
TS: This partnership reflects the reality that healthcare is changing rapidly.
Across the country, health systems are navigating demographic shifts, growing demand for care, workforce shortages and the need to invest in technology, facilities and new models of care. At the same time, patients increasingly expect, and deserve, care that is more convenient, seamless and affordable.
For North Memorial Health, our focus was not only on how to respond to the challenges of today, but more importantly, how we can continue to deliver on our mission and our commitment to our patients for the long term.
We saw an opportunity to build on North’s strengths by partnering with an organization that believes in our mission and shares our values and commitment to community. We are confident that patients, employees and communities will be better served by creating a stronger foundation for the future and expanding our ability to invest in care delivery, workforce development, specialty services and technology.
BG: The broader lesson is that the future of healthcare will require greater collaboration and partnership.
The challenges facing healthcare today are bigger than any one organization. Workforce shortages, affordability concerns, access gaps, behavioral health needs and capital demands exist in communities across the country.
Organizations that will be best positioned for the future are those that can combine strong local leadership and community relationships with the scale, capabilities and resources needed to invest in innovation, workforce development and access to care.
That’s one of the things that attracted us to North. We saw a highly respected organization with a strong mission, deep community relationships and critical statewide assets in trauma, EMS and specialty care.
This partnership reflects what can happen when two mission-driven organizations come together around a shared vision, creating a model that is stronger, more resilient and better positioned to meet the evolving needs of patients and communities for decades to come.
Q: This deal includes commitments around trauma care, EMS integration, ambulatory growth, virtual care and AI-enabled infrastructure. How are you prioritizing major strategic investments while maintaining financial discipline in today’s environment?
BG: As an integrated health system, we have the ability to bring together the scale, stability and resources needed to make long-term investments while remaining intentional and disciplined about where and how those investments are made.
By design, investment decisions are guided by local leadership and governance, ensuring those closest to the community play a central role in shaping priorities. At the same time, Sanford’s leaders work together across regions to evaluate opportunities through the lens of community need, access, quality, operational impact and long-term sustainability.
A key priority is strengthening and modernizing Robbinsdale Hospital to not only ensure the long-term sustainability of this essential provider and level 1 trauma center, but to help it thrive. That includes addressing deferred maintenance, improving operational performance, supporting the workforce and making sustained investments that strengthen care for the community over the long term.
We’re also excited about the opportunities at Maple Grove Hospital. Together, we have plans to double the size of the hospital, expand emergency, inpatient and surgical capacity, grow Minnesota’s largest birth center and improve access to services like cardiology and interventional radiology.
Technology and virtual care will also play an increasingly important role. Sanford has invested $350 million in a virtual care platform spanning nearly 80 specialties because we know what we do will not change but how we do our work must. These investments are focused on the capabilities that will have the greatest impact for patients, expanding access, improving coordination and strengthening long-term sustainability.
TS: For North, this partnership drives our ability to invest from a position of strength.
Demand for specialty care, behavioral health services, trauma care and emergency services continues to grow, while the cost of maintaining facilities, investing in technology and supporting the workforce continues to increase.
One of the things that attracted us to Sanford was its proven track record of investing in local communities while strengthening access to care.
We see that opportunity in both Robbinsdale and Maple Grove. Robbinsdale Hospital plays a critical role as a safety-net provider and level 1 trauma center serving patients from across Minnesota. Maple Grove is one of the fastest-growing communities in the state, with increasing demand for inpatient, outpatient and specialty services.
This partnership gives us greater capacity to invest in our people, facilities and technology to expand access to care and ensure we can meet the needs of growing communities for the long term. It also brings exceptional caregivers and teams together to help bring new solutions to the challenges of healthcare and healthcare affordability.
Q: For leaders evaluating partnerships or affiliations themselves, what was the hardest reality each organization had to confront before deciding remaining fully independent was no longer the best long-term path?
TS: For decades, protecting our mission meant protecting our independence, but things are different now. For us, the hardest reality to confront was the fact that if we truly were going to fulfill our core obligation of protecting our mission, our independence was less important.
North Memorial Health serves a unique role in Minnesota as a safety-net provider, level 1 trauma center and EMS leader. Every day, we care for patients and communities that depend on us for essential services that cannot simply be replaced or replicated.
As leaders, we had to honestly ask ourselves what would best position us to fulfill that mission not just today, but 10 and 20 years from now. The answer wasn’t about remaining independent at all costs. It was about ensuring we had the resources, capabilities and long-term stability needed to continue serving our communities for generations to come.
That shifted the conversation. Rather than asking, “How do we stay independent?” we began asking, “Who can help us strengthen and advance our mission?”
What made Sanford Health the right partner was a shared commitment to patients and communities, strong alignment in values and culture, and the ability to bring additional resources and expertise that will help us do more for the people we serve.
Ultimately, this decision was never about getting bigger. It was about ensuring that North Memorial Health’s mission remains strong, sustainable and capable of meeting the evolving needs of our communities long into the future.
BG: When I think about the future of healthcare, I believe success will be defined by how well organizations can connect care across settings, specialties and communities to better serve patients.
The organizations that will be best positioned for the future are those that can combine deep local relationships and community trust with the capabilities needed to deliver increasingly complex care, invest in innovation, develop the workforce and keep care accessible and affordable over the long term.
What made this opportunity compelling was the chance to bring together complementary strengths in a way that benefits patients across Minnesota.
North brings extraordinary expertise in trauma care, emergency medicine, EMS and caring for medically complex patients. Sanford brings experience connecting care across communities through specialty networks, virtual care, workforce development, graduate medical education and research.
Looking ahead, I believe some of the greatest opportunities in healthcare will come from creating stronger connections, between rural and urban care, between physical and behavioral health, between in-person and virtual care, and across the entire patient experience.
That’s what excites me most about this partnership. It’s an opportunity to build a more connected, more resilient and more sustainable model of care for the future, one that preserves locally driven care while expanding access to the expertise, services and resources patients and communities need to thrive, for generations to come.
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