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My grandma Kennedy used to tell me an apple a day keeps the doctor away.

And if that didn't work, well, maybe this is your plan B. Healthcare.

We're very fortunate here in the Northland to have many great qualified physicians, healthc care providers, and the institutions that take care of us when that doesn't work.

But that's changing.

Look at the changes that are happening in the insurance industry, in Medicare and Medicaid, and more importantly, the changes taking place at the very top, the merger of health care systems.

Just after completing a $900 million redesign of Duth's downtown skyline, Asentia St.

Mary's Medical Center.

That sign on the side of the building, that might be changing.

It might say Health Partners, a Bloomington-based healthc care provider.

They're talking about mergers, and that's what we're talking about this week on In Business.

I'm Ken Ber.

Thank you for joining us.

The big business of health care providers merging together.

We've seen Alina merge with Sutter Health.

We have seen here in Duth, St.

Luke's now a part of Aspirus and no longer based here in Duth.

and Sanford Health just took over North Memorial down in the Twin Cities.

It is what's happening in the healthc care industry.

And it's not new to Essentia St.

Mary's either.

They took a run at the University of Minnesota and Fairview Hospital.

That didn't pan.

Also tried Marshfield Clinic.

Will this merger work that they hope to get done by the end of this year with health partners out of Bloomington.

If it goes through, it includes 22 hospitals, 135 clinics, and 45,000 employees.

On this week in business, we'll talk to the leaders of Essentia here in Duth and health partners out of the Twin Cities.

We'll also take a look at how the unions feel about this by talking to a representative of the nurses union.

And we'll take a look at it from a politician standpoint as well.

Big business, big mergers, big medical.

It's this week on In Business, it's to your health.

Welcome to In Business.

I'm Ken Beer.

This week we look at the proposed merger between Essentia Health and Health Partners.

First, we spoke with Essentia Health and learned more about the proposed merger and why the organization wants to move forward in this direction.

Dr.

David Herman is our guest on in business.

He is the CEO and director of Essentia Health here in Duth and we're talking about the healthc care mergers going on across the nation actually and the one in particular between Essentia based here in Duth and health partners out of Bloomington Minnesota and very good for you to join us.

Thank you very much Dr.

Herman for being on in business.

Thanks very much for getting us together.

Essential Health can uh trace its roots back to the arrival of the Benedicting Sisters.

And why don't you tell us a little bit about that history as you are an expert on the original St.

Scholastica, the sister Scholastica and uh the arrival here of the Benedictine sisters.

Well, the sisters of St.

Benedict came to Duth and their original mission was education and they spent some time uh as did the uh fathers from the uh St.

John's monastery building a school in West Duth and during the time they built that school the school district in duth was formed and there really wasn't a need for the school then so uh wanting to serve the community and serve the community well they made the pivot back in 1888 and started this first St.

Mary's hospital in West Duth in 1888 and moved downtown here in Duth in 1898 and about 100 years later one of the first healthc care mergers took place when uh St.

Aries joined with the duth clinic to form SMDC.

Now I remember that merger at the time as being well radical and um very controversial in some uh circles.

How does this merger between Essentia today uh and health partners compare?

Do you think going back to the mid 1990s it was recognized that what happened in the clinic and what happened in the hospitals wasn't separate.

It was part of the same care.

Yet if there was a handover between the clinic and the hospital, that was probably one of the most challenging times for the patient.

So pulling that together as integrated care where you could smoothly go from the outpatient setting to the inpatient setting and back to the outpatient setting made it much easier for the patients.

Also, the economics dictated it at that time as well.

When you have two things that are separate and healthcare is expensive now and was expensive then, how do you make sure that the dollars go to the right place?

But I would say the fundamental reason that they got together is they recognized that they each had a mission.

Those missions were varied or similar and that by coming together they could serve that combined mission better than they could separately.

So Essentia Health right now is the pulling together of over 30 organizations since that time with the same design thesis that we can do better together than we can do separately.

We each have individual missions within our communities, but pulling together, we can better serve the people and communities we're privileged to serve together.

And why the increase in mergers now?

Uh back in 2025, I think uh for all of that year, there were 15 mergers in the Midwest.

And already in 2026, at least in the first half of the year, uh there's been just over 40 of these planned mergers.

What has changed all of a sudden from 2025 to 2026?

that makes this particular merger and the others so attractive?

Well, I think when we had the pandemic in 2020 through 2022, I think that changed a lot of things and pulling things together after that, people were just trying to get back to the what I would call the new normal and getting their health systems stabilized.

I would say there are different reasons for organizations getting together.

What you may see in some circumstances is there's a an organization that's having particular challenges, usually financial challenges.

Partnering with a stronger organization and pulling those two things together certainly makes sense.

I think the difference between this merger and th those is you have two very strong organizations from a quality safety and workforce standpoint as well as a financial standpoint pulling together.

And the reason we're pulling together is there's another inflection point we believe in medicine right now where I don't think it's a surprise to you that medicine has to become more more affordable.

There has to be less friction.

It has to be easier to navigate.

And what we found with our colleagues at health partners is we're both investing in the type of things that allow that to happen going forward.

Yet we were investing in parallel.

our clinical staff and other staff.

We're working closely together on projects.

And what we did is we sat down and said, really, does it make sense that we're investing in parallel?

We have 45,000 great people.

Does it make better sense to pull them together and invest together and be ready and not just be ready for the new future, but derive some of the things that we believe should be present in that new future.

talking about that parallel investment and the 45,000 employees in mergers.

Sometimes uh it is that back office that uh tends to feel the pain crunch of layoffs and so forth.

What guarantees can you give to those 45,000 people that their jobs will be protected?

Well, what I will say right now is the pulling together is not predicated on its success by laying people off.

I think one of the things that the health partners leadership and essential health leadership agree on is that we have a lot of great people and so how can we employ those people to deliver better health care more costeffective health care more efficient healthcare going forward I don't think any of us can guarantee the future uh my future or your future particularly in a in a environment of change that if not chaotic is certainly dynamic but we know that we can do better together than we can separately What do you think the effects will be noticeably uh other than the name change on the front of the building uh to the communities you serve?

First of all, there will not be a name change on the front of the building.

We're going to keep the Essentia Health name uh likely for years going forward.

Uh and that'll be a decision that'll be made in the future.

I don't think they'll see a a lot of changes.

Certainly, we are looking to provide more services in more locations rather than fewer services in fewer locations.

I think what what they'll find is Essentia Health's commitment to the community remains become stronger and hopefully we can provide better and more services in the communities we're privileged to serve.

Not all mergers uh go well uh in the healthcare industry.

I think of the uh doctors pushing back against Sutter Health right now uh in some editorials that they've posted.

Uh Fairview University had some problems.

Uh the university uh also you took a run at the university hospitals as well.

um what makes this one different?

First of all, I think when you talk about people whether it's in the health care space or other business space, culture is the thing that really drives the success in the organization.

And I'm going to use the quote of one of my colleagues who has worked very very closely with his health partner colleagues over the time.

He said, I found each time when I sat across the table from my colleagues at health partners, it was like looking in the mirror.

They believe in the same things we do.

They invest in the same things we do.

They care for their patients in the same highquality way that we do.

If you look back at the Minnesota community measures as a side, Essentia Health and Health Partners are either one or two over the last several years.

So having that cultural commonality, I think will certainly help.

I think having two organizations that are very capable and currently strong will certainly help.

I also think the most important part is the commitment to the communities we're privileged to serve.

Each of these organizations has a commitment and a long-standing commitment as well as success in providing care close to home.

And those will be just some of the things that will be the glue that'll hold us together and continue to bring us together as time goes forward.

Dr.

Herman, the people that are being served by Essentia Health, what are they going to see as the benefit from this merger?

First of all, you have two organizations that have a long history of high performance and quality.

You have two organizations with a long history and high performance of providing that care close to home.

You will now have the combined power of those two organizations both committed to what you want in your community going forward.

And making those investments together and changing health care together provides more sec and better care in the communities we're privileged to serve.

Dr.

David Herman is our guest on in business.

He's the CEO and director of Essential Health.

We're talking about the proposed merger and uh Dr.

Spectrum and thank you very much for being a guest on in business.

Thank you very much.

I've really enjoyed our conversation.

The proposed merger has also raised questions about what consolidation could mean for the healthcare workers and patients.

We spoke with the Minnesota Nurses Association to hear their perspective on the proposal and the concerns they want addressed.

In business continues as we look at the proposed merger between Essentia Health here in Duth and Health Partners based in Bloomington, Minnesota.

One of the groups that'll be most affected by this proposed merger would be the union members who work for the hospitals involved.

Now, Chris Rubish is the president of the Minnesota Nurses Association.

He also happens to be a registered nurse at Essentia and so he's got a very good insight into the merger possibilities here and how that might affect the nurses union.

Chris, thank you very much for being on In Business.

Thanks for having me.

Thank you for uh taking your time.

I know everyone involved in this proposed merger is very busy at this particular time.

So, let's start with a little bit about um your history.

Uh how long have you been the president of the Minnesota Nurses Association and uh an employee at Essentia?

Um so, I've been a registered nurse, a cardiac registered nurse for 11 years now.

Um that entire time at Essentia St.

Mary's in Duth.

Um, and I just finished my first term as uh president of our union and uh just um will be starting my second three-year term in January.

How many members are there to the Minnesota Nurses Association?

Uh we represent 25,000 mostly nurses uh but also other healthcare disciplines in Minnesota as well as uh having members in Iowa, North Dakota, and Wisconsin.

And how many of those members work at either Essentia or Health Partners?

We have several thousand members um who will be in these two affected systems, you know, so we uh have a lot at stake and have a lot of concerns about uh the proposed consolidation.

The proponents of this who we've also talked to on in business are telling us that there are merger benefits to uh funding in a tight time of reimbursement for hospital and doctor and nurse services.

Um so that's one side.

What is the other side?

what does your uh constituency worry about most in these big healthcare mergers?

You know, well, we're always concerned about consolidations in the healthcare industry and and one thing I would just say is that, you know, I'm not sure that we're really viewing this as a merger.

Um I think it's really more of a consolidation or an acquisition.

Um but whatever you want to call it, anytime a health care system gets bigger.

Um there's uh less choice for patients um where they're going to go, what system they want to be involved in, who their doctor is going to be, and there's less choice for workers.

Um so, you know, when we're limiting options, uh that generally leads to higher prices, less competition, less option for patients and workers.

Chris Rubish is the president of the Minnesota Nurses Association.

This is in business.

We're talking about the merger, acquisition, or the combination, if you will, of uh two very large health care systems.

one uh serving northern Minnesota and the rest serving other states of Wisconsin for instance, North Dakota.

Uh this is going to be a very very large uh organization when it's all said and done.

Um are you worried that uh union representation might be lost in all this?

You know, I think we have a really strong union member leaders uh across the region.

So, I'm not concerned about us losing our union voice.

Um but what I am concerned about is in this instance having an entity that is owned by a health insurance company expanding their footprint in healthcare provision.

Um and I think when you have one organization uh owning both sides of the healthcare equation uh that's a real that's a real concern I think for patients and workers.

What do you think is driving all these mergers?

I mean we've seen a couple in the Twin Cities.

Uh we've seen Sanford coming in uh here in Duth.

Aspirus took over uh St.

Luke's uh once a local organization now run elsewhere.

Um what's driving all this?

You know, I think first and foremost uh we have uh cuts that are coming as a result of uh House Bill one, the um priority of the the current uh federal administration in Washington.

And I think that a lot of health insurance um and health uh health care systems are concerned about what those cuts are going to do um for their funding and their revenue sources starting in January.

Going on another track for a moment, I mentioned before Aspirus is now St.

Luke's uh health partners hopes to be Essentia.

Besides the effect on the workers and the patients, what about the communities?

I mean, these are very big organizations in our town.

Yeah.

Um, I think another thing that isn't necessarily talked about a lot, but has a big impact as companies get bigger and bigger, some of these health insurance uh, health care systems buy more and more space.

They develop more and more real estate.

Um, and because they're nonprofits, that's that's infrastructure.

That's um real estate that's taken off of our property tax roles.

Um, and so we lose revenue for state um and local governments.

And I think that that is something we as a community need to talk about.

Chris Rubish is our guest.

He is the uh president of the Minnesota Nurses Association.

He's also a registered nurse at Essentia here in Duth.

And we thank you very much for being on business.

What uh tell me about the uh possibilities of the good side of what might happen with this.

I mean, we've seen enough mergers and acquisitions.

Um are there upsides and have you seen some?

That's a that's a hard question for me to answer.

I think statistically uh we tend to see prices go up.

Uh we tend to see closures and reductions in services.

We tend to see less option and choice for patients and workers.

Um I would like to know if there are positives.

Um I'm certainly willing to meet with health partners and essenti um to get those written commitments that they won't close services, that they won't um reduce access in rural communities.

Um, but until we see that, um, I'm really skeptical.

As we look at mergers, either this one as being proposed or others that have already taken place, what are some of the things that nurses in your union and patients in general should look for in these new conglomerates?

Well, I would really look for written commitments um that those organizations make with either workers or with the state through the attorney general's office.

Um, and I would I would give the example of Fost, Minnesota.

This is a community hospital that uh contracted with Essentia to run the um hospital.

Essentia committed to keeping labor and delivery services open um and then changed that commitment and and ended up closing labor and delivery services.

So, if I'm a resident of Boston or anywhere in rural Minnesota, I would really be looking for written enforceable commitments um that the attorney general can hold uh the new the new uh organization accountable to.

Chris Rubish is the president of the Minnesota Nurses Association and uh thank you very much for being a guest on in business.

Thanks for having me.

Chris alluded to this in our discussion and unlike sister Scholastica and the Benedictines who founded St.

Mary's Hospital here in Duth, the history of Health Partners started with a legal fight to change Minnesota state statutes that favored traditional insurance companies and outlawed cooperative prepaid medical plans.

Health Partners started as Group Health, a way to help people pay for health care without being an insurance company, but a co-op.

Next, we talked with Bloomington-based Health Partners, who is merging with Essentia Health here in Duth.

Our guest is Dr.

Mark Sanis.

Dr.

Sannis is the chief medical officer and a member of the Health Partners board of directors.

Dr.

Sannis, welcome to In Business and thank you for joining us.

Thank you for having me, Ken.

Now between those existing insurance companies back in the day, hospitals and physician associations that had sway over political leaders, there was substantial resistance to this cooperative idea of prepaying medical coverage.

Uh please tell us how that was coming about and how it got changed and how long it took.

I don't know if I can speak to the history of that as well as uh some.

I I think what has evolved over time though is a situation where we recognize that an integrated system where patients didn't have to navigate both sides of the equation, right?

The the the side where they're needing to find clinics and hospitals for care and then also uh figure out a way to get their care paid for.

The integrated model was a a model and continues to be a model that we think is easier for patients to uh navigate and also drives a more affordable uh price for healthcare overall.

All mergers are difficult and combining anything is is is difficult especially in the healthcare industry this uh time of our uh our country and so forth.

What do you see are some of the driving forces that make a merger of say Health Partners and Essentia uh desirable and maybe even necessary?

Yeah, I think the the partnership matters.

It it really does.

We know Essentia well, Essentia knows us well from really decades of partnership uh whether it be around delivering highquality care.

We've been part of similar organizations over the years.

Putting patients at the center has always been a focus for both.

So choosing your partner wisely I think matters and then also uh the economics and and the the challenges that we're all facing uh with the headwinds of the last several years in particular but those in the in the coming years as well around technology investment facilities investment how can we do this better together than we might do it separately and I think it it was a logical move on on both parties part to come forward and say this makes sense let's let's do this there's push back to all things.

Uh, and we've seen some the Alina doctors are pushing back against Sutter Health in some editorials.

Sanford uh, tried and failed to first merge with Fairview and then were successful a couple years later in merging with North Memorial.

Essentia and University Hospitals along with Fairview took a run at a merger and with the uh, Marshfield Clinic also, but those didn't quite work out.

Why do you think this possible merger has a better chance of success?

Again, I think we're coming at this from a similar place.

Uh we are two strong organizations that have uh really put patients at the center of all that we do.

And I I'd like to think that is the secret sauce in all of this.

One of the uh things that I think we have really recognized over the last 10 years for sure is that intersection of delivering great highquality care at an affordable price.

You can't price health care out of the uh ability of patients to be able to pay for it.

And I think the the commitment to to making that uh something that we're going to work on as a combined organization is something that does set us apart.

We're interested in making that work.

Uh and I I can't speak to why the others might not have worked, but I know that's why we think we will uh be successful in this going forward.

And if you are successful, I believe the number is uh 22 hospitals, 135 clinics, and 45,000 employees uh between the two organizations.

It's the employees that are expressing some concern about what happens in many mergers is finding ways to have fewer of those employees.

What would you say to them?

I would say we are in a a peopleheavy industry and we are looking for how do we do this well over time there will not be uh you know closures as a result of the the combination uh as it is uh we're not looking to reduce workforce as a result of this combination I think we're looking for how do we do this better in all parts of our geography going forward I think the uh thing that I'd like to believe about both organizations is we have strong cultures for our employees.

Uh this is a place where uh we can feel like uh clinician voice uh and colleague voice is heard across both of these organizations.

We take that into account when we are planning uh changes and I think this is going to be a terrific place to work whether you're a clinician uh or support staff at any one of our co clinics or hospitals.

Dr.

Sis, you mentioned about uh gathering input and other perspectives.

Uh what have you done to reach out to different employee groups and community groups to get that input?

Certainly, we've had terrific relationships with our uh different labor unions over time.

Obviously, all of those uh arrangements will be honored during this process and uh they were some of the first folks that we notified uh about the combination happening.

So, look to partner with them on a go forward basis as well.

Both these organizations uh though they had different roots to begin with uh have evolved over time and are now major uh healthcare providers across several states.

Um how do you think at the end essential will be remembered in the years to come when their name comes off the building and its health partners across the entire organization?

You we got we had that question several times actually over the the first few weeks after the announcement.

uh you know obviously the Ascension name will stay well while we work through the integration process.

I I hearken back to my medical student days when uh the very first patient I ever saw in any care setting was at St.

Mary's Hospital as part of the DUTH clinic.

Essential wasn't on the outside of the building at that point either.

And I I would argue that that was great care then.

Great care has continued to be something that I think Essentia has been proud of uh over its entire legacy and I don't see that changing with the the parent company uh changing names either.

Dr.

Mark Sanis is an infectious disease specialist.

He's also chief medical officer and director for health partners.

Thank you for being a guest on in business.

Thanks for having me.

Lastly, we spoke with a state local representative to hear their thoughts on this proposed merger.

My name is Pete Johnson.

I'm the state representative for district 8day.

Yeah.

I I think one of my biggest concerns when I see things like this with these mergers of big companies like that is especially in hospitals is what's going to happen to the workers in these different buildings and how will that be handled and then what's going to happen to access for patients whether it be satellite clinics or hospitals um to make sure that those things actually improve and don't get worse.

I I think the biggest thing to watch out for is what those consolidation look like, right?

I mean, you have thousands of workers in these systems that um have dedicated their lives to serving other people and making sure that they aren't cut for efficiency reasons, right?

Like so clinics aren't closed because they aren't generating revenue or things like that cuz it shouldn't be a cost driver to make some of those decisions.

And if we are going to continue to uh allow these mergers, they have to be in the best interest for the patients and the workers that are working in these hospitals and clinics.

I'm Ken Ber.

Thanks for watching In Business.

Now, if you missed any parts of tonight's show, you can always watch it at pbsnorth.org or listen on Mondays at 5:30 on the North 1033.

Thanks again for watching and until next time, let's take care of each other.