"No matter who owns it, revitalizing Minnesota’s flagship university’s medical center is urgent," Jill Burcum writes. "The U of M remains a health care standout, but there’s an arms race underway nationally to retool academic health centers for future needs and technology." (Alex Kormann/The Minnesota Star Tribune)

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The University of Minnesota’s new president, Dr. Rebecca Cunningham, clearly understands one of her most important assignments: charting a new future for the U’s academic medical center, which trains nearly 70% of the state’s physicians.

The announcement Friday that the U and Duluth-based Essentia Health have a “proposed framework” that “aspires to bring together the collective strengths of both organizations and potentially other University and Essentia Health partners” is welcome evidence that Cunningham is taking this responsibility seriously.

She’s pushing to show progress on this critical front early in her tenure and wanting to be transparent about steps forward. While that’s commendable, a wait-and-see approach is still in order about the new collaboration.

The U and Cunningham appear to be heading in the right direction by partnering with Essentia, expanding the U’s outstate reach. Essentia’s CEO, Dr. David Herman, is also a respected Minnesota health executive. But at this point, there’s not even an agreement between the two organizations to analyze.

In addition, Friday’s announcement generated more questions than answers. One key concern: How does Fairview Health Services fit into the “bold vision” outlined Friday by Cunningham and Herman? And does Fairview want to fit into it?

Fairview currently owns the U’s medical center. It’s also a large Twin Cities-based health system, with medical facilities critical to the U’s future endeavors. Among the reasons why: patient volume. As the Minnesota Star Tribune has reported, Essentia is the state’s eighth-largest health system by revenue, with Fairview the fourth-largest.

Doctors and students at the Twin Cities campus also need metro facilities to practice and train in. If Fairview still owns the U’s teaching hospitals, how would that work?

As Cunningham acknowledged Friday during a question-and-answer session I attended with two other Star Tribune writers, “We’re not talking about doing this without the Fairview system.”

If that’s the case, why did Fairview officials tell a Star Tribune reporter that “they were only just learning” about the Essentia collaboration proposal?

“Fairview became aware of the University’s discussions with Essentia within the last 24 hours and has not been provided with details on the concept,” Fairview said in a statement. “Fairview is an independent, nonprofit organization and decisions about our future will remain under the purview of our Board of Directors and leadership team.”

The proposed framework between the U and Essentia appears to be a merger. If Fairview is to be part of that, giving its leadership 24-hour notice of a new partner is a curious strategy.

I walked away from the Q&A session wondering if this was an attempt to pressure Fairview into speeding up consideration of a merger. But I also worried that the announcement’s handling might have exacerbated long-running rancor between the U and Fairview.

That tension is a challenge that Cunningham, who officially began her presidential appointment in July, inherited. Fairview Health Services, a privately-run nonprofit, acquired the U’s medical center in a late 1990s financial bailout.

I’ve been around long enough to remember well how controversial that decision was at the time. Controversy flared again in 2013 and then in late 2022, when Fairview and South Dakota-based Sanford Health proposed mergers generating intense blowback and involvement by two Minnesota attorneys general.

At issue: control of the state’s flagship university medical center by an out-of-state entity. Two former governors, Mark Dayton and Tim Pawlenty, are on record opposing that. Unsurprisingly, both proposed deals collapsed.

The most recent one seriously strained the relationship between the U and Fairview and led the U to push to acquire the medical center and pursue a new direction.

Cunningham is a physician and it’s fortuitous that she’s leading the U at this critical juncture, bringing a passion and expertise that the U’s previous president sorely lacked. She and Herman did provide welcome clarity Friday on some key issues:

There would be a $1 billion investment into the partnership through private and philanthropic resources. Minnesota legislators would not be asked to contribute public funds, which is smart given the state’s financial outlook and the Legislature’s current dysfunction.
Herman would run the new partnership. He has deep operations expertise and experience, which would benefit the new organization and inspire confidence in it.

But nailing down other information was a challenge. It’s unclear if the U still plans to acquire its teaching hospital campus, for which negotiations had been underway. Also elusive: details on how the $1 billion investment would be targeted. And, what amount of financial support would the new collaboration provide for training health providers? Fairview has said the support it currently provides is not sustainable.

In addition, Cunningham said on Friday she believed the new partnership would have “structural advantages” over the previous one with Fairview. How do you evaluate that with only a “proposed framework” at this point?

No matter who owns it, revitalizing Minnesota’s flagship university’s medical center is urgent. In late 2023, the Star Tribune Editorial Board noted a $1.2 billion investment in the University of Iowa’s medical campus. The U of M remains a health care standout, but there’s an arms race underway nationally to retool academic health centers for future needs and technology.

Failure is not an option. Medical centers are powerful economic engines for their states. The research and breakthroughs they produce power the next generation of startups. The state is currently a medical technology hub and keeping it that way is vital for our future.

So is ensuring that the state is training enough health care providers to meet our needs.

That’s why Minnesotans have a vital stake in the U medical center’s future. There’s a lot riding on Cunningham’s ability to lead, innovate and bring Fairview into the merger conversation. This is also a make-or-break issue for her presidency. Friday’s announcement of the “framework” with Essentia was a start, but heavy lifting lies ahead.