Four Reasons Sanford-MeritCare Merger Provides a Blueprint for Accountable Care

• No JVs, period

Sanford-MeritCare refuses to do joint ventures, making sure the docs are on a level playing field within the organization.

"If someone doesn't want to play our kind of team ball there are plenty of options out there. Free agency is alive and well in medicine, but I believe those days are coming to an end. Our goals is to be one of the best institutions in the country, and none of those, whether it be Kaiser, Johns Hopkins, Cleveland Clinic—none of those do joint ventures, carve-out deals—none of that stuff, he says."

• Huge size, huge goals

The sheer size of the new entity will give it further negotiating clout with insurers and economies of scale. The merger didn't require antitrust review, because the two service areas do not overlap. Health system CEOs should keep that in mind for future acquisition strategies.

"Once a legal team figures out the core business and the relationships between docs, they really start to serve as an M&A center. Our growth has really taken on meteoric proportions lately and it's because the whole team has growth on its agenda," he says.