Haverhill, Mass.-based Merrimack Health is one of the newest health systems in the country — and one of the most unusually formed.
Created in the aftermath of Dallas-based Steward Health Care’s bankruptcy, the three-hospital system brings together Lawrence General Hospital and Holy Family Hospital campuses in Haverhill and Methuen, Mass., under a single regional identity. The integration moved at breakneck speed, transforming longtime competitors into one organization almost overnight.
Diana Richardson, who stepped into the role of permanent president and CEO in October after serving as interim leader since April, has been at the center of that transition. In a recent episode of the “Becker’s Healthcare Podcast,” she reflects on leading Merrimack Health through its rapid formation, the challenges of post-acquisition integration and how she is preparing the safety-net system for financial and coverage pressures ahead.
Editor’s note: Responses are lightly edited for length and clarity. Click here to listen to the full episode of the podcast.
Question. This was a unique transaction given the circumstances surrounding Steward Health Care, but we often hear the most challenging work comes post-integration. What were the biggest challenges you faced in unifying these hospitals?
Diana Richardson: You really have to start with the speed at which this system came together. I’ve had the opportunity to participate in forming, integrating or expanding systems across multiple organizations. Usually, what happens is that conversations begin for a variety of reasons — sometimes financial, sometimes operational. You talk about strategy, what the structure might look like, and then you have lots of people meeting for many months. Eventually, you come together and start executing all the work planned during that preparation period.
In our scenario, though, there wasn’t even a glimmer of these organizations coming together in May of 2024 — and by Oct. 1, they had. It happened that fast. There was no opportunity for any of that usual planning; no time to talk about strategy or culture or how we’d start aligning operations. None of that happened.
So we had to do the work in reverse. We came together Oct. 1, 2024, and then started asking: What do we integrate first? The top priority was the EMR. Normally, a medical record integration takes 12 to 18 months. We had to do it in about six — without prep time or the ability for teams to coordinate in advance.
Coming together as one medical staff, aligning on quality metrics, policies and processes — that was crucial. We needed to ensure that no matter where you were seen in our system, you received the same high-quality care. Even basics, like making sure the phones worked, were a challenge. The hospitals we acquired had been neglected for years.
So when you ask about the biggest challenges — the first was doing this work as fast as possible, while still doing it the right way: respectfully and responsibly, both culturally and financially.
Culturally, it was actually quite different from most integrations I’ve been part of. Usually, there’s a clash — different ways of working, different identities, and a lot of effort goes into aligning people. But here, the commitment to community was so strong across both organizations. The hospitals are less than two miles apart.
When Steward’s future became uncertain, many staff members sought jobs at the other hospital just down the road. So you had familiar faces, colleagues, neighbors — even the patients moved between facilities. There was a natural cultural alignment from day one. The usual hurdles just weren’t there. Instead, the real challenges were operational: restoring facilities, rebuilding infrastructure and restoring the confidence of our patients in the acquired hospitals.
Q: How are you approaching financial sustainability for the health system? Where are you focusing your efforts?
DR: One of the things that really helped us during our first year was the incredible partnership we had from state leadership. The state made a significant investment in Lawrence General, and as a standalone safety-net community hospital, there’s no way we could have pulled this off without that support.
That said, we’re all now facing some very serious challenges in the years ahead. It’s our responsibility to figure out how to make Merrimack Health financially sustainable — not just to weather what’s coming, but to be prepared for it. So we’re asking: What are the areas we can and need to control right now?
First, now that we’re actually a system, we’re no longer competing against each other. These hospitals used to be competitors — and often defined their services based on what their peers across town were doing. If another hospital offered something, we felt we had to offer it too.
Today, we have the opportunity to step back and ask: Based on our community, our population and our patients’ needs, what is the right mix of services? How big should each service line be? And where should it be located?
Some services — like emergency care — absolutely need to be in all three hospitals. They must be easy to access, and we will continue to provide that across the board. But for other services, it may not make sense to maintain multiple physical locations. In some cases, consolidating into one site could allow us to offer the same — or even better — access and quality, while also reducing costs.
That consolidation also creates room to add new services that have never been available in our community — services that a community hospital can and should provide. And that, in turn, supports financial sustainability.
Of course, we’re also doing the essential day-to-day work that every healthcare leader knows well: reviewing every dollar we spend and making sure we’re investing wisely — always looking for the most efficient, effective ways to drive costs out of the system. It takes operational rigor, but we also have new opportunities as a unified system that simply didn’t exist before.
Q: It has been a couple months since you stepped into that permanent president and CEO role. How has your leadership style evolved during this time of rapid change?
DR: It helps to have a healthy sense of humor as we navigate some of these challenging times. I’m fortunate to be surrounded by a team that approaches these challenges — or opportunities, depending on how you look at them — with energy, a strong sense of humor, and a realistic, supportive mindset.
In terms of leadership style, I think during any significant change, the most important things you can do are listen to your team, gather their input and make sure you’re responding to their needs and supporting the people doing the work. We have incredible individuals working across all sectors of healthcare. If we can truly listen to them and support them, leadership becomes a lot easier.
Q: What are your biggest priorities over the next 12 to 18 months?
DR: We still have a lot of work to do around integration. We prioritized clinical systems upfront because they were most critical for ensuring safe, high-quality care. Now, we need to focus on integrating our administrative processes and systems — things like our human resources platform and accounting systems. We need to bring those together into a unified structure.
So while we’ve made a lot of progress over the past year, there’s still a significant amount of integration work ahead. That’s one challenge — but certainly the biggest challenge we’re facing is the threat to care and coverage for our patients in this region.
As a safety-net provider, more than 75% of our patients are supported by some form of government payer — and the majority of those are covered by Medicaid. That puts our patient population in a particularly fragile position. We also serve a very high immigrant population. In one of our primary cities, Lawrence, more than 40% of the population is foreign-born, and over 80% are Latino. It’s a population that is both at risk of losing solid healthcare coverage and in great need of access to high-quality care.
Our challenge over the next 12 to 18 months is to make ourselves as financially sustainable as possible internally, so we’re prepared for the reality that many of our patients may not have coverage or access to care in 2026 and 2027.
We continue to partner closely with legislative leaders at the local, regional and state levels to figure out how to navigate a time when a significant portion of our population may forgo routine and preventive care. That will undoubtedly increase strain on our emergency departments and impact access to care for all patients in the region.
We have some very daunting times ahead, but our job in the next 12 to 18 months is to control everything we can — and do everything we can — to put our organization and our patients in the best possible position going forward.
Q: For other health system leaders navigating consolidation, rebranding or integration efforts today, what advice would you offer based on your experience?
DR: At Merrimack Health, we’ve learned a few key lessons. First: listen, listen, listen. That becomes even more critical in the times we’re in. Listen to your patients, your staff, your physicians — they’re the ones who will help guide you through it.
Second, don’t be afraid to move fast. If you’re truly listening to your teams and responding to their input, they’ll support you — even if things get a little clunky along the way. Have we done some things that were a bit rough around the edges? Absolutely. But the teams helped us through it, and we’re stronger because we moved quickly. So don’t let the fear of imperfection stop progress.
And third, look for partnerships — however they take shape. In our case, we had critical support from the state, but we also leaned on partnerships with other health systems in our region to help provide clinical care and program stability.
We talk a lot about “big P” and “little p” partnerships — formal and informal — but whatever form they take, they matter. Healthcare is going through a rocky period, and the more we can collaborate and support each other, the more successful we’ll all be.
The post ‘Don’t be afraid to move fast’: CEO reflects on high-stakes merger — and push for financial sustainability appeared first on Becker's Hospital Review | Healthcare News & Analysis.
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