Risk is nothing new to acute care health systems working in challenging environments that demand urgent solutions. However, what has changed over the past two years is how quickly an internal or an external decision turns into a public and political story.
For some systems it’s a shift in payer mix, for others it’s a decision to consolidate a service line. Or the staffing shortages that impact expenses and patient expectations. Any of these can now reach patients, employees, community leaders, and regulators before your own team has had a chance
to get ahead of it. The organizations that manage this well treat communication as part of the operating plan rather than as an afterthought once the decision is already made.
At Tunheim, we’ve been helping organizations like yours be understood by your stakeholders for over 35 years. Whether it’s a communications issue you’re currently experiencing or an unforeseen one that could sneak up on you down the line, we’re here for you.
Here are four pressures we are seeing acute care systems in the region experience.
FOUR KEY PRESSURES
1. The Medicaid squeeze has become a community conversation
The federal budget law enacted in 2025 cuts Medicaid by roughly $1T nationally, and Minnesota officials estimate the effect at around $500M a year in lost reimbursement for hospital and nursing home care. The pain falls first on rural and safety-net hospitals already running on the thinnest margins, and the new federal rural fund will cover only a fraction of the loss. When that pressure trims a service line or backs up an emergency department, the community reads it as a statement about the institution's future, so it is better to explain that math yourself than to let rumor fill the space.
2. Consolidation is now happening in full public view
The proposed acquisition of Allina Health by California-based Sutter Health has put the growth strategy of every Minnesota system under a brighter light. The Attorney General is currently reviewing it, and unions are raising questions about jobs and local control. In this climate, any merger, affiliation or service change is measured against one question: whether the move serves Minnesota patients or mainly serves the balance sheet. That question deserves a clear answer, offered early and in your own voice, before the criticism takes hold.
3. Workforce has become a matter of public trust
Staffing is no longer a conversation that stays inside the building. During the 2025 bargaining cycle, roughly 15,000 nurses across the Twin Cities and Duluth negotiated together and, for the first time, ranked safe staffing ahead of wages, and the added pressure on an immigrant care workforce many systems depend on, only sharpens the issue. The systems that come
through in good standing tend to be the ones that had already earned the trust of their staff and community before any contract deadline arrived.
4. Automation and AI are read two ways at once
Cost pressure and clinician shortages are pushing artificial intelligence and automation further into both clinical care and back-office work, and the Sutter and Allina proposal is explicitly built around expanding those capabilities. Inside the organization the right tools can ease documentation and take some weight off exhausted staff, yet from the outside the same
technology can look like a shortcut around the human parts of care. The way through it is to explain these decisions early and to make it clear that clinicians, not algorithms, remain the ones making the patient calls that matter.
The common thread across all four pressures is that risk has become more visible and moves faster than it used to. Patients, employees and regulators now judge a health system as much on how clearly it explains a decision as on the decision itself. That makes communication less a final step than a genuine part of leadership.
HOW TUNHEIM HELPS
- Message architecture - We help you settle your position on the difficult issues before they surface publicly, so the organization speaks with one clear voice.
- Rapid response - We put a plan and prepared spokespeople in place ahead of time, so a breaking story meets a ready team instead of a scramble.
- Community trust - We keep you engaged with the local leaders, reporters and partners who shape how your community understands you.
- Stakeholder Discovery - We map who shapes the outcome, from staff to regulators, and learn what they think before you set a
position.
Let's talk. The health systems that treat communication as part of their strategy tend to hold onto community trust through a period like this one, while those that treat it as cleanup often spend years trying to rebuild it. We would welcome the chance to help you build that plan while the initiative is still yours.
