Spotlight On: James Hereford, President & CEO, Fairview
February 2025 — Invest: spoke with James Hereford, president and CEO of healthcare services company Fairview, to discuss its milestones from the past year, strategies for leveraging innovation and technology, and approaches to addressing challenges in the healthcare sector.
Reflecting on the past year, what have been some of the main highlights and key milestones for Fairview?
2024 was a transformative year for us. Coming out of two challenging years with COVID, followed by the hyperinflation that ensued, we’ve achieved a significant $600 million turnaround. What’s even more remarkable is that we managed this while improving our quality and safety scores, customer service ratings, and staff engagement levels. This turnaround isn’t just about financial recovery; it allows us to reinvest in patient care, expand services, and strengthen our workforce. Fairview has now grown into an $8 billion organization, and we’re actively planning for a future that prioritizes innovation, accessibility, and excellence in healthcare delivery.
What notable market trends or dynamics would you highlight?
The Twin Cities has a unique healthcare landscape — almost a cautionary tale — that presents both opportunities and challenges. Commercial insurance reimbursements here are relatively low compared to other U.S. markets, which places ongoing financial pressures on providers. This dynamic creates a constant need to balance and cost-shift between commercial payers and government programs, which often don’t fully cover the cost of care. While low reimbursements may benefit businesses with more favorable premiums and healthcare costs, they present sustainability challenges for healthcare organizations. To remain financially strong while continuing to deliver high-quality care, we’ve focused on leveraging technology and automation to enhance efficiency. This is a shared goal across healthcare organizations in the Twin Cities as we aim to be both efficient and innovative while maintaining our quality of care. We are also deepening partnerships with employers, policymakers, and community organizations to advocate for payment models that ensure long-term healthcare access and affordability in Minnesota.
How is Fairview leveraging technology and innovation to provide top-quality care for patients?
We’re leveraging technology on both the administrative and clinical fronts to improve efficiency, access, and patient outcomes. For administrative processes, we’re automating repetitive tasks and exploring the potential of AI to streamline workflows, reduce burnout, and enhance decision-making. Clinically, we’re adapting care models to integrate new technologies, such as remote patient monitoring and predictive analytics. We’re also deeply committed to community health. For example, our Cultural Broker Program connects patients with healthcare liaisons from their own communities to help them navigate the healthcare system, as well as find affordable housing, apply for employment, navigate county systems, secure food and other basic resources, complete legal paperwork, and more. Additionally, our Food is Medicine Program enables physicians to prescribe healthy food to patients, which we source in partnership with local, predominately BIPOC farmers. These efforts are innovative and transformative, proving that a healthcare organization can drive real impact when it thinks beyond traditional clinical care. We’re proud to be recognized for this work.
Which services are driving growth for Fairview, and where do you see the strongest opportunities for expansion?
Demand for healthcare services continues to grow, driven primarily by an aging population and increased prevalence of chronic conditions. At Fairview, cardiology and transplantation programs remain among the strongest in the state, drawing patients regionally and nationally. Additionally, our primary care network — one of the largest in Minnesota, with over 600 employed physicians — continues to expand to meet growing patient needs. As private practice models become increasingly difficult to sustain, more patients and providers are turning to Fairview for stability, innovation, and a collaborative approach to care delivery. Beyond traditional service lines, we see significant opportunities in behavioral health, telehealth expansion, and AI-enabled clinical decision support, all of which align with patient needs and future healthcare trends.
How is Fairview addressing workforce development and talent management to ensure a skilled healthcare workforce for the future?
Post-COVID, we have prioritized rebuilding and sustaining our workforce. We have returned to, and in some areas surpassed, 2019 employment levels by focusing on direct hires rather than agency staffing. However, some critical areas, such as CRNAs, remain in shortage due to limited training programs. Looking ahead, the more pressing challenge is medium-term workforce sustainability. Many of our experienced clinical staff are nearing retirement, which mirrors broader demographic trends and will create significant gaps over the next decade. To address this, we’ve streamlined or eliminated thousands of inefficient administrative burdens suggested by clinicians to improve efficiency, particularly in electronic medical records. We’re also exploring new care models, such as virtual admissions and discharges, to reduce workload and allow nurses to focus on direct patient care. Workforce development will remain a critical focus for at least the next decade.
Shifting to patient care expectations, have there been any notable changes in recent years, and how is Fairview addressing these shifts?
Over my 35 years in healthcare, I have witnessed two fundamental shifts: greater patient involvement in care decisions and increased financial responsibility of patients. With the rise of online information, patients are now more informed and engaged in their healthcare choices, expecting transparency, digital access, and personalized care. At the same time, high deductibles and rising out-of-pocket costs have made affordability a significant concern. In response, we’re enhancing digital solutions that enhance transparency, simplify access, and empower patients to manage their care more effectively. Unfortunately, we have also seen a troubling increase in violence against healthcare workers, particularly in emergency and behavioral health settings. We are actively investing in training, security measures, and policy advocacy to ensure a safer environment for our staff and patients.
What do you see as the primary challenges for the healthcare industry, and how is Fairview addressing them?
The U.S. healthcare system is economically unsustainable, with $4.5 trillion in annual spending that doesn’t consistently yield better health outcomes. The system has largely shifted costs to individuals, creating significant inequities and straining families. At Fairview, we believe innovation and collaboration are key to solving these challenges. New patient experiences, clinical models, and technologies are crucial to maintaining quality and sustainability. We’re also collaborating with health plans to create better care experiences while addressing financial challenges. While Twin Cities’ health systems feel these pressures acutely due to lower commercial reimbursements, this will soon become a national issue. We need bold solutions that realign incentives, improve affordability, and ensure healthcare remains accessible to all.
One bold solution that I am extremely proud of is our emergency mental health care model. In 2021, we opened EmPATH, a purpose-built emergency department for mental health. It provides a quieter, more supportive environment and is staffed by specialists trained in behavioral health. The outcomes have been remarkable, including reduced hospitalizations and better care continuity. However, reimbursement challenges remain a hurdle and so there are still only a few such programs in the country. This initiative exemplifies our commitment to innovation and patient-centered care, even when economic incentives lag behind.
Looking ahead, what are Fairview’s main priorities for the next two to three years?
Over the next two to three years, we are committed to positioning Fairview as a national leader in healthcare innovation — an organization known both for its cutting-edge care models and its dedication to supporting our patients, employees and communities alike.
Our primary focus areas include: 1) Becoming the employer of choice for healthcare professionals by fostering a culture of excellence, innovation and wellbeing. We must create an environment where clinicians can focus on patient care without excessive administrative burdens. 2) Expanding the use of AI and automation to improve efficiency, reduce clinician burnout, and enhance patient outcomes. 3) Ensuring long-term financial sustainability by advocating for equitable payment models, driving operational efficiencies, and strategically investing in growth areas that align with evolving patient needs.
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