Rush University System for Health to merge with Endeavor Health

Two of the Chicago area’s leading health systems — Rush University System for Health (RUSH) and Endeavor Health — announced plans to merge, creating a nonprofit organization with 12 hospitals and nearly $11 billion in revenue.  

RUSH is a three-hospital academic system with three affiliated healthcare colleges. Evanston, Ill.-based Endeavor was formed in 2022 when NorthShore University HealthSystem merged with Edward-Elmhurst Health.

The combined health system would have more than 400 sites of care, employ an estimated 46,000 workers (including more than 3,400 clinicians), and serve over 2 million patients per year across northern Illinois and northwest Indiana.

Gerald “J.P.” Gallagher, president and CEO of Endeavor Health, would retain the same roles at the combined health system, which would operate under Rush’s name.

“Together, Rush and Endeavor Health have an opportunity to create a stronger, more connected health system that sets a new standard for how care is delivered and experienced across our communities,” Gallagher said. “Patients and communities will benefit from improved access, advanced research, and nationally recognized, high-quality care close to home.”  

Dr. Omar Lateef, president and CEO of RUSH, would become CEO emeritus and strategic adviser to the CEO.

Dr. Lateef said the combined health system “will embody and expand the foundational values for which both systems are known: excellence, access and health equity, backed by a leading university that drives research and trains our future healthcare leaders.

“As a unified system, we will expand upon the work Rush has done on the West Side of Chicago to strengthen our impact in communities across the region to ensure more patients benefit from the expertise, innovation, and compassion that define us,” he added.

Under the agreement, Endeavor Health has committed to investing $1 billion to support initiatives in the region centering on community impact, academics and research, and care quality and innovation.

The health systems anticipate closing the transaction early next year, pending regulatory review and approval.

Our Take: If the merger is finalized, the resulting health system will be the state’s largest — by hospital count, at least.

Although other health and academic systems have a strong presence in the Chicago area — including Advocate Health, Northwestern Medicine, Prime Healthcare, and University of Chicago Medicine — the size of a newly merged RUSH-Endeavor Health could give it a competitive advantage.  

(Advocate and Northwestern Medicine both have 11 hospitals and more than 200 sites of care in Illinois. Prime Healthcare now has nine hospitals in the state, with the addition of Franciscan Health Olympia Fields earlier this year.)

Given how competitive the Chicago market is, it’s a safe bet that regulators will be taking a close look at how the proposed merger between RUSH and Endeavor might affect costs and access to care.

HCR #222: Award-winning Nature and Science Writer Mary Roach

There's a wide gap between how medical breakthroughs get announced and the reality of what they do for patients in the real world. Few people have spent as much time inside that gap as Mary Roach, author of eight New York Times bestsellers. In this episode, Mary shares stories from Replaceable You: Adventures in Human Anatomy, including reporting from a Chinese sterile pig farm used for xenotransplantation research and what it’s like to spend the night in a working iron lung. This is the first episode in our author series, featuring the best writers in science and medicine today. Available on YouTube, Spotify, Apple, or your favorite source for podcasts.

What else you need to know

Humana announced a new joint venture with BlackRock that will replace existing joint ventures between Humana’s CenterWell and private equity firm Welsh, Carson, Anderson & Stowe. BlackRock, an investment firm, will acquire WCAS’ ownership stake in the joint ventures, valued at approximately $2.8 billion, and will operate an existing network of nearly 150 CenterWell senior primary care clinics. CenterWell will still hold a minority ownership stake and will continue to manage operations at the clinics.

The new joint venture expects to deploy additional capital over the next two years to fund existing clinical operations, establish new clinics, and expand the network through acquisitions, Humana said. CenterWell will have the option to purchase clinics from the joint venture, starting in 2028. If CenterWell has not acquired all of the joint venture’s clinics by the end of 2033, BlackRock will have the right to exit the joint venture through the sale of the remaining clinics. In that scenario, CenterWell would have the right to submit the first bid to acquire those clinics.

By replacing the WCAS joint ventures, Humana eliminates “put options” contained in those agreements. If WCAS were to exercise the put options, CenterWell would be required to buy back its equity stake in the clinics at a predetermined price. The new joint venture transaction with BlackRock is expected to close by year-end, provided customary closing conditions are satisfied and regulatory officials grant the necessary approvals.  

AstraZeneca could pay insitro up to nearly $1.9 billion in an AI-enabled drug discovery deal focused on treatments for metabolic dysfunction-associated steatohepatitis (MASH) and cardiomyopathies. San Francisco-based insitro will use its Virtual Human platform to identify causal disease biology in both indications and advance targets selected by AstraZeneca from discovery to development candidate, according to the press release. AstraZeneca will lead clinical development of the candidates, as well as regulatory requirements and commercialization operations. Insitro will receive $40 million up front and could receive approximately $1.46 billion in milestone payments.

In a separate deal, Danish drug company Zealand Pharma will collaborate with Sommerville, Mass.-based Generate Biomedicines to design and develop multispecific protein therapeutics for obesity and other metabolic diseases. In return for an upfront payment of $30 million, Generate Biomedicines will use its generative AI platform to lead research through lead-candidate selection. Zealand will be responsible for ensuing activities, including clinical development, regulatory submissions, and commercialization. Generate Biomedicines will also receive up to $35 million in early preclinical milestone payments and is eligible to receive nearly $1.2 billion in total milestones, Zealand noted in the news release.  

Johns Hopkins Medicine and OpenEvidence are partnering to design a modernized medical education model with adaptive AI systems. In their joint announcement, Dr. Sanjay Desai, vice dean for education at Johns Hopkins Medicine, said, “Working with OpenEvidence enables us to design and inspire, very deliberately, the model of education and the practice of medicine for this new era.” Dr. Travis Zack, OpenEvidence’s chief medical officer, said, “We believe the future of medicine should be built, not reacted to, and that it must keep patients at the center. There is no institution better suited to build it than Johns Hopkins, the birthplace of modern medical education.”

The two organizations will also partner on developing “human-first AI systems” designed to improve how care is delivered. Dr. Sara Murray, Johns Hopkins Medicine’s chief medical informatics and AI officer, said the collaboration with OpenEvidence is an opportunity to give the health system’s clinicians “tools that make every encounter more informed, more precise, and more attuned to the individual patient in front of them.”

Hospital groups are once again suing HHS over the 340B rebate pilot program, which is set to go into effect on Jan. 1. The American Hospital Association, the Maine Hospital Association, and four safety-net hospitals successfully blocked implementation of the original pilot program at the start of this year with a lawsuit filed in December.

Under the pilot, hospitals would pay the full market price for selected drugs and then be reimbursed after the drugs were administered and proper documentation had been submitted to manufacturers. In February, a district court issued a motion that basically vacated the program and provided detailed steps HHS would need to take in a subsequent attempt.

On July 31, the agency within HHS that oversees the 340B program, the Health Resources and Services Administration, announced a revised, expanded pilot program. On Oct. 1, HRSA announced the approval of 10 drug manufacturers to participate in the revised pilot, prompting the same hospitals and organizations to file a new lawsuit on Oct. 9.

The plaintiffs claim that HRSA underestimated not only the effort and costs hospitals face to implement the program but also the annual administrative costs — which they say would exceed $1 billion. They also reiterate the cash flow issues hospitals could experience if forced to pay full price for the drugs and wait for reimbursement. And they indicate HRSA disregarded more than 1,200 comments 340B hospitals and other covered entities submitted describing the “catastrophic impact” of the pilot program.

In response, AbbVie, Bristol-Myers Squibb, and Boehringer Ingelheim filed a motion last Wednesday and the Pharmaceutical Research and Manufacturers of America (PhRMA) filed a separate motion Thursday asking to intervene in the lawsuit. (They made a similar request in the first round of litigation but were denied.) They say the federal government’s representation of their interests “may be inadequate,” pointing to what happened the first time HRSA attempted to roll out the rebate pilot.

Meanwhile, four House members introduced a bipartisan bill last Tuesday that would delay implementation of the 340B rebate pilot program for two years. The legislation would also prevent the use of federal funds to implement the rebate program or one like it during those two years. The intent, according to a press release from Advocates for Community Health, is to give Congress time to consider legislation introduced in the House and Senate to reform the 340B program.    

MultiCare Health System and Samaritan Health Services will begin integrating on Nov. 1, now that all of the state regulatory agencies reviewing the proposed affiliation have either approved it or indicated they would. The two nonprofit organizations announced their plans to affiliate a year ago. As part of the deal, Tacoma, Wash.-based MultiCare will invest $700 million in Corvallis, Ore.-based Samaritan over 10 years.

Samaritan will keep its name, local leadership, and community-based governance, according to the news release. The combined entity will have 18 hospitals and more than 400 care locations across Oregon, Washington, and Idaho, as well as multiple health plans (under Samaritan).  

What we’re reading

Compassus Leans Into Embedded Health System Partnerships To Power Home Health Strategy. Home Health Care News, 10.16.26

Improving Hospital Accountability And Public Health: The CHNAudit Project. Health Affairs, 10.15.26

Why Medtechs Can’t Afford to Overlook Customer Experience. McKinsey & Company, 10.13.26