Denise Copeland bubbled with laughter during her doctor's visit this month. A banner in the exam room commemorated her 100th birthday, and she recited ailments over the years that were successfully treated at Como Clinic.

"I have been here so many times," the Roseville resident recalled. Indeed, she has been a patient at this medical office building in St. Paul for decades.

Como Clinic served as the launch pad in 1957 for the then-controversial Group Health, an organization that was like just a few others across the country in forging a new model for health care by combining primary care with health insurance.

Eventually, it formed the basis for what's now HealthPartners, the Bloomington-based nonprofit that's on the verge of creating a new home for its founding clinic.

HealthPartners disclosed in a January filing with bondholders that it plans to spend about $80 million to build a new Como Clinic on land it purchased in 2016 just across the street from the existing building.

The facility would continue offering services ranging from primary care and pediatrics to dentistry and cardiology, but also might have new options for imaging services and orthopedic care. Planning started in November, and the opening is expected during the second half of 2026. Change is needed to better care for patients who are clamoring for more access to appointments, HealthPartners says.

Back in the 1950s, Como Clinic literally brought under one roof a medical group and a health insurance company for pre-paid medical care. This dual purpose — health plan coverage as well as employed physicians providing patient care — remains a hallmark of HealthPartners, which is now Minnesota's second largest nonprofit group.

"This clinic and this location, being both clinic and plan together at the outset — we've outgrown it years ago, but we have never outgrown the notion that we want to be located in and with community," said Andrea Walsh, the health system's chief executive, in an interview.

The idea behind HealthPartners dates to 1937 when four leaders of Minnesota's cooperative movement started meeting in St. Paul to talk about how to bring their philosophy to medical care. Co-ops were an important way for farmers at the time to work together when selling crops, and the spirit extended to credit unions where the Group Health founders were leaders.

"What was needed, [they] believed, was a cooperative organization allowing families to budget in advance for medical care, so that they would seek a physician's help when they needed it and not as a last resort," according to "An Enduring Mission," a book that Group Health published in 1991.

The founders created a mutual health insurance company that covered the cost of hospital care only — health plans where people would pre-pay for medical services were not permitted by state law. They also started a push at the Legislature to make pre-paid medicine legal.

'Socked by a big medical bill'

At the time, group health plans were cropping up in a few cities across the country. Physicians in private practice, who collected a fee for every service they provided, feared the movement would lower professional standards. Group practice, they argued, was tantamount to socialized medicine.

"They say: 'The trend will be to knock fees down. We won't be able to do anything because they'll be giving us all our income. The trend then could be to give each patient less and less time, making really careful medicine difficult,'" the Minneapolis Tribune wrote in a 1957 article on the controversy.

The article also noted: "Anyone who ever has been socked by a big medical bill will appreciate any effort to spread out Mr. American Patient's medical costs."

The election of DFL Gov. Orville Freeman in 1954 and Miles Lord as attorney general created a favorable political climate for change. The following year, Lord ruled that pre-paid medicine was legal when practiced by a nonprofit like Group Health.

Group Health believed it was giving providers better incentives for good care. It's a debate that continues today, with critics arguing that putting doctors on a budget could lead to harmful stinting, while proponents counter that fee-for-service medicine pushes doctors to run up costs while providing unnecessary care.

The founders bought a lot at the corner of Como Avenue and Eustis Street in the St. Anthony Park neighborhood of St. Paul. The structure on the western edge of St. Paul still stands. In 1956, it became headquarters for the health insurance business. Como Clinic opened in 1957.

Members paid $3.25 a month for the basic medical plan, or $7 a month for a family of four. There was no charge as patients sought a wide range of outpatient services at Como Clinic including physicals, electrocardiograms, prenatal care and certain surgeries.

Group Health members during the early years included several influential women who led the Prospect Park Co-op, a politically active group in the nearby Minneapolis neighborhood. They shaped a pivotal February 1960 meeting when nearly 350 people crammed into the Como Clinic cafeteria and elected a new slate of directors, clearly establishing the importance of membership control.

HealthPartners is not a co-op, but members still vote annually on board candidates.

In 1962, Group Health became a benefit option for employees at the University of Minnesota, where several faculty members helped chart the organization's early years.

Between 1969 and 1990, Group Health opened a number of clinics across the Twin Cities. The nonprofit took the name HealthPartners in 1992 when it merged with MedCenters, an HMO based in St. Louis Park.

It took control of Regions Hospital in St. Paul in 1993 and has since added seven others, including St. Louis Park's Methodist Hospital. HealthPartners now employs more than 27,000 people including 1,750 physicians.

Among the 55 clinics currently operated by HealthPartners, Como stands out for having an older patient population including many who have sought care there for decades, said Dr. Jason Maxwell, the clinic's medical director.

One of them is Denise Copeland, who moved to the Twin Cities in the 1960s and lived for a number of years in Prospect Park. When she visited the clinic Feb. 14, her doctor said Copeland was the third patient he'd seen that week who had recently turned 100 years old.

Como Clinic initially was a two-story building. Renovations over the years included adding a third floor and countless remodels, but "there are some structural problems with this building that interfere with patient care," Maxwell said.

Walsh, the HealthPartners CEO, said it's been clear for a number of years that Como Clinic has outgrown the building, but replacement plans were delayed by the pandemic.

"It's never about a building — it's about the people inside the building," Walsh said. "A new Como Clinic will give us the ability to care for and serve the community in the future."

Star Tribune staff librarian John Wareham contributed to this article.