The Hennepin County Board and top Hennepin Healthcare officials met Thursday to renew discussions about a possible merger between their Minneapolis hospital, HCMC, and the North Memorial health system.

The talks are in a very preliminary stage, with no timeline for a decision, said County Board Chairwoman Marion Greene. Because “competitive” information was discussed at the meeting, Hennepin Healthcare Board Chairwoman Dr. Sheila Riggs declined to comment.

“The intent of the meeting was to have a more full beginning of a conversation,” said Riggs. “Any and every health system is always looking at a range of opportunities … and the possibility of collaboration. We don’t want to signal anything.”

The merger talks were held in a closed meeting, but the Star Tribune obtained a 15-page report about the proposal earlier this week.

The parties are drafting a letter of intent to negotiate a collaboration, which could range from a partnership between Hennepin Healthcare and North Memorial to a full merger, according to the report.

The two parties briefly discussed the topic late last year, said Greene. The new push comes as Hennepin Healthcare, which operates HCMC and a network of neighborhood clinics, has posted two years of operating losses and against a backdrop of mergers among Minnesota hospitals. The timing of the talks is not related to the recent resignation of Hennepin Healthcare’s chief executive, Dr. Jon Pryor, Greene said.

If a merger takes place, it would bring together two large urban emergency departments, while adding an outer-ring suburban hospital in Maple Grove. Hennepin Healthcare has been investing in new facilities to attract downtown workers and privately insured patients. North Memorial owns Maple Grove Hospital and 25 clinics. Both serve a large number of patients covered by the government programs Medicare and Medicaid, which typically pay hospitals and clinics less than private insurers do.

State hospital reports show that Hennepin Healthcare lost $49 million on operations in 2016 and $29 million in 2017. The County Board report showed that its financial performance improved in 2018.

During an open portion of the meeting, Hennepin Healthcare staff presented an operations update, including successes in decreasing inpatient sepsis mortality, a key measure of hospital quality, and improvements in chronic disease management and preventive health screening.

Goals for 2019 include a reduction in readmissions and reducing employee injury due to workplace violence, a trend that’s become a nationwide issue, said Lori Johnson, vice president of performance improvement service and safety at HCMC.

Several commissioners expressed concern after learning that Hennepin Healthcare received a one-star patient rating from the federal agency that runs Medicare and Medicaid, the lowest in a five-star system. Metrics used in the rating include mortality, readmission, safety of care, patient experience, efficient use of imaging and effectiveness of care.

Dr. Dan Hoody said the rating has some methodology flaws, which are being challenged by several hospital and medical college associations. Hennepin Healthcare has never had a one-star rating, he said.

Hennepin Healthcare’s interim chief executive, Dr. John Cumming, said HCMC is one of the top-performing trauma centers out of the 450 centers in the United States, according to benchmark data supplied by the American College of Surgeons. Another staff member told the board that patient experience, compared to other medical facilities across the county, had improved significantly in 2018. “Do we have an opportunity for improvement? Absolutely,” said Cumming.

Hennepin Healthcare has also undertaken a set of ambitious efforts to improve community health, said Amy Harris-Overby, the hospital system’s population health program director. Language interpreters received training to achieve better results with mentally ill patients from immigrant communities. Homeless patients were given additional assistance during their discharge from the hospital and clinics, she said.

Staff also held listening sessions with black and American Indian women to better understand prenatal and delivery experiences, and to improve cultural awareness and reduce racial disparities in medical outcomes, she said.

HCMC has long engaged different communities to serve them better, said Greene.