An operating agreement between Fairview Health Services and the University of Minnesota will expire at the end of 2026, which places James Hereford in a public spotlight next year; he’s “optimistic we’ll find a path forward that preserves access to academic medicine and research excellence for the people of Minnesota.” Negotiations on a new deal have been lengthy. But Hereford’s main job has been leading a financial turnaround for Fairview. The health system recorded a $315 million operating loss in 2022 but achieved profitability in 2024. Hereford says he’s invested in primary care, behavioral health, and community-based services. He’s keeping watch on federal developments, because Medicaid funding reductions would have a big, negative impact.