Two Health Systems, One Strategy: How Emplify Health Made the Merger Stick

When Katie Nowak moved into the director of strategy role at Emplify Health, she went looking for one thing: a single place to see everything the organization was working on and how it connected to the goals.

She couldn't find it. Project management kept its own list, the agile teams tracked their sprints somewhere else, and strategy itself lived in slide decks that showed up in a meeting and then disappeared. Every time she asked where she could see the whole picture, the answer came back the same. There wasn't one place, and the line connecting all that work to the goals was just as scattered.

Plenty of organizations have a version of this problem. Emplify's came with an extra complication: the company was barely a year into a merger.

A Merger of Equals, And Two of Everything

Emplify Health is what you get when Gunderson Health System and Bellin Health combine, a merger of equals that produced 11 hospitals and more than 100 clinics. The name blends "amplify" and "empathy." Amplifying empathy.

The appeal of a merger fades quickly once you reach the operational reality. Two systems meant two of everything, including two ways of running strategy. Each had built its own governance and its own vocabulary for the work, and each worked perfectly well on its own. Put the two together, and they stopped lining up. The mismatch showed up in the language first.

"We spoke this language, they spoke this language... When we merged, the right hand and the left hand didn't know how to speak to each other." — Katie Nowak, Director of Strategy, Emplify Health

Two regions would sometimes run the same project to solve the same problem, give it two different names, and never compare notes. That kind of duplication is expensive anywhere. In a health system it costs more, because the margins are already thin and getting thinner, with revenue growing slower than inflation. Add the actual work of a hospital, the business of keeping people alive and improving outcomes, and there's no room for strategy that sits in a drawer.

A plan parked on a shelf, governance that exists only on paper, reporting trapped in silos: none of it ever reaches the outcomes that justify the effort.

Start With the North Star

Emplify's first move wasn't a tool. It was a decision about where the combined organization was headed.

The executive team set seven enterprise goals, what Katie's team calls North Star outcomes, and arranged them as a pyramid. Each one carries a five-year target, with annual checkpoints to keep the system honest along the way. The base is foundational: workforce engagement, patient experience, operating margin, quality and safety. Katie's point about these is that they hold each other up.

"If you don't have a workforce, how are you going to have patients? How are you going to have an operating margin? How are you going to have good quality and safety measures?" — Katie

Above the foundation sit the transformational goals, community health and healthcare affordability, and at the very top, the ambition to be the healthcare partner of choice.

Goals at the top are only useful if the people doing the work can see themselves in them. Without that line of sight there's no real buy-in, because nobody can tell how their day connects to a number living three levels up. So Emplify pushed the North Star down through every layer. A VP looks at the seven goals and decides which ones their team can actually move. A director works out how their group contributes to the VP's targets. The frontline, closest to the day-to-day, often has the sharpest read on what will shift the number. That only works if the direction is clear enough for people to make their own calls inside it.

"You can give more autonomy to your workers and your workforce, as long as they understand and can connect with where you want to go." — Katie

Without that line of sight, you get the opposite: a lot of effort that looks like progress but isn't pointed anywhere.

A Shared Language for the Work

Once everyone could see the goals, a different argument started. Why is your project a "project" and mine isn't? Who gets the resources?

Emplify settled it by naming the work. Three categories, defined from the top:

• Standard work keeps the lights on: answering emails and the routine things a team can finish inside its own function without borrowing anyone. Roughly 20% of what moves the goals.
• Operational priorities are cross-functional. They need assigned people from IT, marketing, or medical, which turns capacity into a real question, and they usually run on a quarterly rhythm.
• Strategic priorities are the big buckets, the work that reshapes how the system runs over the long term. These often get a dedicated agile team, and about half the progress toward the North Star comes from here.

The labels sound mundane, but they did real work. In a merged organization where two cultures were still learning each other's habits, a shared vocabulary for "what kind of work is this" was the difference between teams talking past each other and teams lining up.

Governance as a Blueprint

Governance is a word that shows up in every strategy deck and rarely changes how teams actually work day to day. At Emplify it's a real framework for decisions, accountability, and oversight, and the way Katie describes it, it behaves less like a rulebook than a blueprint, the shared drawing everyone builds from.

The distinction matters, because governance in a merger can harden into red tape and top-down control. Emplify built theirs around the work types, with an enterprise level and a regional level sitting side by side. Some decisions belong to the whole system. Others stay with the Gunderson or Bellin markets, which serve genuinely different populations and need the freedom to act like it. A people-and-process group watches resourcing across all of it, including how much change any one area, like primary care, can absorb at a time.

There's a quieter upside to running governance this way. When two regions surface the same problem, the structure pushes it up to be solved once instead of twice.

"The beauty of merging is to knowledge share and understand how one system solved the problem versus the other." — Katie

A blueprint lets people build in parallel without building the same thing twice.

Why Emplify Brought in Cascade

Katie was only weeks into the strategy role when she went looking for a tool, and the timing is the interesting part. The merger was still in motion. Governance wasn't finished. What she needed, a single source of truth that tied every piece of work back to the goals, didn't exist anywhere in either legacy system.

She nearly built it herself. With a background in design systems, she was ready to map the whole thing out in Miro by hand. Then she came across Cascade. She ran the maturity assessment on her own, recognized the fit, and started pulling stakeholders in to pressure-test it before she committed.

The decision that shaped everything afterward was not waiting for the rest of the organization to settle first.

"We didn't wait to perfect governance and then map it into Cascade — we built both side by side. The structure evolved with the system, and that's why it stuck." — Katie

That sequence is worth sitting with, because the instinct in most rollouts is the opposite: finalize the model, then buy the software to hold it. Emplify let the tool and the governance shape each other as the merged system found its footing, which meant Cascade reflected how the organization actually worked rather than how someone hoped it might.

It had a second effect they didn't plan for. Putting work into Cascade forced clarity, because you can't enter an initiative you haven't named, sorted into a type of work, and tied to a goal. The tool quietly pressured Emplify to settle questions it might otherwise have left fuzzy. That's a pattern worth naming: to use a system like this well, an organization has to confront how mature its strategy process actually is.

Katie didn't do this alone. The team at Cascade worked alongside her to figure out how the platform should map onto the governance model and how to build the reporting that sat on top of it, and stayed a thought partner as the way Emplify used it kept changing. That hands-on support is part of why the rollout held rather than stalling at the configuration stage, where a lot of tools quietly die.

→ Take the strategy maturity assessment Katie used and see where you land.

What Changed Once it was In

The first payoff was the obvious one. The single view Katie had gone hunting for on day one finally existed. But storage was never the real prize, and she reframed the question early: not where do we keep all this, but how do we use it to predict and understand. A filing cabinet answers the first question. Cascade had to answer the second.

Because the platform was built around the governance model, the reporting could be cut to fit whoever was reading it. The operational-priorities team pulls up operational priorities and nothing else. Tag a goal as a finance goal, and every metric touching finance lands in one view. Each leader sees the slice they're accountable for and exactly how it ladders up to the enterprise goals, rather than the entire system at once.

That reframed what a status check is for. A traditional dashboard can tell you a number is red and then leave you to work out why on your own... With the plan and the work connected in one place, a red goal becomes a starting point instead of a dead end. You follow it down to the specific initiative behind it.

"It allows leaders to come in from a high level, zoom in, and understand where to start to diagnose the barriers or roadblocks to achieving the goals, earlier than before." — Katie

Catching it early is what matters, because the headline metrics are lagging on a five-year target built on annual checkpoints. You can't confirm those until the year is nearly gone, so the leading indicators underneath are the early warning, and they only help if someone can watch them move.

Put the real plan and the real work in one place and the tool starts to double as a mirror. You can see where the organization is mature and where it isn't, which governance is missing, which parts of the plan have stopped moving.

None of this happened by flipping a switch. Getting executives comfortable took a round of one-to-one sessions, walking each priority-team owner through their reports and showing them when to zoom in and when to pull back. As much of the work was about changing how people read their numbers as about the software itself. That's the honest version of adoption, and it's the version that lasts.

What Comes After the Merger

The merger forced Emplify to build all of this: the North Star outcomes, the shared language for the work, the governance, the reporting layered on top. None of it is merger-specific, though. It's how the organization runs now.

The clearest sign is what Katie did next. Twenty-eight days into a new role on the population health team, she's already building a department-level plan in Cascade so her group stays aligned the same way the enterprise does. The model scales down to a single team as readily as it stretched across two regions, which is the real test of whether it took hold.

That's the takeaway for anyone walking into a merger of their own. The systems you stand up to get through the integration are the same ones that run the company once the integration is over. Worth building them to last, not just to cope.

This article is based on a conversation between Katie Nowak, who led strategy through Emplify Health's merger, and the team at Cascade. Watch the full recording →