Health care systems have been consolidating for years, but that pace has recently picked up.
Top officials at the Sanford Health System say the best and least expensive way to care for patients is to centralize clinics and hospitals to share equipment and expertise.
It has been a long road for Sanford Health to get where it is today. Despite the recession, the health system has made a name for itself based on decisions made more than two decades ago.
"It was definitely intentional that we had the best health care system that we could possibly create for the betterment of patients," Executive Vice President, Marketing and Public Policy, Cindy Morrison said.
And with an aim to become a household name, not only in the Upper Midwest, but also across the globe.
"Here we are 20 year later and really glad we did it because I think we are well positioned right now for what is going to happen with health care," Morrison said.
Sanford is now considered one of the largest rural, not-for-profit health care systems in the nation.
"There's also a lot of knowledge that gets shared, so there's the benefit for the patient," Morrison said.
That benefit includes 81 different medical specialties from family practice to genetic research. A dream from 20 years ago, made possible by the generosity of one man.
"The first Denny Sanford gift back in 2007 and what we have seen is quite rapid growth and rapid expansion," Chief Operating Officer Nate White said.
Expansion that now spans across more than 260,000 square miles and it's not done growing yet.
"You're going to see continued growth. And for us, the size and the scale allows us to start to standardize and use standardization to our benefit," White said.
The systems now includes 39 hospitals and more than 220 clinic locations.
"The growth has really been a positive effect for us. If you think about the changes in health care, with the Affordable Care Act and some of the things that are happening with regulations and the economy in general," White said.
There's no disputing that business has been good for Sanford. Despite the economy, the system now brings in approximately $3 billion in annual revenue. But Sanford also invests some of that profit into areas where it will never see a return.
"We wanted to provide care where it was needed. Secondly, we wanted to learn about health care delivery in other parts of the country and other parts of the globe, Senior Executive Vice President Dave Link said.
The first Sanford World Clinics in Ghana was built in January of 2012.
"You know for the first clinic we built, it probably took us 18 months from the time we identified the location to get it up and running and now we can really do it much quicker than that," Link said.
The clinics now employ more than 145 people who care for an estimated 400,000 patients each year.
"For example in Ghana where we have four clinics open, we will have a fifth one opened at the end of the month," Link said.
Yet as far-reaching as Sanford's footprint is today, those who carry it's more than 100 year legacy are always mindful that it all began with just one patient.
"And we realized if we align those incentives, the patients will receive the better care," Morrison said.
"I think the Sanford brand really does stand for quality and stability and it stands for growth that makes sense," White said.
Growth which is very likely to continue for years to come.
In Sioux Falls, Sanford is preparing the Edith Sanford Breast Cancer Facility, which will start later this year. Also, the new Sanford Imagenetics building is expected to start in the next 18 months after that.