Why partner?

Top 5 “Why Partner?”

• Secure healthcare for North County for generations to come:

  Healthcare is arguably the most critical infrastructure need in any thriving community. It is the one thing that every individual resident will need at one point or another in their lifetime. When that time comes, North County residents should expect that the best in care will be available to them locally. There is no better option to ensure exceptional, community-based care than to partner with a leading health system, such as Sharp HealthCare.

• Long term sustainability:

  Hospitals throughout the nation are in distress. 1 in 5 California hospitals are at risk of closure, and 71% have unsustainable margins. While Tri-City is making progress towards its turnaround goals, the Board views their role through the lens of long-term sustainability, not short term variability. Being part of an integrated health system will position Tri-City for future success in an increasingly challenging landscape.

• Expand Access to Care:

  The District Board’s vision is to expand access to high quality care for all constituents. This includes bringing new services to North County, increasing access to more primary care doctors, developing more ambulatory care facilities to care for residents in a more convenient and comprehensive fashion, along with recruiting more specialty physicians to our region.

• Investment:

  It’s no secret that healthcare costs are out of control. A recent spending report from the Office of Health Care Affordability concluded that hospitals are not the driving force behind escalating healthcare costs. Yet the regulatory burden placed on hospitals including seismic requirements is daunting, and will require significant resources to build or rebuild the infrastructure needed to serve generations to come. Joining with a partner with proven management expertise and access to more resources will be critical as Tri-City looks to build new facilities and services.

• Community:

  Tri-City is a community hospital, owned by the community, and built by the community. Tri-City has fulfilled its promise to deliver care to every member of this community for 64 years, and it will never abandon that promise. Regardless of what hospital might be one’s medical home, Tri-City will be here in your community to serve every individual when they might least expect to need those services. Whether it be a heart attack, or stroke, or in the near future, a mom in labor, every minute will count, and our community will count on Tri-City being ready to care for all of us in that moment. This partnership is, and has always been, about serving the greater good of our community.

Latest Updates

May 30: UPDATE

On Thursday, May 29, at the open, public session of the Tri-City Healthcare District Board of Directors meeting, the Board unanimously voted to move forward with an exclusive partnership with Sharp HealthCare, a highly respected nonprofit healthcare leader in Southern California.

This decision follows months of exploration, community input, medical staff engagement, and strategic planning. At the heart of every discussion has been you—our community—and the patients and families we serve.

Why This Matters

Tri-City Hospital has served this community faithfully for 64 years. While the District is making progress towards its turnaround goals, the reality is that the healthcare landscape has changed dramatically. In order to ensure that this critical asset is capable of meeting the needs of an aging and growing population for the next 64 years while simultaneously positioned to expand services and access to care, a long-term partnership is in the best interest of the residents of North County.

Sharp HealthCare provides care to every aspect of our community including 38% of the County’s Medi-Cal beneficiaries; is a committed partner for seniors and MediCare Advantage; possesses an incomparable reputation in women’s health through Sharp Mary Birch; has a legacy of commitment to supporting regional community hospitals such as Grossmont and Coronado; has a history of delivering not only world class care but also world class caring called the Sharp Experience, and is the region’s only integrated health plan and California’s top rated health plan.

Sharp also shares our commitment to clinical excellence, community connection, and expanding local access to primary care and specialists.

Through this partnership, we will:

• Preserve our mission as a community hospital
• Expand and enhance local services
• Invest in modern technology and systems
• Support and retain our dedicated workforce

This is truly a transformational step forward towards building North County’s flagship medical campus

The Process

The interactive graphic represents a roadmap outlining the process the Tri-City Healthcare District Board of Directors have undertaken during this critical exploration for a health system partnership. Hover over the dates to gain further insights into milestone events and future steps.

Pre-process

TCHD Board of Directors selected Juniper Advisory to provide guidance through a competitive, dynamic process towards identifying a long-term strategic alliance

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Process Design

Designed a process to proactively assess strategic options, maximize Board objectives, and minimize operational disruptions

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Review Procedures

Reviewed procedures with Board at Jan 30 meeting

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Approach Market

Identify qualified partners and engage through confidentiality agreements, instruction letters, information memorandum, and data room access with uniform phase one due diligence materials. 25 entities approached with 3 indications of interest.

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Initial Proposals

Review of initial phase I proposals by the advisory team

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Select Finalists

Board ad hoc committee made recommendations for selection of finalists

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Instruction Letter

Finalists provided instruction letters for phase II proposal submission

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Partner Discussions

Advisory team worked with finalists to define potential submission of proposals

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Refined Proposals

Phase II proposals due from finalists with two of the three entities completing process

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Decision

Proposals made available to public and Board during open Board meeting, at which time the ad hoc committee recommended the selection of Sharp HealthCare to enter into a letter of intent

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Letter of Intent

Letter of Intent executed by TCHD and Sharp HealthCare for a proposed transaction involving a 30 year lease structured according to the applicable requirements of the California Health and Safety Code Section 32121(p) (2) for the benefit of the community

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Development of Definitive Agreement

Due diligence period working towards a definitive agreement

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OHCA submission

Submission of proposed transaction for review by the Office of Health Care Affordability

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Voter Approval

Ballot initiative to request voter approval of Sharp/Tri-City partnership

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Close of the transaction

Upon certification of voter approval, the transaction closes and Tri-City joins the Sharp family of hospitals

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In response to evolving market dynamics and the growing challenges faced by independent hospitals, the Tri-City Healthcare District Board of Directors in 2023 authorized a formal process to explore potential affiliations with regional health systems. The Board outlined a series of strategic objectives and goals to guide this process, including:

• Ensuring long-term sustainability of the District
• Expanding access to primary and specialty care locally
• Securing capital and infrastructure investment to enhance services
• Achieving economies of scale to reduce costs and improve community value
• Broadening access to specialty care and improving care coordination
• Restoring advanced specialty services, such as women’s and newborn care
• Continuously enhancing quality and health outcomes
• Investing in next-generation technologies and innovation
• Meeting community needs by providing best-in-class care close to home

UC San Diego Health was initially selected as a potential long-term partner. However, following an extensive due diligence process and shared goals, the parties were unable to reach a consensus on definitive terms.

The District subsequently engaged Juniper Advisory, a nationally recognized investment banking firm specializing in not-for-profit healthcare mergers and acquisitions, to conduct a national search for a strategic partner. The process, guided by Juniper’s proven methodologies, included three key phases:

1. Situational Assessment

   A thorough review of regional and national healthcare markets, coupled with stakeholder engagement involving community members, employees, medical staff, labor unions, elected officials, and management.

2. Partner Input

   Distribution of a detailed information memorandum to potential partners, supported by a secure data room and instruction letters to facilitate a transparent, competitive evaluation process.

3. Transaction Phase

   Finalist health systems submitted Phase II proposals detailing their vision and partnership terms. These proposals were reviewed by the Board of Directors to determine which partner best meets the District’s strategic objectives.

During the Transaction Phase, the District’s advisory group fielded Phase II proposals and eventually identified two finalists who met the criteria outlined by the Board. These proposals were presented at a public Board of Directors meeting on May 29, 2025. After public comment, the board ad-hoc committee made the recommendation to select the proposal put forth by Sharp HealthCare. This was unanimously approved by the full Board, directing the administrative team to enter into a Letter of Intent with Sharp.

What’s Next

We are entering a period of exclusive due diligence with Sharp HealthCare to collaboratively develop a formal agreement for our partnership. It is anticipated that this will take three to six months. The end result of this due diligence period will be a definitive agreement and 30-year lease agreement, with Sharp assuming responsibilities involving the acute care operations of the District. Following this, voter approval is required to finalize the agreement.

Additionally, the transaction may require review by the Office of Health Care Affordability(OHCA). While it is unclear if an agreement for the benefit of the community and eventually approved by the community requires OHCA review, it is the District’s intent to maintain full transparency at each and every step of this process across all constituents and agencies. Therefore, Tri-City intends to submit an application for review given the overwhelming community benefit of such a transaction and the District’s desire to garner community input.

What You Can Expect

• A strong commitment to transparency
• Opportunities for questions and feedback through multiple public forums and town hall meetings
• A shared focus on what matters most: our community

Through this partnership, we are investing in a stronger future for our community, our staff, and everyone who walks through our doors.

We’ll continue to keep you informed starting with a series of public meetings and town halls. A complete listing of public meetings will be posted here shortly.

Learn about Sharp

Sharp HealthCare is:

• Not for profit
• Four acute care hospitals and four specialty hospitals
• Three affiliated medical groups
• Originated as a community hospital and grew by supporting local communities
• Provides care to every aspect of our community
• Largest provider of care to Medi-Cal beneficiaries in SD County(38% of all SD Medi-Cal patients)
• Largest provider for seniors and MediCare Advantage beneficiaries
• Committed partner to Federally Qualified Health Centers
• Incomparable reputation in Women’s health through Sharp Mary Birch
• Legacy of commitment to supporting regional community hospitals including Grossmont, Coronado, and Chula Vista
• Nationally recognized for delivering not only world class care but also, world class caring called the Sharp Experience
• Notable managed care infrastructure with unrivaled ability to deliver value to communities
• Region’s only integrated health plan and California’s top rated health plan(Sharp Health Plan)
• 2,800 affiliated physicians
• 20,000+ employees
• Exceptional Quality and Outcomes

To learn more about why Sharp is San Diego’s leading provider of healthcare, please go to sharp.com/about

FAQs – Frequently Asked Questions

1. Why did the Tri-City Healthcare District choose Sharp?

   Answer: Much like Tri-City, Sharp started as a community hospital and has a proven legacy of supporting communities where they live and work. The culture of Sharp aligns closely with that of Tri-City Healthcare District, as a not for profit entity committed to serving every valued member of our community, including those who have historically been subject to healthcare inequity, seniors, our valued military community, and members of the North County workforce that make this community what it is today. Our respective missions speak to how intertwined we are in our DNA: Sharp’s is to improve the health of everyone we serve, while Tri-City’s is to advance the health and wellness of the community we serve.
   For more information on why Tri-City hopes to partner with Sharp, please read more at Why Partner.

2. Isn’t Tri-City doing better? So why partner now?

   Answer: Yes, however, when this Board assessed how best to strategically position Tri-City for long-term success, the answer was overwhelmingly clear that a long-term health system partnership was necessary. The landscape of healthcare has changed and by all indications, will not get easier. Costs of supplies and staff continue to escalate . Containing costs remains essential on a go-forward basis and can be better accomplished with an integrated health system partner, but in order to expand services and enhance the quality and delivery of care, a health system partner is essential. Hospitals in California are in distress, labor and delivery units are closing throughout the State, and instability is the theme of the day. The District Board’s vision is simply to do better for this community, and the time to make difficult decisions for our future is now.

3. Is Tri-City being purchased?

   Answer: No, the proposed transaction is a lease of the District to Sharp defined in the California Health and Safety Code 32121(p)(2). The terms have yet to be agreed upon but in such a deal, the District’s assets are typically turned over to an operating partner for a nominal fee in exchange for a commitment by that partner to take financial and operational liability for the hospital and its assets. That means that Sharp would have operating responsibility for the acute care services of the District, assume the District’s assets but also its liabilities and debt, along with financial commitments towards service line development, growth, infrastructure, deferred maintenance and capital projects. Given the costs of operating a hospital in today’s market, this transaction exceeds $400 million in commitments from Sharp.

4. Does the community have a say?

   Answer: 100%, absolutely, yes. Community input is essential to this process. Without community input and eventually, community support, this transaction can not proceed. As we get closer to a definitive agreement, the District will schedule a series of community forums and public meetings to garner feedback on the proposed partnership. In the meantime, you may send questions to communitypartnership@tcmc.com or we welcome you to join us for our upcoming healthcare district board meetings

5. How long will this take?

   Answer: Barring any unforeseen delays by the Office of Health Care Affordability’s review, we anticipate that this lease proposal will be on the ballot for voter approval by the District residents in June of 2026. If approved by the voters, Tri-City will affiliate with Sharp once the results of the vote have been certified by election officials.

6. Will the publicly elected board still have a voice?

   Answer: Yes. This is not an attempt to privatize our local District or wrest control away from publicly elected officials. Quite the contrary. While indeed, a new board will be formed with operational responsibility, of the proposed fifteen member board, eight will be Tri-City delegated, of which, three will be from the publicly elected District Board. Another three will be members of the community chosen by the District Board to further heighten community input. All District board members will have additional opportunities to serve on various hospital committees, as will members of the public. The District Board will still have oversight responsibility for tax revenues, and added responsibilities that may be in the form of community wellness and health education initiatives, to enhance the wellness component of the District’s mission.

7. Will this impact jobs at the hospital?

   Answer: Yes, we anticipate it will increase job opportunities at the hospital. With the partnership comes an opportunity to build not only stability but to add services, to grow. With that growth comes more opportunity for highly-skilled positions right here in North County.

8. I love my Tri-City affiliated doctor. Will I be able to keep my doctor?

   Answer: Yes. The medical staff at Tri-City will remain independently governed. No changes are expected that would adversely affect you or your doctor’s relationship with Tri-City. In fact, we anticipate adding additional health plans to our network, including Sharp health plans along with the recruitment of more primary care doctors to support our community.

9. Are there plans to close any services?

   Answer: No, there have been no discussions to close any services currently being offered at Tri-City.

10. Will Sharp bring Mary Birch hospital to North County?

    Answer: The final answer will come through the process of due diligence over the coming months. However, Sharp is proud of their longstanding reputation as San Diego’s leader in women’s health at Sharp Mary Birch and our shared vision is to rebirth labor and delivery care at Tri-City under the Sharp Mary Birch flag(or stork).