Things are going pretty well for Vanguard Health Systems in Detroit, where it has been pumping millions into renovating and expanding its Detroit Medical Center network. But big changes are in the offing both internally — CEO Mike Duggan has said he will step down soon — and beyond the company's walls — in the shape of a big merger by two rival systems. Dale Buss at The Detroit News takes a close look at how both dynamics are unfolding.

When Vanguard bought the DMC, it promised a capital spending splurge on facility renovations and improvements through 2021 in a bid not only for more suburban customers, but also as a gamble on the city's comeback.

"It's a bet that, 10 years from now, the population will return and the downtown area will become vibrant again," said Whit Mayo, health facilities securities analyst for Robert W. Baird & Co., which has received investment banking compensation from Vanguard.