PHOENIX — On Day 3 of the Rural Health Care Leadership Conference, Todd Linden, president and CEO of Grinnell (Iowa) Regional Medical Center, asked attendees a million-dollar question: As health care continues along the second curve, how will hospitals get paid in a way that can sustain the Triple Aim?

His answer was both familiar but ambitious: Prepare for population health and get a bigger share of the “premium dollar.”

With the future of value-based payments looming, rural hospitals must become more integrated, accountable and willing to take on risk. 

The pressure is on to make bold structural changes, and Linden suggested joining with a hospital network as a means to do this. However, he advised, hospitals must be transparent and in good shape to attract an affiliate.

“The issue with transparency is, if you’re going to be naked, you better be buff,” Linden said.

So, where should hospital leaders begin? First, Linden said, they should honestly consider whether they possess the core competencies needed to work in the value-based payment model and, if so, they must devise strategies to implement that framework.

Linden suggested turning to the American Hospital Association’s reference booklet, “Your Hospital’s Path to the Second Curve: Integration and Transformation,” as a helpful reference tool for those hospitals that are in this stage.

Once an affiliation has taken place, the path to driving down costs and boosting quality can accelerate, said Dave Hickman, vice president of Mercy Health Network in Des Moines, Iowa [GRMC pays an affiliation fee to Mercy. You can learn more about how that’s working in this video interview with Linden]. One way to do this is to share leadership and management positions.

“In some instances, two hospitals share a CFO,” Hickman said. “They couldn’t even think about it five years ago, but ultimately it shares the cost of high-level personnel.”

Through such alliances, hospitals can benefit from shared expertise and best practices, common financial statements, comparisons of financial dashboards with benchmarks and comparative quality dashboards — all of which set the tone for progress.

“Just by listing those outcomes, you’re going to improve your performance,” Linden said.

According to Stanley Johnson, board treasurer at Clarinda (Iowa) Regional Health Center, coordinating care and forming these types of strategic affiliations will become inevitable for rural providers.

“I don’t see that the small hospitals can stand alone forever,” he said. “It may not be for another 15 to 20 years, but they’re going to need to work on a bigger scale.”