Doctors are seeing the patients and making care decisions. Maybe it's time they also run the show, clinically and in such ways as meeting with insurers and negotiating contracts.

Two sizable health systems traveling along separate paths recently converged around that idea, hoping to improve access and quality of care through better coordination in the state of Michigan. Ascension and CHE Trinity Health are forming a clinically integrated network of providers that stretches across the entire state, encompassing 27 hospitals and hundreds of other care sites. With such a wide reach, the newly formed Together Health Network will have a facility within 20 minutes of 75 percent of Michigan residents, according to the two partners.

Physicians will be key to the effort. The network will be led by a physician CEO, governed by a physician-majority board and guided by various physician committees. Leaders say that the two systems will act as "silent partners" in the pursuit of population health, while their physicians will lead the way, including in negotiating value-focused contracts with health insurers, says Rick O'Connell, executive vice president of CHE Trinity and president of its health division. "Traditionally, it's been the health systems that have driven the relationships with payers. They go out and negotiate, and the physicians come along," O'Connell says. "With this — because it's truly about the population and better health, better care at a more affordable price — we need the physicians to help lead and be committed."

Such clinical collaborations between competing health systems are scarce, but growing in number. In one example, four hospitals and health systems in Iowa joined in 2012 to form the University of Iowa Health Alliance, representing some 50 hospitals, also to plunge into population health management. All told, there are roughly 600 clinically integrated, single-system health networks across the country, and only a small handful integrating with others, says Dennis Butts, director of the health care practice at consulting firm Navigant.

Butts expects that number to swell in the next year, as systems add touch points and care continuum sites to their arsenal, without having to pay the capital costs to build them.

"Many networks are beginning to strategize how they fill those gaps, and some are reaching the conclusion that historical competitors, in a fee-for-service world, are maybe our partners in a value-based payment world, and so they're considering these types of multisystem networks in order to be successful," he says.

Ascension and Trinity plan to appoint an interim CEO to lead the limited liability corporation, and a permanent physician CEO in the next few months; a dedicated board, meanwhile, is closer to being in place. Leaders interviewed say anything is possible in the endeavor, whether it's creating a Together Health Network insurance plan, or even trying the approach in other states far down the line. Trinity operates in 20 states, while Ascension is in 23.

"I see collaboration spawning innovation for us, with the understanding that, whatever work we do, we're going to keep the patient at the center," says Patricia Maryland, president of health care operations and chief operating officer at Ascension. "I'm not taking anything off the table at this point, as we look at an array of products that can be produced together with this relationship."