Besides the session that the American Hospital Association's Rich Umbdenstock moderated on the HEN initiative and reducing patient harm (watch the video above), a highlight of Monday’s Rural Health Care Leadership Conference proceedings was the plenary session on how rural hospitals are navigating the path to the proverbial second curve.

Scott Duke put it in simple, yet stark, terms for the nearly 600 hospital executives and board members packed into the hotel ballroom, "The status quo is deadly for our patients and our communities."

Duke, vice president of regional operations at Billings (Mont.) Clinic, moderated the session at which three hospital executives drilled down into their strategies for leaving the status quo behind.

Columbus (Neb.) Community Hospital has joined with eight other hospitals in Nebraska to form the Regional Provider Network, a limited liability company that will focus on several core operational areas where the hospitals can benefit from economics of scale, including shared services and IT. The network will also have a clinical committee that will look to improve care coordination and share clinical best practices and will explore different options for payer contracting. The nine hospitals will stay independent, though.

"The vision is to improve outcomes for patients, but also gain some efficiencies and delivery higher value," said Michael Hansen, president and CEO of CCH.

Meanwhile, Todd Linden, president and CEO of Grinnell (Iowa) Regional Medical Center, explained how his organization formed a limited liability company to tackle the prickly issue of clinical integration. At the same time, Grinnell officials are assessing how the hospital can engage in some broader initiatives undertaken by its parent company, Mercy Health Network.

At the other end of the spectrum, Susan Starling explained that independence is the right path for Marcum and Wallace Memorial Hospital. Starling, CEO and president of the critical access hospital in Irvine, Ky., said that she’s not convinced that an ACO or merger or formal collaboration is the right direction for the hospital right now. Instead, the organization is focused on building out its primary care network and developing referral and other informal relationships with neighboring tertiary hospitals.

As Duke pointed out, there’s no single answer. Hospital leaders must assess their markets and determine which path makes the most sense for their institutions. Standing still, though, shouldn’t be on the list.