Go it alone or find a partner? It's a question many hospitals face as the transformation of the nation's health care system gallops ahead.

Where once there were disparate health care providers, four hospitals and health networks are banding together in Iowa to plunge into population health. Together as the University of Iowa Health Alliance, they plan to share data and build a clinically integrated organization that would serve much of the Hawkeye State.

With the arrangement, the four partners gain the perks of a merger, but keep their independence.

"The days of being in your ivory tower or on an island are over," says Tim Charles, president and CEO of Mercy Medical Center in Cedar Rapids. "What you're seeing across the country is significant consolidation of markets. So, for those of us that are independent, to be able to achieve the necessary scale that we believe is important to be competitive in the future without having to give up your local identity is very important."

The other players include 41-hospital Mercy Health Network (part of Catholic Health Initiatives), six-hospital Genesis Health Systems and University of Iowa Health Care. Together, they gain considerable reach, including more than 50 hospitals, 160 clinics and 2,300 integrated physicians.

Even before the late summer announcement, members had been meeting for the better part of a year and collaborating in other ways. But the framework of the alliance really started to come together when the university entered the picture more recently, says Dave Vellinga, president and CEO of Mercy Health Network and chairman of the alliance.

They'll partner to invest in a data warehouse, clinically integrate staffs and build the back-office functions of an accountable care organization, all to address health care at the population level. Physician leaders from each organization will meeting monthly and work together to align best practices. The alliance is organized in a way that will allow other health care providers in or near the state to participate down the road.

"This is a better way to get more people involved at a quicker pace," Vellinga says. "This model allows that and sustains and maintains the backbone of Iowa's health care systems, which is a host of community physicians and community hospitals that really are engaged with their communities to then connect with a larger statewide system."

The next steps are picking a vendor for the data warehouse and hiring an executive director to run the alliance, which has been established as a limited liability corporation. Leaders say it's likely a three-year journey to fully flesh out the mechanics of the partnership.

"One of our board members said it best. When we announced the alliance, he said, 'Congratulations on getting successfully to the starting line,'" Doug Cropper, president and CEO of Genesis recalls. "We've established this relationship, now let's see how much we can do together. Certainly the possibilities and opportunities are significant, but the proof's in the pudding. We'll see exactly how far we can get in the next couple of years."