Rural hospitals have long faced some daunting challenges, according to various sources:

•18 percent of the rural population is age 65 or older.
•14 percent of the rural population lives below the poverty line.
•28 percent of people in rural areas consider their health fair or poor.
•10 percent of physicians in the country practice in rural areas, despite the fact that one-quarter of the population lives in rural areas.
•Roughly half of people in rural areas report having one or more chronic condition.

As if those demographic trends weren't enough, there are the financial constraints that come with running a small hospital in an isolated area.

And now, we have the Great Transformation in which all health care providers must figure out how to migrate to a new delivery model. Yet, as challenged as rural hospitals are, there are also some unique opportunities to become integral players in a system that's focused on population health and value-based care.

"Small and rural hospitals and care systems can leverage strong relationships with their community and patients and with urban health centers, and increase integration of services with other local health providers," concludes a new report from the AHA's Health Research & Educational Trust.

The report details ways in which rural hospitals can forge those partnerships and create better care models for their communities. "Small and rural hospitals and care systems that build partnerships with the communities they serve can have a significant positive influence on population health," the report notes. "Through networking, coordination, cooperation or collaboration, small and rural hospitals or care systems and partner organizations can marshal their resources to create successful community health initiatives and improve population health."

As the University of Iowa's Clint MacKinney, M.D., told me in an interview earlier this year, rural hospitals have a significant role to play in the promotion of population health and the formation of accountable care organizations. But, he says, "accountable care networks are interested in those providers that provide value." He adds that rural hospitals are "nimble" and can improve processes to ensure that they are moving toward that value equation. He says he is hopeful that rural providers will step up to the challenge to "aggressively" improve quality, cost and the patient experience.