Marna Borgstrom was explaining why health care needs to change and how her system, Yale New Haven Health System, is responding when she articulated a thought that's likely top of mind for every hospital executive: "We want to do the right thing, but going bankrupt while doing the right thing is not a good strategy."

It's a dilemma. Reducing readmissions — even admissions — shortening length of stay, embarking on population health are the right things to do. Tackling them keeps patients healthy and out of the hospital. Since we are still largely in a fee-for-service world though, keeping patients out of the hospital doesn't lead to a healthy bottom line. That will be the case until we fully transition to a value-based model where all providers are rewarded for doing the right thing.

"The holy grail is execution," Borgstrom, president and CEO of the Connecticut-based system, said in her remarks at last month's 14th Annual Non-Profit Health Care Investor Conference. So is timing. Transition too early and watch revenue plummet. Hold off too long and watch the competition speed by.

Borgstrom joined her peers from 28 other top -performing nonprofit health systems in New York City for this unique, inviteation-only event where the sell side and buy side come together for two days. Hospital executives present their strategic and financial plans to investors and rating agency officials in the hopes of leaving a lasting — and positive — impression for the next time they come to market with a bond issuance.

Virtually all of the CEOs in attendance echoed Borgstrom's thought: We are moving to a new business model, but are trying to figure out exactly how much risk we can afford to take on during this transition. Oh, and how long it will take.

Mountain States Health Alliance, with 13 hospitals (and, at press time, one acquisition pending) serving Kentucky, North Carolina, Tennessee and Virginia, is on a 10-year journey to transform itself. The effort started in 2010 when the board approved a strategic plan built on three pillars: Focus on population health management using evidence-based practices, achieve smart growth, pursue and achieve operational efficiencies.

Sound familiar?

MSHA President and CEO Dennis Vonderfecht said the goal is to evolve from a health system that's reactive and provides "sick care" to one that is predictive and focused on overall health. Eventually, that move will require taking on full financial risk.

As Mountain States' 10-year strategy suggests, getting there will take time and hard work. It will also take partners. The executives gathered in New York City acknowledged that their systems can't do it alone; they need to develop partnerships that stretch across the care continuum and, in some cases, with the competition.

Those strategies also involve figuring out what not to do. Charles Francis, senior executive vice president and chief strategy officer at Dignity Health, said executives should ask three important questions: What business are you in,? What are your core competencies? What differentiates you from the pack?

What sets these health systems apart from the pack is vision, mission and leadership. A healthy balance sheet helps, too, but that doesn't happen without executing a sound strategy, which will be even more important in the years to come.

— You can reach me at