A New Rural Blueprint: Strategic Partnerships That Keep Care Local

When 10 rural hospitals across Wisconsin announced in September that they were forming the Wisconsin High Value Network (WHVN), it marked a significant milestone for independent providers looking to keep care local, while enhancing the quality, improving affordability and gaining the strength of scale. The WHVN hospitals — stretching from Southwest Health in Platteville to St. Croix Health on the Minnesota border — are partnering with Cibolo Health to establish a clinically integrated network (CIN) that will jointly design and implement value-based care arrangements, share data and coordinate quality improvement initiatives while preserving their own governance. The group serves roughly 400,000 patients.

Leaders framed the effort not as a merger but as “independence through interdependence,” emphasizing local control while acknowledging the need for new strategies to navigate rising labor costs, payer pressure and shrinking resources.

A Growing Shift Toward Strategic Partnerships

The WHVN announcement reflects a broader trend: Rural hospitals across the country are turning to structured partnership models to help protect essential services, strengthen negotiating leverage and prepare for new payment arrangements.

While financial pressures on rural hospitals are familiar, what is emerging now is a more intentional wave of operational collaborations — networks, affiliations and joint ventures designed to solve challenges that individual hospitals often cannot tackle alone.

A Multistate Network Built Around Value-Based Care

In early 2025, 26 rural hospitals across Ohio and West Virginia formed the Ohio High Value Network, one of the country’s largest rural CINs. The network spans 37 counties, includes more than 115 communities and serves more than 2.5 million patients.

Unlike collaborations that focus on purchasing or shared staffing, the Ohio network is expressly designed to pursue value-based contracts collectively. Most rural hospitals lack sufficient volume to participate in risk-based arrangements independently. By sharing data, clinical performance best practices and care management capabilities, members can improve patient outcomes, reduce costs, ease administrative burden and strengthen their position with payers. Early efforts center on strengthening preventive care metrics and aligning care coordination across participating hospitals.

Deepening Affiliations to Bring Specialty Care Closer to Home

In Michigan’s Thumb region on the Lake Huron coastline — where rural residents often travel long distances for advanced care — Aspire Rural Health System and Covenant HealthCare recently renewed and deepened their affiliation through a new three-year agreement. Originally formed in 2018 as the Covenant Regional Thumb Network, the partnership now aims to bring more high-acuity services directly into local communities.

Under the agreement, the organizations are expanding cardiology coverage to five days a week at two Aspire campuses and developing a comprehensive cancer care facility at Aspire’s Marlette campus. These are tangible service expansions that would be difficult for a single rural hospital to sustain independently. Leaders emphasize that shared planning is helping to determine where providers and services can be deployed most efficiently across the region, enabling more patients to receive care closer to home.

A Statewide Collaborative Builds Specialty Care Networks

Rural hospitals in Kansas are advancing specialty care by leveraging a long-standing CIN. The University of Kansas Health System’s Care Collaborative, launched in 2014, now supports quality-improvement initiatives for 91 member organizations across 79 of the state’s 105 counties, including nearly every rural county with a hospital.

In October 2025, the Care Collaborative and the University of Kansas Medical Center announced a new initiative backed by a $12.1 million grant to expand specialty access in rural communities. The effort will use telehealth-enabled models to extend high-demand specialties — including neurology, pulmonology and rheumatology — while dedicated care coordinators work across sites to keep as much care as possible locally. For rural hospitals, this illustrates how mature CINs can evolve into platforms for targeted innovation without requiring hospitals to relinquish local control.

Local Governance with System-Level Backing

In eastern North Carolina, UNC Health Nash operates as a managed affiliate of UNC Health — a model that allows the system to provide operational and management resources while Nash retains its own board, fiduciary responsibility and community-based decision-making.

Through this structure, patients gain access to expanded primary care, specialist outreach and coordinated care between Nash providers and UNC Medical Center in Chapel Hill. Leaders frame the affiliation as combining local governance with statewide expertise, offering stability and access without requiring full consolidation.

Across these examples, one theme stands out: intentional design. Rural hospitals no longer are approaching collaboration as a last resort. Instead, they are structuring partnerships around the specific capabilities they need most — care coordination infrastructure, specialty access, workforce stability, operational efficiency and strategic alignment with payers.

Join the Conversation Shaping the Future of Rural Health

Don’t miss your chance to connect with the innovators redefining rural care delivery. Join senior executives, board members and emerging leaders at the AHA Rural Health Care Leadership Conference Feb. 8-11 at the JW Marriott San Antonio Hill Country Resort & Spa.

With sessions focused on workforce strategies, value-based transformation, digital access, collaboration frameworks and governance excellence, this flagship event offers actionable insights and real-world solutions.

Position your organization at the forefront of rural innovation. Learn more and register today.