St. Louis-based Ascension’s $3.9 billion acquisition of Amsurg in early June brought its footprint to more than 300 surgery centers and put a new spin on the growing health hub model.
Thomas Aloia, MD, executive vice president and chief clinical officer of Ascension, told Becker’s the model works best when it is centered around specific community needs.
“There is no one-size-fits-all formula for a viable hub model,” Dr. Aloia said. “Patients need access to both preventive care and timely treatment. The common themes we hear from patients include access to care for hypertension, obesity and diabetes management, as well as behavioral health and women’s primary care. More advanced service line offerings include cancer care, cardiology, neurology and orthopaedics.”
Dr. Aloia said this concept can help make care more affordable and keep it closer to home.
To be successful, a health hub model must rely on aligning hospital-based services, outpatient procedures and virtual care. It also must invest in digital infrastructure, technology, physician partnerships and specialized clinical teams to create a unified care network.
Kenny O’Neill, managing director of strategy and business transformation for Kaufman Hall, agreed that these models must start from population needs rather than a focus on clinical ambition.
“You have to switch it the other way,” Mr. O’Neill told Becker’s. “I’m a big believer in form follows function. What does a population where you have that hub need? You could have the best clinical model for a hub, but you could put it somewhere where you can’t staff it, or it doesn’t fit the population you’re serving.”
Mr. O’Neill pointed to three areas harming rural health: chronic illness mismanagement, behavioral health access and lack of primary care access. For organizations looking at health hub models, they must be built for generalist populations, not for specialists.
On the flip side, Mr. O’Neill said the most difficult part of the model is deciding what a hub cannot provide. He pointed to maternity care, which has seen significant cuts and closures over the last few years.
“If you’re doing two births a month, is that really the service you want to have in a hub,” he said. “Maternity is as planned as it can be, but is that better to be done in a larger center with more activity, so therefore you’re increasing the safety of the mother and the unborn baby. There’s a lot of hard decisions to make as you build this integrated network of hubs and spokes.”
For standalone rural hospitals, the ability to build this model without a larger partner can depend on staffing and scale.
“It is challenging for smaller rural hospitals to provide all needed services to their communities,” Dr. Aloia said. “Fortunately, technology and information transfer have improved, supporting our ability to create a network of care that can move bidirectionally between flagship hospitals and rural partners. Inserting a health hub model between rural and system partners enhances opportunities for timely access to needed care as well as some operational and medical efficiencies that could further support continuity of care.”
Shane Sanborn, CEO of Kellogg, Idaho-based Shoshone Medical Center, said it’s important for independent rural hospitals to make strategic decisions when thinking about health hubs on service line development, technology investments, physician recruitment, partnerships with community organizations and payer negotiations.
Success, he said, depends on quick adaptability and understanding community needs.
“While capital investments are still necessary, many of the most impactful changes come from rethinking care delivery rather than building new facilities,” he told Becker’s.
Mr. O’Neill added that margin for error is shrinking for hospitals looking to transition but remain independent.
“There are many relatively small to medium-sized rural hospitals that are operating, and the better ones do have the pathways agreed with their large partners,” he said. “It’s becoming harder and harder because of the economic headwinds they’re seeing — reduced reimbursement, reduced activity, inflationary pressures … and the sheer ability to try and get staff and pay them in the model they have.”
Dr. Aloia said reimbursement is lagging behind patient needs and organizational capabilities, with sustainable reimbursement for broader cross-state licensure and virtual care a possible northern light for systems looking to expand access and maintain care quality.
Mr. Sanborn also said traditional reimbursement has failed to keep pace with the transition from episodic acute care to longitudinal community-based care.
“Fee-for-service still rewards treating illness more than preventing it, making it difficult to sustain many services that improve long-term health outcomes,” he said. “However, new models such as Idaho’s Rural Health Transformation Program represent a meaningful step toward aligning payment with value, prevention, and whole-person care. Continued evolution of reimbursement will be essential if rural hospitals are expected to serve as true community health hubs.”
In the next two to three years, Mr. O’Neill said he expects to see the hub-and-spoke model spread, even as the physical facility numbers shrink.
“You might see a reduced number of facilities, but I think you’ll see a much better hub-and-spoke network working together,” he said. “The physical footprint of these hub and spoke models might not be as many facilities, but they might be more planned and structured, [having] a more comprehensive digital layer wrapped around them to have more virtual care as part of the future model of rural healthcare.”
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.