Rural hospitals are finding ways to tie themselves to larger systems in 2026 without surrendering ownership.
Since July, at least three critical access hospitals have entered or approved management or affiliation agreements with larger systems. In each, Lakeland Community Hospital in Haleyville, Ala., Medical Center Barbour in Eufaula, Ala., and Bradley County Medical Center in Warren, Ark., the rural hospital remains locally owned.
The deals come as about 720 rural hospitals, roughly one-third of the nation’s rural facilities, are at risk of closure, according to the Center for Healthcare Quality and Payment Reform.
“Being an independent rural hospital is only going to get harder, which is why we have focused on identifying a partner,” Kyle Kramer, CEO of Putnam, Conn.-based Day Kimball Health, a formally designated rural hospital, said in an August episode of the “Becker’s Healthcare Podcast.”
Day Kimball is in the final stages of a potential partnership that would lead to an affiliation with Farmington, Conn.-based University of Connecticut Health System. Mr. Kramer framed the goal as amplifying the hospital rather than absorbing it.
Management agreements
The most hands-on model gives a larger system control of daily operations while ownership stays local. Opelika, Ala.-based East Alabama Health agreed in August to take over management of Medical Center Barbour, a 25-bed critical access hospital, starting Oct. 1. The Health Care Authority of the City of Eufaula remains the owner.
Little Rock-based University of Arkansas for Medical Sciences has struck several lighter-touch deals. Bradley County Medical Center, a critical access hospital in Warren, Ark., approved a management consulting and co-branding agreement with UAMS Sept. 24. UAMS will advise on key operational areas, and the hospital will retain full operational authority and its assets. UAMS has also announced co-management agreements in 2026 with Helena (Ark.) Hospital and Mena (Ark.) Regional Health System.
Affiliations
Other systems are offering financial backing without taking control. Huntsville (Ala.) Hospital Health System affiliated with Lakeland Community Hospital, a 25-bed critical access hospital, effective July 1. Huntsville is giving the hospital money, strategy support and other resources, while Lakeland stays independent and keeps running its own operations under its existing leaders. Jeff Samz, president and CEO of Huntsville Hospital Health System, said the agreement is meant to act before the county loses hospital access.
Ogdensburg, N.Y.-based North Star Health Alliance, which is in bankruptcy, is planning a strategic partnership with Rochester (N.Y.) Regional Health. The two will jointly seek a multiyear state safety net transformation grant and continue talking about a more formal affiliation, which would need regulatory and court approval.
Networks and joint ventures
Some rural hospitals are teaming up with each other instead. More than 150 independent rural hospitals in eight states have joined high-value networks while keeping their own governance. North Dakota’s Rough Rider network of 23 critical access hospitals has secured supply discounts of up to 20%, a July Commonwealth Fund analysis found.
In New Richmond, Wis., six critical access hospitals, some independent and some owned by Bloomington, Minn.-based HealthPartners, formed a joint venture cancer center. Steven Massey, president and CEO of Baldwin, Wis.-based Western Wisconsin Hospitals & Clinics, said competing hospitals can still partner on some service lines.
“I think all six communities are better today in terms of the care that they’re providing locally around cancer care than they were prior to that partnership,” Mr. Massey said.
Rural leaders have also said that ownership is no longer the only way to add services. Tiffany Means, DNP, RN, CEO of Eureka Springs (Ark.) Hospital, said her 2027 plan links specialty and geriatric care, technology and community resources without assuming the hospital “has to own every component of care to create value from it.”
