Strategic Partnership Task Force Update

March 5, 2017

Dear Board, Physicians, Employees and City Council Members,

Guttenberg Municipal Hospital’s (GMH) Strategic Partnerships Task Force (Task Force) is pleased to provide this fifth stakeholder update. As a reminder, the members of the Task Force are:

  • Bill Allyn, Task Force Chair and Board of Directors Vice Chair
  • Russell Loven, Mayor
  • Karen Merrick, Board Member
  • Andrew C. Smith, MD

February: A Month of Reflection and Dialogue

As we have continued to share information with you about our Task Force process and progress, many of you have offered both input and questions for us to consider in response. We continue to hear from you a desire to know more about why GMH would consider partnership and how a partnership might make us better and stronger for our employees and entire community. In our February update, we explored three reasons to consider partnership (physician recruitment, better care delivery and financial realities) but noted that these were not the only ones. To assist in exploring these and other reasons in more detail, GMH recently invited Mr. Greg Boattenhamer, former vice president of government relations at the Iowa Hospital Association, to share his perspectives on the transformation of rural health care in America. Now a health policy and health care strategic planning consultant, Mr. Boattenhamer described a health care environment challenged by an aging population, projected provider shortages, care fragmentation, rising costs, and difficulty raising capital. At the same time, he sounded a note of optimism by outlining some critical steps forward for hospitals to ride the waves of change and remain vibrant. In remarks to our City Council and Board, managers and providers, he stressed imperatives for rural hospitals to:

  • Find ways to align services across the continuum of care.
  • Improve efficiency through productivity and financial management.
  • Invest in integrated information systems.
  • Join and grow integrated provider networks and care networks.

He further described how strategic partnerships can assist in addressing these challenges by achieving economies of scale, reducing costs and improving access to capital, strengthening competitive positioning, enhancing population health management, and preparing for new payment methodologies. From him, we learned that GMH certainly is not alone in the challenges it faces, with many U.S. rural hospitals at risk of closure and those located in the Midwest (Iowa, Wisconsin and Minnesota specifically noted) especially vulnerable. At the same time, we heard of the special role that critical access hospitals play, not only providing essential health care but serving as the source of many jobs and significant economic value in their communities.

In closing, Mr. Boattenhamer urged GMH to consider the following as it evaluates opportunities for strategic partnerships and specific partners:

  • Sufficient financial margins to sustain change.
  • Available capital to fund service expansion, investment in facilities and equipment, and information technology.
  • Adequate primary care and appropriate specialty care.
  • Robust ambulatory care network.
  • Adequate population size to take on risk in new payment models.
  • Clinical integration across all services and service lines.

His input will certainly prove valuable as we move to the next steps in our process and dig deeper to understand whether and how a partnership can benefit GMH.

Upcoming Meetings with Potential Partners

In our last update to you, we reported the GMH Board had decided to invite Mercy Health Network, University of Iowa Hospitals and Clinics, and UnityPoint Health to Guttenberg for more in-depth conversations with the Task Force. Later this week and next week, the Task Force will be meeting with representatives of these 3 potential partner organizations to build on what we have learned about them through our process thus far. Our meetings with the potential partners will focus on:

  • Questions the Task Force has identified for each organization based on input received through initial interviews with them;
  • Questions that you, our stakeholders, have identified as important to you. (An overview of these questions is attached).

Our efforts to-date have paved the path for this and next week’s dialogue with potential partners. Along the way, we deepened our understanding of the value we bring as a partner while refining what we hope to gain through partnership. Now, our focus shifts to the details—specifics on how each partner might assist us and exactly how we can collaborate to create an improved, sustainable health care system for the future.

We urge you to keep your input and questions coming and reaffirm our pledge to keep our process and progress open to you.


Bill Allyn

Strategic Partnerships Task Force Chair and Board of Directors Vice Chair

Stakeholder Questions for Potential Partners

Based on input received from our stakeholders, the Task Force has asked all the potential partners to be prepared to address the following questions when they meet with us this month:

  • Why are you interested in partnering with GMH? What would be the advantages to your system to be partnered with GMH?
  • What is your rural strategy? How would GMH fit into that strategy?
  • What is your regional approach or philosophy?
  • What examples can you provide of success stories regarding your partnerships with rural hospitals, Critical Access Hospitals and rural health clinics?
  • How would you help us grow?
  • How would you help us recruit physicians? What type of support have you provided in the past?
  • How would you help bring specialty services to GMH? How have you helped other communities gain access to specialty services?
  • What services along the continuum of care have you developed or will you develop in our region?
  • What insurance companies are you in network with? Could we keep our current contracts?
  • What are your system’s expertise, experience and resources regarding the evolving value-based payment methodologies and population health management?
  • How many Patient Centered Medical Homes (PCMHs) are in your system? What level of certification has been achieved?
  • What partnership model(s) are available in your system? Which would you recommend for GMH and why? What are the pros and cons of each?
  • What might be the impact of each partnership model on our status as a municipal hospital?
  • What would be the impact on our employees’ employment status, compensation, benefits, and seniority? How would you handle GMH’s desire to keep IPERS?
  • What would be the management and reporting hierarchy? Would we keep our CEO? To whom would the GMH CEO report?
  • What management support would be available at the department level?
  • What would be the clinical support mechanisms and resources (for referrals, clinical consults etc.)?
  • What financial assistance and access to capital would be available?
  • How would we be handled if GMH were not making money?
  • What shared services would be available?
  • What is your main technology platform? If different from ours, what do you recommend / require?
  • What are your quality, safety, and patient satisfaction measures and outcomes?
  • What would be the impact on our governance structure and functioning? Would there be a local board? If so, what would be its composition and what reserved powers would the system have over the GMH Board?


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