A likely alliance between Renton's Valley Medical Center and Seattle-based UW Medicine is yet another sign that stand-alone community hospitals probably are a vanishing breed.

Valley Medical and UW Medicine say they began "exploring the feasibility of establishing a strategic alliance," in which Valley would "operate as an integral component" of UW Medicine.

Valley Medical CEO Rich Roodman says the Renton hospital is giving up its "Switzerland" strategy of remaining independent while "being everyone's buddy."

Valley is far from alone in its move to tie in with someone bigger.

"This is going to be the trend, not the end," says Leo Greenawalt, president of the Washington State Hospital Association.

The probable alliance between Valley Medical and UW is just "the latest" such linkage, observes Swedish Medical Center CEO Dr. Rod Hochman. "Everyone is talking to everyone."

Regional consolidation in the hospital industry, Hochman says, is occurring as everyone now "appreciates they must get faster, smarter, and cheaper, and achieve better (patient-care) outcomes with less reimbursement" from public and private insurers.

Northwest Hospital & Medical Center, of Seattle, last year joined UW Medicine. And Stevens Hospital, in Edmonds, linked up with Swedish, which has three hospital campuses in Seattle and is building a hospital in Issaquah.

Linkages of some sort among hospitals now are occurring with seemingly greater frequency as health care reform ushers in this decade's version of managed care with a new Medicare program starting next year.

Under the program, groups of hospitals and physician practices will begin working collaboratively in groups as "accountable care organizations." And they'll probably have to accept some sort of payment per patient rather than payment for service—which will force them to put all the more stress on quality and efficiency.

What's more, hospitals joining together may enable more investments in technology such as electronic medical records, more efficient operations, and more breadth and depth of clinical services for patients.

Christopher Rivard, chairman of the health care group at accounting firm Moss Adams, notes that health care reform is limiting premium increases by insurers, which will pressure them to decrease payments to hospitals and doctors. Alliances, through their greater size, could position hospitals to negotiate better service rates with health insurers.

Apart from these possible benefits for hospitals, Valley Medical CEO Roodman says an alliance with UW Medicine could yield enriched clinical opportunities for patients, in such areas as cardiovascular and stroke services as well as obstetrics and occupational health, to name but a few.

"UW Medicine is interested in expanding specialized services into Southeast King County communities," Valley Medical said in a statement. "This would allow Valley Medical Center to ensure a broader range of local services."

UW Medicine already comprises UW Medical Center and Seattle's Harborview Medical Center as well as Northwest Hospital. UW Medicine CEO Dr. Paul Ramsey says still more UW alliances are possible.

"By working together, we can develop improved approaches to the quality of care, to patient safety, and to align services so they can be provided in a more efficient manner," Ramsey says.

Besides UW Medicine, Swedish stands out as the other large hospital system in Seattle, having earlier acquired Ballard Community Hospital and Providence Health & Services' Seattle hospital, and having last year pulled Stevens Hospital into its orbit.

Other large and growing hospital systems in the Puget Sound region include five-hospital Franciscan Health System, headquartered in Federal Way, and Tacoma-based MultiCare Health System, which now comprises five hospitals, including, as of 2006, Good Samaritan Hospital, in Puyallup.

"MultiCare is very interested in talking with anyone who would like to partner with us," says spokeswoman Marce Edwards, "and we have had some preliminary conversations with other organizations."

Hospital alliances, mergers, and linkages of one kind or another seem to come in many forms. "If you've seen one, you've seen one," Roodman says.

Just this week, Virginia Mason Medical Center, which has partnered with Group Health Cooperative, announced a telestroke arrangement with Kittitas Valley Community Hospital, in Ellensburg.

Valley Medical began to think about connecting with someone else early last year. Roodman says he visited with about a dozen other health care organizations in this area about strategies to survive the national reforms. He figured Valley Medical's "Switzerland" strategy of working with other hospitals while remaining independent would no longer suffice.

By April, he says, he had developed a list of 10 "core strategies necessary to survive under health care reform and the advent of ACOs." The strategies were largely based on such business and operational considerations as sites, contracting, technology, cost, clinic management, and financial performance.

But following a fall meeting of a 22-member advisory council, consisting of local business and community leaders, Roodman says, Valley's focus "morphed from business to clinical."

Valley's criteria for linking with another hospital organization shifted to focus on such matters as clinical excellence, opportunities for new programs, compatible missions, and the "ability to help Valley Medical Center add to the breadth and depth of comprehensive clinical services," he says.

Then Northwest Hospital CEO Bill Schneider introduced Roodman to UW Medicine's CEO, Ramsey.

"We did a lot of walking and talking," Roodman says. "Paul and I talked, and then we talked, and then we talked," he says, and in the end "it was just like the planets had aligned."

An alliance with UW, Roodman says, "has the potential to really elevate us, irrespective of health care reform."