For independent, rural hospitals, the networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system. “Anything that can help our rural hospitals and add services is awesome,” said Jacobi, who provides speech therapy to children in the local school district. Rural health care providers are increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices that launched in 2015 in rural western Colorado. “In theory, quality should improve with the alignment of health care organizations, but there is no evidence,” the report said. He said health systems sometimes cut services and staff at rural hospitals they acquire.