Many rural hospitals are struggling to stay afloat, in part because they lack power to negotiate payments with private insurers. Some have either joined bigger health care systems or sold to private equity to survive. Nathan White, CEO of Cibolo Health, had an idea that would allow small rural hospitals to stay independent: create a clinically independent network of hospitals that would operate like a co-operative, sharing resources and pooling patient numbers to better negotiate contracts and pricing with insurers.
As of 2025, Cibolo helped start networks in eight states, including Nebraska, Ohio, and Wisconsin, with more states already expressing interest. The scale provided by the network allows the more than 400 member hospitals to enter into value-based care arrangements with payers, which incentivizes them to close gaps in care like missed annual wellness visits and cancer screenings. “We ran a pilot for our Medicaid population in 2025 and we’re starting to get really remarkable data,” White says. “We’re talking like 90% improvement on closures in gaps in care.”