Everyone has a story about a beloved local café or bookstore that was bought out by a regional or national company and quickly stripped of everything that differentiated it. Chicagoans, for example, still mourn the 2005 acquisition of Marshall Field's, a glamorous department store, by Macy's, which has all the glamour of an auto parts dealer. Maybe Field's wasn't quite the paragon of service and selection we mistily recall today, but it was ours, and that mattered.

Given the quantity of ink devoted over the past few years to mergers and acquisitions (including in this magazine), you might think that the remaining stand-alone hospitals will be scooped up before you finish reading this column. But that's not the case, and here's why: They have other routes to sustainability in the value-driven world.

Our cover story "Strategic IT Alliances" takes a look at innovative regional partnerships among independent hospitals [Page 8]. These organizations band together to purchase powerful information systems, then load them with data. Together, they achieve the scale necessary to identify best practices, manage health risk and address gaps in the care continuum. But that's where the partnership ends. Each organization remains its own entity.

"Independent Partners" gets at this concept another way [Page 25]. Noncontrol transactions are affiliations that do not involve a transfer of ownership. They include investments, operating agreements and branding arrangements among organizations. While the smaller hospital may no longer be completely autonomous, it still has a sizable role in local governance.

Preserving community access to care will always trump staying independent for independence's sake. But, as nearly everyone says, health care is local. And keeping it that way matters.