Joining forces: hospital woo payers in an effort to build managed care relationships. (Health Care Quarterly)

As Richardson Medical Center officials watched several large groups of potential patients slip away, they read the handwriting on the wall: managed health care contracts can make or break a hospital.

To land -- and keep -- the contracts that often control thousands of prospective patients, the independent hospital chose to join a larger health care system. The need to attract managed care patients prompted Richardson to affiliate with Baylor Health Care System, said Leonard Bubis, vice president for managed care. In the short run, the affiliation will help the hospital contract with managed care companies, he said. Long term, it allows the hospital to join a vertically integrated health care delivery system. That type of network -- which includes diagnostic services, home health care, hospitals and more -- allows the health care provider to retain patients regardless of the level of care needed. "It was a proactive decision. But we would have been in an increasingly difficult position if we hadn't affiliated," Bubis said. Baylor's managed care expertise made it an attractive partner for Richardson, he added.

Although Richardson's move isn't unique -- smaller hospitals increasingly are joining larger systems eager to expand their geographic …