"The point you raise about minority ownership ranging from arms-length contracts to joint ventures and affiliation agreements is important," he says, equating such deals to "dating."
"Let's just say there's a lot of dating going on right now."
But what about those who may not be particularly well-positioned for the future, but happen to dominate their local markets? They shouldn't wait too long before exploring their strategic options, Saxena cautions. In other words, don't be a wallflower at the dance.
"If you wait until you're in a precarious position, you've probably waited too long," he says. "If you're just resting upon a strong balance sheet, you're arguably not adding the kind of value you need to in the community and you're existing for the sake of existing.
Those executives should be out in the marketplace looking for partners and doing scenario planning exercises where with a certain trigger they'll go one way or another and agreeing on those triggers with their boards."
Should any of those "triggers" be set off, a sense of urgency would come into play around creating a transaction, he says. In the case of smaller hospitals, you could call it a "living will."
"That would serve them well and ensure they get the most value from a transaction and can name their terms," he says. "If you wait too late, it's just a fire sale and you've destroyed value in the community."