In a conversation that could easily double as a blueprint for rural healthcare innovation, Erik Thorsen, CEO of Columbia Memorial Hospital (CMH) in Astoria, Oregon, shared insights on the success of CMH’s long-standing partnership with Oregon Health & Science University (OHSU). This isn’t your typical affiliation story: This is a collaboration built on independence, trust and community-centered design. Below is an edited excerpt of my conversation with Erik.
John Andersen: Let’s start with the big picture. What’s the primary advantage of CMH’s partnership with OHSU?
Erik Thorsen: The biggest advantage has been improving access to care, especially specialty care, in our community. Before OHSU, many of these specialties simply didn’t exist locally. Now, not only do we offer them, but about 80% of the specialists actually live in Astoria. They’re part of the community—you see them at ball games and the grocery store. That local presence makes a huge difference.
Andersen: That’s a rare model for a rural hospital. What made this partnership model successful?
Thorsen: We created a structure where providers are employed by the academic medical center but live and practice full-time in our rural setting. They benefit from the professional support of OHSU while enjoying the lifestyle of a smaller town. It’s attractive for specialists who might otherwise overlook a 25-bed critical access hospital (CAH).
The OHSU name helps too—on résumés, in recruitment and in the clinic. The association with OHSU builds trust in the care we’re providing. That trust has translated to more patients staying local rather than traveling to Portland.
Andersen: How financially integrated are CMH and OHSU?
Thorsen: Our cancer program is the only specialty that is financially integrated with OHSU. For all other specialties, we essentially “lease” providers from OHSU—we pay their salaries, benefits, malpractice and a small administrative fee. That simplicity has spared us a lot of governance headaches and keeps our focus on patient care rather than audits and profit-sharing negotiations.
Andersen: Was there a template for this model or did you build it from scratch?
Thorsen: It was mostly homegrown. OHSU had a similar relationship with another rural hospital in Oregon, so we collaborated with them and learned from their experience.
Andersen: Have others shown interest in replicating your model?
Thorsen: At conferences, yes. People are genuinely interested when we present. But once they go home, follow-up is rare. It’s not necessarily easy to replicate—you need the right leadership on both sides. Trust and flexibility are key.
Andersen: What about downsides? Are there any risks in the model?
Thorsen: Because we are not fully integrated our relationship is bound by a collaboration agreement. Agreements can be terminated, which poses risk to both parties. To safeguard against that we’ve built long termination runways into our agreements.
Andersen: You mentioned CMH’s Cancer Center earlier in our conversation. How did that evolve?
Thorsen: That’s the one area where we have a mor formal joint operating agreement. We needed tighter integration because of the technical demands of cancer care. OHSU contributed capital and their brand, which was the first major co-branded initiative. Now, patients can get the same quality of cancer treatment in Astoria as they would in Portland. It’s been a game-changer for our community and a model of success.
Andersen: You recently transitioned all CMH-employed providers into the OHSU system. What drove that move?
Thorsen: Over time, more than half our providers were already employed by OHSU. That created logistical inconsistencies—different hours, benefits and policies. It made sense to unify under one umbrella. The transition to the CMH-OHSU Health Medical Group went smoothly—we didn’t lose a single provider.
Andersen: Let’s shift to inpatient care. Like many rural hospitals, CMH faces a declining census. What’s driving that?
Thorsen: Several things—more procedures are performed as outpatient now, especially in orthopedics. But we’re also seeing a drop in births. Our county’s birth rate is declining, and that threatens the sustainability of maternity services. That’s a concern, especially in rural settings where maternity care is already vulnerable.
Andersen: Are there strategies to address underutilized inpatient capacity?
Thorsen: Yes. We’re exploring ways to take post-op or post-acute patients from OHSU to recover here. Swing beds are another opportunity. We’re also looking at service gaps—like inpatient dialysis—that currently force us to transfer patients out.
Andersen: Tell us about CMH’s hospital expansion project. What’s driving it?
Thorsen: Four things: infrastructure age, space limitations, resilience, and patient experience. Our current facility is 50+ years old, in a tsunami inundation zone and built for an inpatient era. The new hospital will feature a tsunami-resistant design with a rooftop safe refuge area for up to 1,900 people and a helipad for evacuation.
Andersen: That’s impressive. How did you include the community in the design?
Thorsen: We had over 250 participants across six design sessions, including frontline caregivers, providers, leaders and our patient-family advisory committee. It wasn’t just architects and administrators. Everyone who will use the facility had input.
Andersen: What role did Kaufman Hall play in the expansion planning?
Thorsen: We started planning in 2017 and spent three years modeling financial scenarios. Kaufman Hall helped stress-test those scenarios and communicate clearly with our board. That work gave us confidence to work with Kaufman Hall’s Treasury & Capital Markets team on one of the largest debt issuances we’ve ever tackled and, we believe, one of the largest CAH debt issuances ever.
Andersen: Has CAH status played a role in your sustainability?
Thorsen: Absolutely. We wouldn’t be here without it. The “tweener” hospitals—too big to be CAHs but not big enough to compete with urban centers—are really struggling. CAH status helps us keep key services running even when they are lower margin.
Andersen: Do you think your model is replicable in other communities?
Thorsen: I do—if the conditions are right. Start small. Build trust. Don’t begin with something massive like an EHR conversion. Focus on services you can provide safely and sustainably. And if you can bring in a respected academic partner, that branding alone can shift community perception and retention.
Andersen: Lastly, what’s your outlook on rural healthcare in general?
Thorsen: It’s tough. More closures are likely. We need honest conversations about what level of care can be sustained safely in rural communities. More hospitals may transition to rural emergency hospitals. We also need more collaboration—less isolation. The appetite for acquisitions in rural healthcare may be fading, but there’s still space for creative partnerships like ours.
Andersen: Any final advice?
Thorsen: Match your growth to your mission and community needs. Make sure it’s sustainable, and don’t underestimate the power of perception. When your community believes in your hospital, everything else gets a little easier.
