In Des Moines, brides are posing in the spring sun under the profusion of flowering trees in the Arboretum and families are strolling the path around Gray’s Lake. Up in the cavernous Veterans Memorial Convention Center, UnityPoint is wrapping up its Leadership Symposium celebrating its 20th anniversary as an integrated system.

An outsider might be forgiven for thinking of Iowa as a fairly traditional place, a family place, not given to wild leaps into crazy schemes. We don’t necessarily think of Iowans as change-mongers and avante-gardists. But in its own quiet Midwestern way, UnityPoint has been promulgating the Next Healthcare across three states.

UnityPoint was founded 20 years ago when several local institutions came together to form the Iowa Health System. It grew over time, amalgamating hospitals across Iowa, in southern Illinois, and southern Wisconsin. It changed its name to UnityPoint two years ago.

The name change reflected a more fundamental change: Bill Leaver had become CEO in 2007. Since 2009, he had been patiently remolding what was a decentralized hospital-centered amalgamation into a patient-centered, physician-driven integrated delivery system. “I told my board that we could wait until outside factors force change on us,” Leaver told me, “or we could get out ahead of it and help shape the change.”

Today, its 1200 docs across nine regions are knit into a single physician enterprise linked to its 17 hospitals and other services with a single EHR instantly accessible from anywhere in the system. Its call center has been shifted from a simple advice line to become the front-line triage across the system, with full access to the patients’ records. All primary care is in full patient-centered medical homes tied directly to a single home health system. “Truly unified care coordination has to be the core competency” of any system in today’s healthcare, Leaver told me, “especially to get better at managing chronic disease.”

UnityPoint is building out its own insurance capability. This summer it will be lighting up a virtual care center to do medicine at a distance for its far-flung rural populations. It has long been the go-to organization for behavior healthcare in its regions. Its newest ED in the Quad Cities region builds behavioral health triage directly into the workflow.

Today some 25-30% of its revenue comes from Medicare Advantage, ACOs and other value-based arrangements, rather than traditional fee-for-service. “The healthcare world is moving toward value, buying healthcare based on what is your patient experience?” says Leaver. “What are your outcomes? What’s your price?”

Leaver is retiring this year, moving back to Michigan to be near the grandkids, handing the tough task on to Kevin Vermeer, now the president and chief strategy officer.

This is my experience across healthcare: The pace of change is highly varied, and depends to a great extent on individual leaders who get it, who grasp the complexities and have the skills to bring together the pieces and capacities and skills across their organization to make it work. There are revolutionaries across healthcare, sometimes in what you might think are the quieter places. Here’s to them, here’s a shout out and wave and a tip of the hat.