Things change, including in health care, and largely for the better. There are cures for diseases that once killed us, medicines that mitigate what were once debilitating maladies, surgical advances that send patients home the same day rather than keeping them in a hospital bed for a week.

Yet folks can sometimes wax nostalgic. Long gone are the home visits by the family doctor. Even the lone practitioner is fading into days gone by, replaced by large practices in which doctors, physician assistants and advanced practice nurses take a team approach to care and share the expense and burden of navigating the complexities of health insurance.

Also passing into history is the small community hospital that acted independently. Just look around. Hospitals have evolved into health care systems, grouped together by mergers, acquisitions and affiliations of various stripes.

It is no surprise then that Lawrence + Memorial Healthcare is seeking state approval to formally affiliate with the larger Yale-New Haven Health System. L+M itself expanded when it acquired smaller Westerly Hospital a couple of years back.

The rapidly rising cost of health care has to be controlled. The state and federal governments are doing that by putting a brake on the fees paid out by the Medicare and Medicaid programs. Insurance companies have sent the message they will no longer accept seeing the costs of the care provided to the uninsured shifted to the fees they pay and the premiums they assess.

Meanwhile, the Affordable Care Act is driving a movement to provide more seamless and efficient care with the goal of both controlling costs and providing better health outcomes. In a meeting with the editorial board, Yale-New Haven President and CEO Marna Borgstrom explained that means using evidence-based practices to find the best way to provide care, from patient entry into the system through follow-up.

By using documented best practices, information systems accessible to all the treating health professionals, and by better aligning the care provided, Borgstrom said redundant testing can be eliminated, hospital stays shortened, and incidences of re-admission due to complications reduced.

A partnership with Yale-New Haven provides L+M and the patients it serves the best opportunity to pursue this new model of care.

It is unclear, however, whether the deal will any time soon obtain the certificate of need necessary to move forward. In February, after the review process started, Gov. Dannel P. Malloy issued an executive order prohibiting until Jan. 15, 2017, the granting of a CON for hospital network mergers and acquisitions.

In issuing the order, Malloy expressed concern about the rapid succession of mergers and appointed Lt. Gov. Nancy Wyman to chair a study group reviewing the situation.

We remain convinced the order was unfair to L+M and Yale-New Haven in that it was issued after the application process began. It could well fall to a legal challenge. We urge the governor to amend the order as necessary to allow the review by the Office of Healthcare Access to reach an expeditious conclusion.

The planned affiliation with the prestigious Yale-New Haven network will mean access to more specialists and the addition of an estimated 20 new physicians, bringing more primary care doctors to the area. Yale-New Haven is pledging to invest $300 million in new equipment and services.

L+M and Yale have a history of cooperative ventures, including in the fields of radiation oncology, care of stroke victims, pediatric emergency medicine, invasive cardiology, angioplasty and vascular surgery. With a formal affiliation, L+M patients would be able to participate in the many clinical trials conducted by Yale-New Haven.

Fiscally, savings will come in part from reductions in administrative costs and integration of such back-office functions as human resources, legal counsel and financial services.

Under the proposed affiliation, both L+M and Westerly retain their separate hospital licenses and boards of directors, but add representation from Yale-New Haven. Endowments and any funds raised for the local hospitals remain in control of the boards.

The Yale-New Haven board, however, would set the strategic plans for the expanded network and have final say on any decision by L+M to take on debt or sell or acquire assets.

Organized labor groups have spoken in opposition to the affiliation. That’s understandable. Reducing costs to any significant degree invariably involves reductions in labor spending.

But those savings are unavoidable regardless, and could be worse. If the deal is rejected or stalls, savings still would have to be found by way of labor and service reductions.

Eventually, L+M would collaborate with someone, perhaps someone not as favorable as the Yale-New Haven proposal.

The Office of Healthcare Access should act diligently in reaching a certificate of need decision and we ask the governor not to stand in the way.