| Part III, Program Service Accomplishments |
Ballad Health (Ballad) is an integrated healthcare delivery system consisting of 21 hospitals in Northeast Tennessee and Southwest Virginia, including a Level 1 Trauma Center, dedicated children's hospital, several community hospitals, three critical access hospitals, a behavioral health hospital, an addiction treatment facility, long-term care facilities, home care and hospice services, retail pharmacies, outpatient services and a comprehensive medical management corporation. Ballad works closely with an active independent medical community and community stakeholders to improve the health and well-being of over one million people in 29 counties of the Appalachian Highlands in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky. Ballad is a Tennessee non-profit corporation and is the main provider of healthcare services in Northeast Tennessee and Southwest Virginia. Ballad Health is a tax-exempt entity and the parent corporation of both Mountain States Health Alliance (MSHA) and Wellmont Health System (WHS). On February 1, 2018, Ballad was formed through a merger of two legacy systems, Mountain States Health Alliance and Wellmont Health System. Ballad was formed under state-action immunity in compliance with federal antitrust law, to create a healthier region and keep healthcare local. The action approving the merger was officially taken through the agreements made between Ballad and the State of Tennessee in the Certificate of Public Advantage (the "COPA") and the Letter Authorizing the Cooperative Agreement (the "CA") in Virginia. Pursuant to the COPA and CA, Ballad must fulfill certain obligations, commitments, and covenants. Tennessee and Virginia, through their respective health departments, supervise specific aspects of Ballad's operations under certain conditions of the COPA and the CA. The COPA and amendments is publicly available on the website of the Tennessee Department of Health, at https://www.tn.gov/health/health-program -areas/health-planning/certificate-of-public-advantage.html. The Cooperative Agreement is available on the website of the Virginia Department of Health, at https://www.vdh.virginia.gov/licensure- and-certification/cooperative-agreement/. Form 990 for Mountain States Health Alliance (MSHA) includes eight wholly owned hospitals including a children's hospital and a behavioral health hospital; two others, also wholly owned by MSHA, each file a separate return. Form 990 for WHS includes six wholly owned hospitals; three others, also wholly owned, each file a separate return. MSHA is sole shareholder of Blue Ridge Medical Management Corporation (BRMMC), a for-profit entity that owns and manages physician practices and real estate and provides other health care services to patients in Tennessee and Virginia. MSHA is the sole member of Integrated Solutions Health Network, LLC (ISHN). ISHN, also included in this Form 990, is a regional health solutions company headquartered in Johnson City, Tennessee. ISHN is an expansive network of providers serving residents of Northeast Tennessee and Southwest Virginia and consists of provider groups, primary care physicians, specialists, and allied health providers. Specific to the hospitals included in this Form 990, services were provided to: 41,650 inpatients 599,645 outpatient visits 161,525 emergency visits 3,776 deliveries 21,365 surgeries 113,080 home health visits |
| WASHINGTON COUNTY, TN: JOHNSON CITY MEDICAL CENTER (JCMC) |
- Located in Johnson City, Tennessee and serving the community since 1911. The 585-bed regional tertiary referral center has 416 beds dedicated to acute care, 85 beds for children and 84-beds for behavioral. - Provides a wide array of acute care services, including a complete range of cardiovascular, neurology, oncology, surgical and rehabilitation services. JCMC is a comprehensive, acute-care teaching hospital affiliated with James H. & Cecile C. Quillen College of Medicine at East Tennessee State University (ETSU). - Region's only Level I trauma center, one of only five in Tennessee, with 24/7 orthopedic traumatologist specialist coverage. - Region's only safety net hospital. - Regional Cancer Center at JCMC has relationships with Harvard, Duke, and Vanderbilt universities. - Quantros named JCMC in the top 10% of hospitals in the nation for patient safety in overall medical care, trauma care, heart attack and heart failure treatment, stroke care, hip fracture treatment and major neurological surgery in its 2023 CareChex awards. JCMC was also recognized among the top 100 hospitals and top 10% of hospitals in the nation for medical excellence in hip fracture care. - U.S. News recognized JCMC as "high performing" for knee replacement procedures, heart attack care and treatment, heart failure care and treatment, and care of stroke patients. - Niswonger Children's Hospital (NsCH) is a hospital within a hospital located on the campus of JCMC. NsCH is the only children's hospital in northeast Tennessee and serves more than 200,000 children in the four state, 29-county region. NsCH has more than 20 pediatric subspecialties providing specialty care through a pediatric emergency room and 85 inpatient beds, including a 16-bed neonatal abstinence syndrome. The Level III designated neonatal intensive care unit is only one of five state-designated tertiary centers for high-risk maternal fetal care in Tennessee and is the regional referral center for neonatal patents. A Ronald McDonald House is located on the campus and provides services to the pediatric patients and family members. In October 1999, a clinical affiliation was entered with St. Jude's Children's Research Hospital to provide pediatric cancer and other catastrophic disease treatment services. The affiliation with St. Jude's in one of only eight in the country. The First Regional Hemophilia Program, a state sponsored program for congenital bleeding disorders, is housed in the St. Jude affiliate clinic and provides programs for both children and adults with hemophilia. - Woodridge Hospital, a free-standing 84-bed behavioral health hospital located across the street from JCMC, provides mental health and chemical dependency services for adults, adolescents, and children in Northeast Tennessee and Southwest Virginia. Woodridge is the only dedicated inpatient behavioral health hospital in the region and provides a 24/7 intervention helpline. In 2023, Woodridge opened a new access point for behavioral healthcare with a 24/7 walk-in behavioral crisis clinic for patients experiencing behavioral health emergencies, such as suicidal or homicidal ideation, acute psychosis, auditory and/or visual hallucinations and other extreme mental or emotional crises. |
| WASHINGTON COUNTY, TN: FRANKLIN WOODS COMMUNITY HOSPITAL (FWCH) |
- 80-bed acute care hospital located in Johnson City, Tennessee and providing services since 2010. - Provides specialty and subspecialty care, including general acute medical, maternity, comprehensive diagnostic imaging, emergency services and advanced surgical services, including minimally invasive robotic surgery. - FWCH was the first "Leadership Energy and Environmental Design" (LEED) certified hospital in Tennessee. - U.S. News recognized FWCH as "high-performing" for pulmonary disease care. - Healthgrades recognized FWCH as a Five-Star Recipient for Treatment of Sepsis in 2023. |
| SULLIVAN COUNTY, TN: INDIAN PATH COMMUNITY HOSPITAL (IPCH) |
- 239-bed acute care hospital located in Kingsport, Tennessee serving the community since 1984. - Provides general medical and surgical services, including the Center for Women and Babies, various outpatient services, including advanced services such as the lung nodule clinic, a regional cancer center, and a sleep center. - IPCH opened the third Niswonger Children's Network Pediatric Emergency department in 2023, strengthening the system of care for children by joining Niswonger Children's Hospital in Johnson City and the J.D. Nicewonder Family Pediatric Emergency Department at Bristol Regional Medical Center. - Quantros named IPCH in the top 10% of hospitals in the nation for patient safety in overall surgical care, medical excellence in general surgery, patient safety in gastrointestinal care in its 2023 CareChex awards. IPCH was also named in the top 10% in the State of Tennessee for patient safety in general surgery. - U.S. News recognized IPCH as "high-performing" in pneumonia care in 2023. |
| CARTER COUNTY, TN: SYCAMORE SHOALS HOSPITAL (SSH) |
- 21-bed acute care facility located in Elizabethton, Tennessee providing services to the community since 1955. - Provides inpatient, geropsychiatric, and outpatient care for medical and surgical patients. - Healthgrades named SSH among the Top 10% in the Nation for Patient Safety in 2022 and Recipient of the Healthgrades 2022 Patient Safety Excellence Award. - Quantros named SSH in the top 10% in the nation for medical excellence in gallbladder removal in its 2023 CareChex awards and in the top 10% of hospitals in the State of Tennessee for gastrointestinal hemorrhage. |
| JOHNSON COUNTY, TN: JOHNSON COUNTY COMMUNITY HOSPITAL (JCCH) |
- Federally designated critical access hospital located in Mountain City, Tennessee serving residents of the upper Northeast Tennessee, parts of western North Carolina and Southwest Virginia since 1998. - Provides inpatient, emergency and outpatient care along with cardiac rehabilitation, diagnostic, and physical therapy services. |
| RUSSELL COUNTY, VA: RUSSELL COUNTY HOSPITAL (RCH) |
- 78-bed Medicare dependent hospital located in Lebanon, Virginia. - Included in the 78-bed complement, is a 20-bed inpatient psychiatric unit. RCH offers a full array of primary care services and some specialty services, including a cancer center. |
| UNICOI COUNTY, TN: UNICOI COUNTY HOSPITAL (UCH) |
- 10-bed acute care hospital, located in Erwin, Tennessee and providing services since 2018. - Provides general acute inpatient, emergency, cardiology, diagnostic imaging, sleep lab, and rehabilitation services. |
| LEE COUNTY, VA: LEE COUNTY COMMUNITY HOSPITAL (LCCH) |
- 6-bed critical access hospital located in Pennington Gap, Virginia providing services since 2021 to residents of Southwest Virginia and Southeast Kentucky. - LCCH was specially designed to meet the needs of its community, with acute and emergency services, diagnostic radiology and lab services, outpatient cardiology and additional rotating clinics for specialty care and telehealth access. |
| Novel Coronavirus (COVID-19) Public Health Emergency |
In March 2020, Ballad Health (Ballad) executed its disaster plan in response to the COVID-19 pandemic. This plan included the activation of its Corporate Emergency Operations Command (CEOC) to coordinate efforts across the system and around the region to rapidly plan for and execute an ongoing response to the issues resulting from the COVID-19 pandemic. Throughout 2021, Ballad continued to battle against COVID-19 as new variants emerged, such as the Delta and Omicron variants. As these variants spread through the Ballad service area, Ballad's emergency rooms experienced significant surges. In addition to caring for patients within the hospital's walls, Ballad also supported the community through testing and vaccination efforts. In 2021 alone, Ballad conducted almost 300,000 tests and delivered over 88,000 total doses of COVID-19 vaccines. In September 2021, Ballad expanded its Safe at Home program, which was designed to provide at-home COVID-19 care to include patients presenting at Ballad urgent care and primary care locations and those visiting Ballad hospitals. Launched in November 2020, the program aimed to prevent hospital overcrowding and conserve inpatient beds during current and expected COVID-19 surges. Eligible patients in the Safe at Home program were equipped with a pulse oximeter and thermometer to monitor their vitals at home and ensure they receive timely and appropriate care if their condition worsened. The program also involved regular interactions with Ballad's clinical team members via phone calls. In April of 2021, Ballad launched the region's first Center for Post-COVID Care, an innovative approach to COVID-19 care that creates an access point to comprehensive clinical care for patients struggling with post-COVID symptoms. Through the Center for Post-COVID Care, Ballad offers a full spectrum of services, including care navigation and case management, for post-COVID patients. The health system is also fostering research and learning opportunities and collaborating with other leading institutions to understand post-COVID care and increase awareness among healthcare providers, patients, and community members of this condition. In April 2022, Ballad closed its Corporate Emergency Operations Center. Ballad continues to vigilantly monitor COVID-19 and its variants in its service area and will respond accordingly. FOCUSING ON QUALITY |
| EMPHASIZING ZERO-HARM THROUGH TIERED SAFETY HUDDLES - As part of Ballad |
Health's systemwide initiative to improve safety and reduce harm, Ballad Health continued its tiered safety huddle program throughout the pandemic. Each day, frontline team members across the Ballad Health organization begin their morning with huddles focused on clinical quality and safety. These huddles provide an organized manner for team members to express opportunities to improve safety and quality and strive towards becoming a zero-harm institution. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership needs help to resolve the problem, the issue is further elevated to the market and corporate levels. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise. LAUNCH OF IBM/WATSON TOP HEALTH SYSTEM JOURNEY - Since the merger in 2018, one of Ballad Health's priorities has been to instill a zero-harm culture and become one of the highest-performing health systems in America for the quality of care it delivers to patients. After a rigorous review of the various systems for measuring that success, Ballad Health leaders chose IBM/Watson because it provided measurable, achievable, and valid guideposts for the health system. To help lead Ballad Health on this journey to become a top health system in the nation, health system leaders formed the IBM/Watson Top 15 Health System Task Force, comprised of stakeholders from multiple departments of Ballad Health. IBM/Watson identifies the 15 top-performing health systems in the nation based on four key performance domains: inpatient outcomes, extended outcomes, operational efficiency, and patient experience. Dr. Amit Vashist, Ballad Health's chief clinical officer, who leads the IBM/Watson top health system journey, stated, "We looked far and wide at various methodologies to identify the most appropriate benchmarks to measure ourselves against, and we ultimately chose IBM/Watson because it included an ideal blend of metrics and measures that are truly meaningful and appealed to our frontline clinicians, such as hospital-acquired conditions, ED throughput, readmissions, mortality, costs of care and length of stay." CLINICAL COUNCIL - A unique feature of Ballad Health is the establishment of a robust and diverse Clinical Council, comprised of about 30 physicians. The physicians were nominated by the leadership of all Ballad Health hospitals, the health system's medical group and independently practicing community physicians. The Council's members also include pharmacists, advanced practice providers and nurses. The Council reports directly to the Quality Committee of the Ballad Health Board of Directors. The council aims to ensure excellence in clinical care through physician engagement and leadership and is charged with guiding Ballad Health's transformation into a community health improvement system. As a result of the council's efforts, several important quality measures are now performing among the top-decile health systems in America. CONTINUED PUBLIC ADVANTAGE - Ballad's compliance with each of the COPA and CA is supervised by Tennessee and Virginia respectively. Ballad is in compliance with all terms of the COPA and CA. Each year since the creation of Ballad, the State of Tennessee and Commonwealth of Virginia have independently confirmed the public advantage created by the unification of the hospitals in the rural region. In the latest report dated June 2022, the Tennessee Department of Health highlighted that despite the significant changes for population health across the United States during the COVID-19 pandemic, the 11 Tennessee counties served by Ballad in "the COPA region performed better, and [were] shown to be healthier, than peer counties in 50 percent of population health" measures and that drug overdoses have decreased considerably in the region since the merger. The region also outperforms peer counties on all vaccination measures for children and adults. The overall cost of healthcare was reduced due to the reduction of preventable hospitalizations in adults 65 and older by almost half. The merger has reduced unnecessary administrative overhead costs and eliminated unnecessary duplication of high-cost services reducing the overall cost of care for the Appalachian Highlands. In the Tennessee Department of Health report covering the period of July 1, 2020 to June 30, 2021, the department noted that as a combined health system, Ballad Health was able to respond to the COVID-19 pandemic "in ways that would not have been possible with two separate health systems" to ensure the deployment of staff, beds and personal protective equipment met the needs of the community and served as a trusted voice in the region for COVID-19 information. In each year before the COVID-19 pandemic, Ballad Health also maintained one of the nation's most successful Accountable Care Organizations, which has been highlighted by the Centers for Medicare and Medicaid Services as one of a handful of organizations that have produced savings for taxpayers in each year since the program's creation, while making high-quality scores. |
| ENVIRONMENTAL, SOCIAL, AND GOVERNANCE (ESG) |
Ballad Health is committed to being a responsible and concerned citizen of the communities of the service area where it operates and is driven by its mission: "honor those we serve by delivering the best possible care." Ballad continues to deploy initiatives intended to improve the overall health and well-being of the over one million people living in its service area. ENVIRONMENTAL - Environmental stewardship and preserving the environment is important to Ballad and is demonstrated in the following practices: - Environmentally responsible supply chain - Encourage the recycling of materials and minimization of waste - Encourage the reduction of energy usage - Incorporate environmentally preferable alternatives when designing new construction SOCIAL - Social commitments are an integral part of Ballad's mission, vision, and values. By working and collaborating with others in the communities in which it serves, Ballad works "to build a legacy of superior health by listening to and caring for those we serve". Ballad provides direct and in-kind support to improve access to care and deliver healthy lifestyle services, education, and activities. The community health programs are designed to improve access and quality of care, strengthen community outreach and partnerships, decrease healthcare costs, and assist in the reduction of health care disparities in the region. Ballad has opened two new rural hospitals in the past five years. Ballad offers extensive education and outreach programs throughout the community at little or no cost to participants. Program areas include: - Community events, such as health fairs, screenings, flu shots, health and safety education, support groups, stroke education, baby and child health, and medical libraries - Children's resources, such as the Morning Mile Program, B.E.A.R. Buddies, car seat safety, and Families Thrive. - Heart and Soul, senior health, and well-being programs. - General health resources, individual health, nutrition, and safety education. - Regular health education speakers covering a wide range of topics. The following are some of the programs designed to improve healthcare equity and availability: Ballad as a Community Health Improvement Organization: Ballad's goal is to ensure the sustainability of rural healthcare services while improving the health and well-being of the region as a whole. In the short-term, Ballad will address health related social needs to improve access to care, reduce inequity, and empower individuals to adopt healthy behaviors and manage health conditions. In the long-term, Ballad will address social drivers of health to provide a community level foundation for permanent regional health improvement through multi-sector collective impact. Ballad is taking an intergenerational approach to focus on children's health initiatives to give kids a strong start in life, as well as assisting adults with overcoming obstacles to health and self-sufficiency. Ballad is on a journey to universalize social needs screening and prioritized navigation resources throughout the system using embedded Epic tools combined with the UniteUs referral management platform. These efforts are informed and supported by a multi-departmental team called the Social Needs Council which has accountability to the system Population Health Council, the Chief Population Health Officer, and ultimately the board Population Health and Social Responsibility Committee. STRONG Accountable Care Community: Driving Community Level Action and Change: The STRONG Accountable Care Community is a regional collective impact model focusing on community level strategies across a life course model that includes a multi-generation approach to parenting support and family self-sufficiency. Established in 2018, the STRONG Accountable Care Community (STRONG ACC), sponsored by Ballad, is a 350 organization, multi-sector model serving the same geographic footprint as Ballad and additional contiguous counties. The STRONG ACC has adopted the "Five Conditions of Collective Impact": a common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support. Ballad is providing backbone support and investing in the STRONG ACC because the health system believes the collective impact model is necessary to accelerate, leverage, and sustain community level change. The STRONG ACC is also using the UniteUs platform for a "no wrong door" approach to social needs across hundreds of networked organizations. The organization is also creating an Early Care and Education Plan for all of Northeast Tennessee and Southwest Virginia. For more information, visit https://www.strongacc.org/. Accountable Health Communities ("AHC"): When Ballad was awarded the Accountable Health Communities grant from the Centers for Medicare and Medicaid Services in 2017, the system acted on its vision to universalize social needs screening and navigation. Health related social needs create major barriers to health for some individuals. Since its inception, the program has screened 182,000 individuals on Medicare or Medicaid and identified 50,000 distinct needs, working with nearly 2,000 regional organizations to successfully connect individuals to services which provide food, housing, transportation, safety support, and utilities among other needs. AHC has provided 29,681 community referrals and navigation for 7,573 patients. The program has revealed new information about the extent of social needs within Ballad's patient environment and informed the goal to scale social needs screening and navigation services throughout the organization. Appalachian Highlands Care Network: Appalachian Highlands Care Network, started in 2020, is Ballad's program to serve low-income, uninsured people of the region through a realignment of charity care dollars. The goals of the Appalachian Highlands Care Network are to identify low-income uninsured people, enroll them in the program, and serve them to improve quality of care, increase access to care, and reduce avoidable cost of care. Patients in the program receive free needed medical care from Ballad and a network of other providers. This includes ensuring all patients have a source of primary care and are screened and navigated to social need resources, provided with medical care coordination, and assisted through care management services. Ballad partners significantly with Appalachian Mountain Project Access, the region's free and reduced cost clinics and health departments, and hundreds of regional social support agencies to break down barriers to medical care, improve chronic conditions like diabetes, and address social needs. To date, the program has enrolled more than 4,800 individuals. |
| STRONG Starts: Ballad believes safe, stable, nurturing environments |
for children are essential to optimal early development and later success in life. Started in 2021, STRONG Starts is aimed at improving birth outcomes and reducing the negative impact of chronic stress for mothers, babies and families. The birth of a new baby is a pivotal time for a mother and her family. No one should feel alone or unsupported during this time. Ballad seeks to connect with every expectant mother as early in her pregnancy as possible to ensure access to early prenatal care - all in partnership with the region's obstetric providers. As the life situation and pregnancy experience for every woman is different, Ballad will build supportive relationships aligned with the unique circumstances of every woman and family. With embedded staff in the region's obstetric practices and hospital birthing centers, these relationships begin early. Staff will help families connect with community resources for issues from food/housing insecurity to parenting resources to education/job training. To date, the program has screened more than 7,300 women and served nearly 3,000 through the course of their pregnancies. The program continues into the post-natal and early stage of life. Ballad staff assist those in the program through kindergarten entry with a whole-family approach. This ongoing relationship will help with evolving needs and the transition in healthcare from the obstetric environment to the pediatric environment. Ballad works with regional pediatricians to ensure they can refer children and families into the program. The developmental milestones of children will be assessed so early supports can be provided, and Ballad assist with connections to community resources as children grow, including programs which support resiliency and early learning environments. Ballad seeks to further support the safety, stability, and self-sufficiency of families and to help ensure children enter kindergarten developmentally, socially, and emotionally ready to learn. This first experience with the educational system is foundational, as it sets the tone for later success with grade level reading, math proficiency, and the academic discipline needed to ensure high school graduation and college and career readiness. These benchmarks are predictors of later economic and health outcomes which can reshape the life trajectory, health, and well-being for children and families for generations to come. To date, this section of the program has served more than 2,000 families. In addition to these programs, Ballad invests significant funding annually to support partnering organizations, Community Health Improvement Sites, who provide aligned services and mutually serve the populations mentioned above. These services include free health services, care coordination, housing supports, substance use and recovery, social needs support, maternal/child supports, early learning and literacy improvement initiatives, and women's health services. Ballad also provides a host of other services to vulnerable populations including free cancer screenings, mobile health services, health fairs, children's resources, and health education programs notably through a network of faith community nurses. The health system continued to address the cost of care in the region. For example, Ballad successfully managed the care of thousands of COVID-19 patients in their homes through the "Safe at Home" program. The program served 5,654 patients and saved millions of dollars in potential hospitalization costs and freed up hospital capacity for the most seriously ill patients. Based on the strength of this program, Ballad's Hospital at Home waiver was approved by the Centers for Medicare and Medicaid Services (CMS) for Ballad's Bristol Regional Medical Center, Holston Valley Medical Center and Johnson City Medical Center. This waiver will allow Ballad to provide hospital-level care at home for Medicare patients who traditionally qualify for hospital admission. Early results from similar programs around the country indicate high patient satisfaction and quality outcomes at a lower cost than traditional inpatient hospitalization. |
| Governance |
Governance is overseen by the Ballad Board of Directors and ongoing ESG work through the following committees: - Audit and Compliance - environmental and sustainability performance - Community Benefit & Population Health - social and community goals and performance - Executive Compensation - human capital; diversity, equity, and inclusion; and pay equity goals and performance - Governance - governance goals and performance - Quality - equity of care, patient safety and quality of care goals and performance Ballad has a conflict-of-interest policy and plans to align reporting with the Sustainability Accounting Standards Board's topics for disclosure and other reporting frameworks in the coming years. Ballad has leader diversity with 30% of CEOs being females and 33% of Executive Vice Presidents being females. Forbes recognized Ballad as The Best Employers for Diversity in 2020. CHARITABLE CONTRIBUTIONS - From its inception in February of 2018, Ballad Health made significant contributions to the community it serves totaling over $29 million to date in direct contributions and other community health improvement initiatives. A few examples from fiscal year 2022 include: Support for Speedway Children's Charities, aid to Feeding Southwest Virginia, provision of new EKG equipment to regional emergency medical services, and investments in regional programs for schoolchildren. IMPROVING ACCESS TO HEALTHCARE SERVICES RE-IMAGINE RURAL HEALTHCARE - Our region has a variety of health, economic and other issues that, when combined, present a unique and challenging environment for healthcare access and outcomes. These unique challenges were reaffirmed in a 2017 report issued by the Appalachian Regional Commission, the Robert Wood Johnson Foundation and the Foundation for a Healthier Kentucky (Health Disparities in Appalachia), which found that the health outcomes in the greater Appalachian region are worse than those experienced in the United States as a whole in 7 of the 10 leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes and suicide. The region also faces economic challenges, with performance on incomes, poverty rates, unemployment rates and postsecondary education lagging the national level. This is relevant because, as the study notes, socioeconomic and health outcomes are often interrelated, if not interdependent. Since 2010, more than 151 rural hospitals have closed in the United States, according to the North Carolina Rural Health Research Program. Compared to other states, Tennessee ranks amongst the worst in the nation, with 15 rural hospital closures since 2005. In the region served by Ballad Health, however, it is a different story. Every community in the region with a hospital prior to the merger creating Ballad Health continues to be served by a hospital. In fact, in the middle of the pandemic, Ballad Health opened the country's newest rural hospital. In July 2021, Ballad Health followed through on its promise to the residents of Lee County, Virginia, and reopened Lee County Community Hospital in Pennington Gap. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - A critical success factor of the COPA and CA is avoidance of duplication of hospital resources. Ballad Health consolidated two Level I trauma centers operating within 25 miles of each other and subsequently created a coordinated regional trauma system. In approving this move in advance of the merger, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers. The Tennessee Department of Health, after conducting a rigorous review of the trauma program at Johnson City Medical Center, issued its Level I Trauma Center Reverification Site Visit Report. The report found the hospital "has demonstrated an outstanding commitment to care for the injured patient." Further, the survey resulted in zero deficiencies, a first for trauma care in the region. CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. As a result of this law, Tennessee recognizes five regional perinatal centers. Niswonger Children's Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, two neonatal intensive care units (NICUs) existed and were not coordinated. After the merger, Ballad Health immediately took steps to consolidate the NICUs to achieve a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSU's Quillen College of Medicine to provide ongoing expert neonatology coverage for the hospital 24 hours per day. As a result of the merger and NICU consolidation, every newborn in the region has access to more than 25 pediatric specialists at the regional Perinatal Center. EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support Niswonger Children's Hospital. Our partners at ETSU's Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health. PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH - Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, Ballad Health has committed to contributing more than $15 million during the next 10 years to the Center. The goal of the Center will be to work with Ballad Health, local healthcare delivery partners, national experts and the leadership of ETSU Health to identify new mechanisms to improve health in rural and nonurban communities. Specific emphasis will be placed on strategies that disrupt inter-generational cycles of behaviors that contribute to poor health outcomes, which ultimately can affect college and career-readiness. RECRUITMENT OF NEW PHYSICIANS TO THE APPALACHIAN HIGHLANDS - Ballad Health provided the necessary resources to recruit new specialists to serve our region, many of whom were recruited to private practices not owned by Ballad Health. The addition of specialists is helping to improve access to care in rural communities. For instance, Wise County, Virginia now benefits from an orthopedist, a cardiologist and several other physicians and providers. Wythe County, Virginia, a community not served by a Ballad Health hospital, benefits from a cardiologist recruited by Ballad Health. Throughout the region, new physicians and advanced practitioners, recruited and funded by Ballad Health, are serving the region - from trauma care to pediatrics, from Wythe County, Virginia to Hancock County, Tennessee. |
| OTHER NOTABLE EVENTS AND AWARDS |
- Ballad has invested significantly across the region specifically in academic and community institutions that serve the people in the Service Area. Examples of this investment are shown through the continuum of service from the offering of observation opportunities to students of all ages within our clinical facilities, to providing experts to lecture to school children on a broad variety of healthcare topics. The commitment to giving back extends to direct investment in regional educational partners. Some key examples of this include the Appalachian Highlands Center for Nursing Advancement, The Center for Rural Health Research, the STRONG BRAIN Institute, and the Gatton College of Pharmacy Center for Pharmacy, Education, Outreach, and Advocacy. The work of these centers at ETSU focuses on some of the leading issues facing the Service Area, from the development and support of the next evolution of nursing as a profession, to understanding the unique challenges facing our public health, to the scourge of adverse childhood experiences, to access and intervention at the community pharmacy, Ballad is committed to understanding and addressing the significant issues facing the Service Area. - Ballad is also engaged in funding the development of new and expanded healthcare training programs across the region. Ballad has granted support of programs in Nursing and Allied Health. From a new BSN program in Southwest Virginia at Emory & Henry College, to a new program in Ultrasonography at Southwest Virginia Community College, we are supporting programs large and small. We have expanded the Medical-legal partnership we have in the Appalachian Highlands to include all of the Ballad facilities as well as many of the outpatient clinics. This one-of-a-kind program partners Ballad with Virginia Tech and the Appalachian School of Law together to address the challenges of access to social supports for the poorest members of the Service Area. Ballad is a sponsor of a residency in Advanced Education Graduate Dentistry in Southwest Virginia. This program has seen dramatic growth over the years and surpassed 10,000 patients cared for in fiscal year 2022. The endemic problem of poor oral hygiene across Service Area accounts for loss of economic opportunity, loss of self-esteem, and profound impacts on the health of individuals suffering from missing or diseased teeth. - Ballad's research department serves as the central office for multi-specialty research oversight in the System. In addition to providing full spectrum support for studies generated and managed by the research department, the department provides oversight for studies generated by external groups. The research department has participated in several large-scale, multi-center trials with subject retention at nearly 100%. Oversight services include administrative, legal, regulatory support, internal service arrangement and financial management. Ballad is a world leader in cardiovascular clinical trials. Ballad's chair of clinical research and medical director of the interventional and diagnostic catheterization labs led a new clinical trial in the United States for a potentially groundbreaking new carotid stent. The cardiovascular program at Holston Valley has performed as the No. 1 or No. 2 enroller in the United States and globally in at least 30 top research trials. - Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS) - Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care - Earned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired. - After the creation of a regional and coordinated system of trauma care nearly two years prior, in July 2021, a Tennessee Department of Health survey concluded the trauma program serving the Appalachian Highlands provides "outstanding commitment to care for the injured patient and found zero deficiencies at the Level I Trauma Center at Johnson City Medical Center, a first for trauma care in the region. As a result of the regional and coordinated system of trauma care, Ballad decreased mortality by 40% and reduced the cost of care by approximately $3 million. - Ballad has achieved seven EPIC Gold Stars. |
| Form 990, Part VI, Section A, line 6 |
Line 6 explanation - Mountain States Health Alliance is a Tennessee non-stock, nonprofit organization with Ballad Health as its sole member. |
| Form 990, Part VI, Section A, line 7a |
Line 7a explanation - Ballad Health has the authority to appoint Mountain States Health Alliance board members. The President and CEO of Ballad Health serves as the President and CEO for Mountain States Health Alliance. |
| Form 990, Part VI, Section A, line 7b |
Line 7b explanation - Decisions of the Mountain States Health Alliance Board of Directors are subject to approval by the Ballad Health Board of Directors. |
| Form 990, Part VI, Section B, line 11b |
Line 11b Explanation - The Ballad Health Tax Department prepares and reviews the Form 990. During preparation other functional areas within the organization provide information and support to complete an accurate return. The return is reviewed by the organization's EVP/CFO and is provided in electronic form to all members of the Board of Directors prior to being filed with the IRS. |
| Form 990, Part VI, Section B, line 12c |
Ballad Health has a conflict of interest policy for all members of the Board of Directors, the Executive Chair/President, Executive Vice Presidents, Senior Vice Presidents, and Vice Presidents, and applies to all Ballad Health organizations. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "Conflicts of Interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict. |
| Form 990, Part VI, Section B, line 15 |
Line 15a - Compensation Process for Top Official The executive compensation committee serves as the compensation oversight committee of Ballad Health's Board of Directors. The executive compensation committee is comprised of members who are determined to be independent and whom are not reliant upon any business relationship with Ballad Health for income or compensation. The compensation plan for Alan Levine, Ballad Health's Chairman, President and CEO, was reviewed and approved by the executive compensation committee and then by the Ballad Health Board of Directors in accordance with the Board's compensation policy and practice. The Board of Directors relies upon the advice of an independent and experienced compensation consultant with knowledge about pay practices for comparable positions within the industry, and who has access to broad data, studies and surveys in order to ensure the compensation falls within competitive and appropriate ranges for the position. Line 15b - Compensation Process for Officers On an annual basis, Ballad Health's Human Resources (H/R) Department evaluates compensation for all executives at a position level of Assistant Vice President and above. H/R's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on this comparable data, Ballad Health's CEO evaluates the data and, if appropriate, makes necessary adjustments. Any adjustments to Senior Vice Presidents or above are reviewed by the Board of Directors Executive Compensation Committee. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics categorized by; Quality, Service and Safety; Access to Care; Financial Stewardship, and any other metrics approved from time to time by the Board of Directors. |
| Form 990, Part VI, Section C, line 19 |
Governing documents and conflict of interest policy are made available upon request to the appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis. |
| Form 990, Part IX, line 11g |
Collection Services: Program service expenses 0. Management and general expenses 34,866,922. Fundraising expenses 0. Total expenses 34,866,922. Consulting Fees: Program service expenses 75,369. Management and general expenses 265,149. Fundraising expenses 0. Total expenses 340,518. Contract Labor: Program service expenses 38,831,004. Management and general expenses 2,838,659. Fundraising expenses 0. Total expenses 41,669,663. Dietary Services: Program service expenses 12,197,627. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,197,627. Environmental Services: Program service expenses 8,217,147. Management and general expenses 675,869. Fundraising expenses 0. Total expenses 8,893,016. Hospital Supported Clinics: Program service expenses 47,516,695. Management and general expenses 0. Fundraising expenses 0. Total expenses 47,516,695. Laboratory Services: Program service expenses 6,134,627. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,134,627. Laundry Services: Program service expenses 2,870,831. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,870,831. Other: Program service expenses 10,356,210. Management and general expenses 6,117,547. Fundraising expenses 0. Total expenses 16,473,757. Physician Fees: Program service expenses 33,950,382. Management and general expenses 0. Fundraising expenses 0. Total expenses 33,950,382. |
| Form 990, Part XI, line 9: |
Temporarily Restricted Grants 284,916. Intercompany Transfers 8,293,963. Other Acquisition 589. |
Attach to Form 990 or 990-EZ.