When Ballad Health formed in 2018 through the merger of Mountain States Health Alliance and Wellmont Health System, the Johnson City, Tenn.-based system set out to serve a largely rural region with a lower cost structure. In the years since COVID-19, that effort has hinged in part on stabilizing its nursing workforce.
By raising nursing pay, building a homegrown talent pipeline and opening childcare centers for employees, the system has reduced nursing turnover from almost 30% to below 12% and is now posting its strongest financial results since it was formed, according to Alan Levine, chairman and CEO.
Mr. Levine, who spoke with Becker’s at the CEO + CFO Roundtable in Chicago, said Ballad saw nursing turnover near 30% for two years because of the pandemic, which led the system to put a comprehensive staffing plan in place. That plan included nearly doubling nursing wages, launching Ballad Health Academy in partnership with school systems across the region with support from a $16 million Bloomberg grant, opening nine early learning centers that hundreds of employees’ children now attend and starting an affinity program called Balladeers.
“The success story there is that our nursing turnover has dropped to below 12%. That’s well below the industry median, so we finally stabilized the staffing, and everything flowed from that,” he said.
The national staff RN turnover rate was 17.6% in 2025, according to the 2026 NSI National Health Care Retention & RN Staffing Report.
Mr. Levine said the improvements are also reflected in how patients rate the system’s hospitals. Three years ago, Ballad’s hospitals averaged around 2.5 stars in Google reviews, and some now have ratings as high as 4.6 out of five.
“When you read the comments on those Google reviews, you see such amazing positive feedback, and that’s a direct result of the investments we made in nursing,” he said.
The investments came with a financial cost, so Ballad leaned heavily on the revenue side, renegotiating contracts with insurers and working with the state to put state-directed payments in place in its Medicaid program, Mr. Levine said.
The system generated a 4% operating margin in fiscal 2026, which ended June 30, and is sustaining about a 4% margin so far in fiscal 2027, Mr. Levine said. He attributed the financial improvement to a combination of service consolidations, staffing investments, expense management and revenue enhancements. With the region’s population growing about 1.5% a year, he said, the gains are not coming from volume.
“So the financial success isn’t being driven by growth. It’s being driven a lot by the expense management we’ve done and the revenue enhancements we’ve made by working with our states,” Mr. Levine said.
The academy reflects a broader lesson Ballad took from the pandemic about how a rural system has to approach its workforce.
“As a rural and non-urban system, what we learned and realized after COVID was that we cannot rely on recruitment alone to fill our needs, whether it’s physicians or clinical team members. We have to find ways to grow our own,” he said.
Through the program, Ballad identifies students as early as middle school who show an aptitude for science and introduces them to healthcare careers, whether in nursing, finance or other areas, Mr. Levine said. The system lowered its working age to 16 so students can gain hands-on experience while still in the program. Ballad also expects to graduate high school students who are already licensed practical nurses and can begin working for the system after graduation.
The system has also used technology to ease the load on staff. Ballad invested about $8 million in a clinical command center that connects all of its hospitals. The center has helped eliminate nearly 7,000 transfers to its tertiary hospitals by giving clinicians at smaller community hospitals real-time access to specialists, allowing patients to stay closer to home, according to Mr. Levine.
He said the approach has relieved pressure on both rural emergency departments and staff at Johnson City Medical Center, which had previously been overwhelmed by transfer requests.
Ballad has also used AI to speed stroke care. The technology allows CT scanners to notify the stroke team in real time, and Mr. Levine said the system has reduced the time from a patient’s arrival to a head scan to eight minutes, compared with a best-practice benchmark of less than 45 minutes.
Mr. Levine said the system weighs every technology decision against its effect on the workforce.
“Our No. 1 priority for deploying technology is whether it makes things easier for our labor force,” he said.
Even some of Ballad’s more contested decisions tie back to staffing. When the system consolidated two level 1 trauma centers, the move drew pushback, but Mr. Levine pointed to a study published in The American Surgeon that found a 24% reduction in mortality among the most severely injured trauma patients after the consolidation. He said the combined center can now be fully staffed across all specialties, which was not possible with two centers in a rural region.
With labor costs now stabilized and wage increases back to more typical levels, Mr. Levine said Ballad’s bigger cost concerns are supply and medication expenses, which are growing at nearly double-digit rates year over year, along with policy uncertainty stemming from Medicaid changes in HR 1. He also said the system is closely watching how inflation affects employees.
“Inflation and the cost of living are putting pressure on our team members, so we’re trying to keep our ear to the ground on that and make sure we’re doing everything we can to support them,” Mr. Levine said.
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