In 2018, Ballad Health was created through the merger of Kingsport, Tenn.-based Wellmont Health System and Johnson City, Tenn.-based Mountain States Health Alliance, forming a 20-hospital system serving northeast Tennessee and southwest Virginia.
“In our rural area, we had two health systems competing for a couple percentage points of market share every year, spending over $2 billion annually, while the population health metrics — like mortality and morbidity — were not improving,” said Anthony Keck, system innovation and chief population health officer. “The board, our CEO and community leaders realized that if we came together, we could eliminate a lot of the duplication in the market. We had hospitals less than a third full and just two or three miles apart, urgent care centers across the street from each other. By consolidating, we could redirect those savings into services the region really needed — like behavioral health — and into addressing social determinants of health and health-related social needs.”
Post-merger, the health system launched a long-term population health strategy centered on becoming a national model for rural health. Its core metric: reducing years of potential life lost, or YPLL, by 100,000 over the next decade.
YPLL is a metric used by public health experts and researchers to measure premature mortality by calculating the number of years a person would have lived if they hadn’t died prematurely. It’s based on death certificate data, including causes of death.
“In our region — Appalachian Highlands — we have significantly higher early death rates than the national average, and higher than the rest of Tennessee and Virginia,” Mr. Keck told Becker’s. “Even within our 21-county service area, there’s a twofold difference between counties in early death rates.”
In Ballad Health’s service area, the top contributor to YPLL is cancer, followed by cardiovascular disease and accidental deaths, including overdoses. Knowing that, the health system has built programs specifically targeting these issues. For example, it increased screenings — especially nontraditional screenings such as low-dose CT scans for lung cancer and coronary calcium scoring for heart disease.
Additionally, the system expanded its smoking cessation program. Mr. Keck said more than 2,800 people have gone through it, and over 25% have quit, which equates to tens of thousands of potential years of life saved over time.
“Our investments are focused on the long term,” he said. “Unlike traditional value-based contracts, which expect savings within a year, public health investments may take a generation to yield results. Our structure allows us to layer multiple programs and take that long-term view. And what’s great is that every employee in our organization — whether in cardiovascular, NICU or primary care — can connect their work back to that shared YPLL goal.”
