Ballad Health reduced all-cause mortality by 22% and lowered its observed-to-expected mortality ratio by 10% between fiscal years 2023 and 2025. This progress is more than an operational win. It reflects a shift in mindset. At its core is a systemwide commitment to identifying deterioration earlier, acting faster and delivering care that is aligned with patient values.
This work is part of Ballad’s broader journey toward becoming a high-reliability organization. Safety, accountability and continuous learning are being embedded into every level of care.
From review to redesign
A mortality gap analysis in 2023 revealed variation across documentation, care escalation and alignment with clinical best practices. One key insight emerged around MS-DRG 283, which includes patients admitted with acute myocardial infarction who died and had a major complication or comorbidity. Leaders noted a larger-than-expected gap between observed and expected mortality for this group. This prompted focused reviews to better understand the care journeys of these complex cardiac patients and to improve alignment across coding, documentation, and clinical pathways.
Ballad treated this as a signal that warranted structured and systemwide attention. The team moved quickly:
• A mortality case review algorithm was adopted across all hospitals.
• A revamped system mortality review process was introduced to bring clarity, consistency and follow-through across facilities.
• Predictive analytics tools were deployed to help caregivers recognize and act on early signs of deterioration.
Clinical gains across key conditions
The redesigned approach led to measurable improvement across high-risk conditions:
• Heart failure mortality dropped by more than 25% between FY23 and FY25
• Pneumonia-related mortality decreased by 18%
• Sepsis mortality declined by 14%
• Sepsis bundle compliance rose by 5%
These outcomes are tied directly to stronger alignment with the Surviving Sepsis Campaign guidelines, use of standardized screening protocols, and consistent accountability through real-time feedback and coaching.
Protocols have become more than checklists. They are now shared expectations for how to save lives.
Compassionate care through predictive insight
Ballad’s quality and palliative care teams are working together to develop and embed a compassion index into the EHR. This predictive tool helps identify patients who may be approaching the end of life and supports clinicians in initiating earlier conversations about goals of care.
The intent is not only to reduce mortality but to improve how patients live with serious and potentially end-stage illnesses. It also changes how care teams think about timing and trust. Some of the most impactful conversations happen when patients are still vertical and able to express what matters most. Waiting until a crisis risks delivering care that is too late, misaligned with the patient’s wishes, and marked by unnecessary suffering.
Early identification, proactive discussion and alignment with patient values are reshaping how care teams support dignity, choice and quality of life.
Upstream strategy for sustainable change
Ballad is now linking mortality insights to upstream chronic disease management. This work seeks to identify patients earlier in their disease journey, coordinate more proactive care, and reduce preventable hospitalizations and complications.
Mortality is no longer viewed simply as a retrospective quality measure. It has become a forward-facing lens. It reveals gaps, prompts questions and guides action.
Every percentage point gained represents more people who make it home. Each avoided hospitalization, earlier conversation or documented preference is a step toward care that is safer, more timely and more human.
A system that learns
These changes reflect more than performance improvement. They represent the evolution of a health system’s culture that responds to challenges, learns from its data and adapts relentlessly to improve outcomes. It is a reflection of Ballad’s commitment to becoming a true learning health system.
The journey is not finished. There are still many metrics where the work is cut out. But with a strong playbook, aligned infrastructure and shared purpose, Ballad has gained the confidence that it is moving forward in the right direction. One decision, one life and one lesson at a time.
