Report outlines how Ballad Health’s progress will be evaluated by the state


Ballad Health is the largest state-governed merger in the country but the hospital system’s future is not guaranteed. 

That’s according to the Tennessee Department of Health’s first Certificate of Public Advantage Index Report published Wednesday.

The report says, “The COPA Index will be used to determine if the disadvantages caused by a reduction in competition of health care and related services continues to be outweighed by clear and convincing evidence of benefits of the Cooperative Agreement.”  

The report says TDH collaborated with internal experts, hired consultants and members of the public to come up with a set of measures that would objectively evaluate the progress of the merger.

Progress will be measured based on four categories that each have their own sub-index: population health, access to health services, economic advantages, and other benefits.

The “Economic Sub-Index” will receive its own pass or fail grade. The other three categories will be calculated separately, weighted and ultimately combined to produce a final score. 

That score will then be used to determine, on an annual basis, whether or not the Ballad merger is to the public advantage. 

“The COPA can be denied or terminated if the likely benefits of the Cooperative Agreement fail to outweigh any disadvantages,” the report says. 

The report released Wednesday, being the first of it’s kind, will serve as a baseline for future comparison. 

The “Population Health Sub-Index” identifies four priorities that directly influence six of the top ten leading causes of death in Tennessee, according to TDH. 

The so-called “Big Four” are smoking, obesity, physical inactivity and substance abuse. 

Ballad has committed to spending 75 million dollars over ten years to address these problems. 

Ballad’s progress will be tracked by comparing dozens of data points on Ballad’s geographic service area to information from other counties in Tennessee, Tennessee as a whole and the United States. 

Measures included in the “Access to Health Services Sub-Index” are designed to target three questions: 1) Is care available, 2) Is the right care being delivered at the right time and in the right place, and 3) Are people satisfied with the availability of care?

There are 28 measures total in this section, which evaluate factors like distance to urgent care, emergency department wait times, specialty recruitment and engagement in substance abuse treatment. 

“For the first year of the Ten-Year Period, Ballad will be required to maintain baseline performance on each Measure. For Measures where the target is to improve, the expectation is for improvement over the baseline to be achieved and maintained,” the report says. 

The “Other Sub-Index” focuses on quality of care. This section takes patient experience surveys into account, among several other indicators. 

The report shows an average of about 80 percent of respondents said they would “definitely recommend” the hospital where they received treatment. 

But an average of nine percent of people said they “sometimes or never” received help as soon as wanted from hospital staff. 

Plus, an average of nearly 11 percent said hospital rooms or bathrooms in Ballad’s systems were “sometimes or never” clean. 

Ballad Health declined to comment on these numbers, saying they’re still reviewing the report. 

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