What's in the merger?

Hank Hayes • Nov 4, 2019 at 8:00 AM

BLOUNTVILLE -- Tennessee and Virginia have different processes in place to govern the Wellmont-Mountain States merger that formed Ballad Health.

Tennessee’s is a Certificate of Public Advantage (COPA), while Virginia’s is a Cooperative Agreement.

Both agreements provide immunity to the hospitals from state and federal antitrust laws by replacing competition with state regulation and active supervision. The goal of both agreements is to protect the interests of the public in the region affected and the states.

Both agreements are strikingly different in one area ‑ population health.

Tennessee has 25 population health performance measures, while Virginia has 13 measures, as was pointed out in a recent COPA Local Advisory Council meeting held at the Sullivan County Health Department.

Virginia’s measures were crafted and approved by the Southwest Virginia Health Authority in 2016. Tennessee approved the COPA in 2017.

The common areas both states address in their population health plan are tobacco use, obesity, substance abuse, immunizations, community/environment and outcomes. Tennessee has a physical activity population health measure, while Virginia does not.

Ballad Health has committed to spend a minimum of $75 million over a 10-year period on population health improvement.

“As you know, those are big initiatives that Ballad is undertaking and the initial plans have been approved,” Ballad Health COPA Compliance Officer Gary Miller said of the health care system’s population health plan and other COPA commitments. “(COPA Monitor Larry Fitzgerald) is in a process reviewing Ballad’s spending commitments related to those plans. He is reviewing Ballad’s quality data. He does see that any complaint gets a response.”

But what population is being measured? Ballad Health’s patient base? Or the Northeast Tennessee/Southwest Virginia region as a whole?

“I don’t know which population we’re talking about,” said council member Gary Mayes, the director of the Sullivan County Health Department.

According to the COPA, Ballad Health expects to pursue “Accountable Care Communities” in its service area in partnership with local, state and federal agencies, payors, service providers and community groups.

The COPA Local Advisory Council’s mission is to assist the Tennessee Department of Health in ensuring that the COPA issued to Ballad Health provides a public benefit for residents of Northeast Tennessee and Southwest Virginia by facilitating public input and reporting on information received.