Ballad CEO talks to Six Rivers Media: Takeaways

Ballad Health Chairman and Chief Executive Officer Alan Levine met with the Six Rivers Media editorial board Thursday to discuss the state of health care and the intricacies of Tennessee's largest hospital system.Throughout the conversation, Levine stressed Ballad's growth, their feedback process and a desire to keep ownership local. Here are some of the main takeaways from the discussion.Growth after transitionLevine started the conversation by reflecting over the last eight years — a decade that has been filled with strain on rural health and an increasing prevalence of mergers and acquisitions in health care."The change is happening all around us, and we're having to adapt to it," Levine said. "The change became, do we allow ourselves to be acquired by outside entities, and therefore the health care in this region be controlled by outside entities, or do we decide to create our own path?"The CEO said that Ballad knew that hard decisions would have to be made — like the consolidation of trauma centers, for example — but that they want to be the ones making the decisions."The alternative universe where you're acquired, prices go up, services are closed and the profits go to the hometown of wherever that entity is from," he said.Levine added that as the outcomes of changes play out, data has supported moves made by the system. As an example, he cited one 2024 study that concluded that the consolidation of Ballad's trauma services to one center ultimately decreased mortality for the most injured patients.He also emphasized Medicare Hospital Compare data, which shows that hospitals like Johnson City Medical Center, Bristol Regional Medical Center and Holston Valley Medical Center have better rates than the Tennessee and national average in metrics like patients who leave the emergency department before being seen."I think we're now starting to see where the data is showing that they were the right decisions," Levine said, "whether it's trauma, NICU, the decision to stabilize our staffing and invest in our staffing."Feedback on BalladBallad has faced criticism from the public, which often feels that the system doesn't listen to patient feedback. It's a critique that the health care system is well aware of. Levine said that Ballad uses a variety of methods to interact with people who use their services."We can't compete with social media, but we can be honest about what we're doing," the CEO said, adding that he is frustrated by misinformation spread by people and elected officials online. "Our focus has been on, what do our patients who use us actually say about us, and how do we interact with them in a way that we can improve?"Information provided by Ballad specified that the system collects feedback through text and email surveys, web and app conversations, customer service line calls, social media engagement, Google Reviews and nationally-benchmarked surveys from Press Ganey and the Centers for Medicare and Medicaid Services.The system also has a variety of methods to connect with their faculty and team members.Unicoi County Hospital and MedicaidLevine added that any impact on Medicaid patients will be felt disproportionately in the region.On the Unicoi County Hospital, he said the system is honing in on the likelihood of providing a free-standing emergency room and some diagnostics in the area, or a microhospital. This would build on what he said was the most used service at the former hospital.He added that conversations with the state and others are ongoing to get help from Congress' rural health fund for at least five years of stability."My biggest fear is, in two years in January 2028, we're going to face a financial cliff, because we start getting cut $25 million per year," he said, referencing upcoming cumulative cuts to Medicaid. "Our total operating income in our best year was $30 million… so when you're sitting here talking about spending $50 million to build a new hospital and in two and a half years by the time that hospital opens, you're facing a $135 million cliff, I mean it's sort of an illogical investment financially."Additionally, he guessed that increases to certain health insurance premium rates caused by changes in the "Big, Beautiful Bill" will cause a large majority of people affected to drop their coverage."That's going to obviously have an impact on us," he said.