Ballad estimates new spending through end of COPA

Ballad Health's new and incremental spending plans under the Certificate of Public Advantage estimate a more than $9 million increase in investment from its last three-year period.The plans cover Ballad's budgeted and estimated spending from fiscal years 2026–2028 — the final stretch of the current state-approved agreement.They do not outline Ballad's entire budget, just the new spending requiring state approval. The healthcare system must meet certain monetary commitments for specific initiatives under the COPA's terms of certification, with funds increasing incrementally over time. In total, the system must spend a minimum of $308 million over 10 years on a variety of programs."Ballad spends way more in these areas than what is in these plans," Ballad Health Chairman and Chief Executive Officer Alan Levine noted in an email. "The spending plans are intended to give the states visibility into the ways we are prioritizing what we will be investing those dollars in."The plans are broken down into four categories. Over the next three years, Ballad estimates investing the following funds into new initiatives under these groupings:Behavioral health services: $53,898,200Population health improvement: $31,813,042Human resources and graduate medical education (HR/GME): $47,238,217Region-wide health information exchange (HIE): $11,495,000Expanded outpatient and addiction treatment services for behavioral health have seen the largest increase in spending from fiscal years 2023–2025. Future initiatives include adding staff to meet demand and renovating the former Mountain View Regional Hospital for residential and outpatient services.The terms of certification also require monetary commitments toward children's and rural health services. These two categories are not included in the new submitted plans because Ballad already met those benchmarks, Levine said."That does not mean we don't budget for these services and programs," he wrote. He noted that Ballad has continued to invest in children's and rural health, including plans to recruit neonatologists for the children's hospital, replace cancer care equipment and invest in rural community hospitals.Ballad has spent about $29.9 million more than its overall minimum requirements for the plans, according to its budgets and estimates since 2019. This includes significantly higher investments than required in behavioral health services, children's services and health information exchange."As the state reviews our spending each year, they determine if we are on target, over or under," Levine wrote. "We use that benchmark to help track whether we are making the progress we hope to."The plan still needs to be approved by the Tennessee and Virginia Departments of Health, and Ballad's budget is not final until approved by the board of directors. Last year, Tennessee Department of Health Commissioner Ralph Alvarado approved the fiscal year 2025 budget in late July, noting that the fiscal year 2026–2028 spending plans should have "more direct KPIs demonstrating a clear public advantage."