The people living in Ballad Health’s service region die younger and have higher incidents of diseases and illicit drug use than elsewhere in the U.S. And those are just a few of the problems. Against this backdrop, the two primary hospital systems serving Virginia’s coalfields and Tennessee’s Tri-Cities region sought permission from the states to merge. Ballad Health was formed in 2018 after Virginia and Tennessee agreed to grant what amounts to a monopoly – despite the FTC’s objections — but under the condition that Ballad do what neither legacy system had done: measurably improve the health of the people living in its region. No place else in the country has done anything on this scale.
I set out to explore the economic and social conditions that play a role in community health and the efforts underway to improve health outcomes, and to see whether Ballad was meeting its mandates. During one of my early interviews with Ballad’s CEO, Alan Levine, he shared a story he had just heard from a pediatric resident who was trying to figure out why a 9-month-old baby wasn’t sleeping. The resident went through a checklist of a hundred possible reasons with the parents. When he couldn’t figure it out, he suggested testing. “So as he’s leaving, the mom pulls out the bottle, and there’s this yellow liquid in the bottle. And he looks and asks, ‘What is that?’ And it was Mountain Dew,” Levine said. “He was like, ‘Why are you giving your 9-month-old Mountain Dew?’ And she goes, ‘Because the last time we were here you told us not to give him juice.’”
He then explained why he shared that story. “You understand you can’t change a culture on a dime. You have to transform a culture over time. And we are generations into this. What we are starting here, is we are creating momentum that will transform the region. But if anyone has expectations that in one year we are going to be the healthiest region in the country they are going to be disappointed. We always said this is going to be a 10-year process.”
Turns out, Ballad executives didn’t know the culture as well as they thought. Throughout 2019, I wrote more than two dozen stories while reporting for the “Sick, Broke and Left Behind” series in an attempt to answer the question: What does it take to build a modern-day health care system in a place where people live sick and die young? At the heart of the stories is state policy that allowed for the creation of Ballad with the hopes of improving population health.
What I found were regulators overwhelmed by a task that was so different from and more complex than anything they had ever done; a health system anxious to begin consolidating services; people who were suspicious and distrustful of much of what was being forced on them, and others piecing together health services in novel ways. I reported on stories about a community without a hospital; nursing and physician shortages; the role of telemedicine in rural communities; reliance on large free clinics; expansion of Medicaid; an effort to teach and train children for jobs that don’t rely on coal; barriers – physical, financial, geographical – to health care; and, fundamentally, how failure by state regulators and health executives to communicate have thwarted their best intentions. I’ve included a sampling of stories in this submission.