Q&A

Wellmont Health System and Mountain States Health Alliance are exploring the creation of a new, integrated and locally governed health system designed to be among the best in the nation and to address the serious health issues that affect our region.

The proposed new health system will bring together the capabilities of both organizations – under a new name – to serve the region and result in unprecedented quality and value.

The decision to explore a merger was made by the Wellmont and Mountain States boards of directors, and reflects a vision they developed following more than a year of merger discussions, internal analysis within each system and thoughtful conversations in the community. It reflects the desires of both organizations to ensure our region has access to the highest quality, affordable health care, and that we are able to meet the ever-changing needs of our communities.

In addition to the significant headwinds for hospitals nationally, our region suffers from serious health issues that need to be addressed. We have some of the highest rates of cardiovascular disease, diabetes and pulmonary disease in the country. We are experiencing an epidemic of addiction and untreated mental illness without access to the right level of inpatient and outpatient treatment. And, we admit more people to the hospital per thousand than most other areas of the nation.

The cost of this poor health is not sustainable. Despite the high-quality care both systems provide today, there is more we can be doing to contribute to improving the health of our region. We believe that by working together in an integrated system, we can redirect spending away from unnecessary duplication that has not added value, and invest in what evidence has shown will help make our region healthier while controlling costs and making health care more affordable.

Culture and heritage are critically important to both organizations. That’s why we created a Joint Board Task Force, which is composed of current board members from Wellmont and Mountain States as well as several community members, and an Integration Council, which includes executives and physicians from both systems. These two groups are working out plans to weave our operations and cultures together if the proposed merger is approved, so we benefit from the best of both.

Actually, with this proposed merger, our patients and our region will have access to more choices and health care options than they do today. By combining our resources, we can draw more specialists and add new services for which people now have to drive hours to find. In addition, this potential new organization would involve the institution of a Certificate of Public Advantage (COPA) in TN and a cooperative agreement in VA, which establishes enforceable commitments to guard against effects from any loss of competition. A COPA in TN / cooperative agreement in VA will mean that the future health system must meet commitments in driving down unnecessary costs, keeping care affordable, improving quality of care, enhancing access and benefiting the communities we serve.

As we describe in our Certificate of Public Advantage (COPA) and cooperative agreement applications, 70 percent of physician services in our area and 50 percent of outpatient health care services are delivered by independent providers of care. These other providers will remain strong forces in the regional health care market.

Additionally, Ballad Health would be actively supervised by Tennessee and Virginia through the terms of the COPA and cooperative agreement. Ballad Health has made enforceable commitments to both states to guard against negative effects that could result from the loss of competition. This means the future organization must meet commitments to keep care affordable, improve quality of care, enhance access and benefit the communities we serve. These protections are not something that “may” happen with the merger; they are requirements that Ballad Health will be responsible for achieving.

Thank you again for your support throughout this process. We are excited about what the coming months hold. From all of us at Wellmont and Mountain States, we wish you a very happy and healthy new year!

Tennessee’s Certificate of Public Advantage (COPA) and Virginia’s cooperative agreement provide a regulatory framework for both states to approve and actively supervise the terms of the COPA and cooperative agreement to ensure the future health system meets its obligations.

The COPA and cooperative agreement process offers us an opportunity – like no other – to improve the health of the people of the region. Through it we are able to accomplish much more for our region than we could separately. We applaud the leaders of both states in enabling this solution. We look forward to working with officials in both states to answer their questions and move this process toward a successful conclusion.

It is the policy of the state of Tennessee and the commonwealth of Virginia to permit mergers of health systems under certain circumstances. In compliance with this policy, we are pursuing approval through a Certificate of Public Advantage application in Tennessee and a cooperative agreement application in Virginia. We filed these applications in February 2016 after a period of public comment on the pre-submission report. The applications initiated the review processes in both states.

In accordance with the law, state officials in Tennessee and Virginia developed regulations and a  framework for review and approval of the proposed merger. Each state will then actively supervise compliance with the COPA and the cooperative agreement.

Both states have developed comprehensive criteria to use when evaluating our applications.

Officials in both states will review our applications to evaluate whether the proposed new health system will benefit the region by providing health care that is affordable, accessible and high-quality for generations and whether the advantages outweigh the potential disadvantages. We’ve worked diligently with officials to understand the criteria and to ensure our applications meet these high standards. We believe our applications clearly demonstrate the public benefit that will result because of the proposed merger, and we look forward to reaching a successful conclusion of this process.

In February 2016, we filed applications for a COPA with the Tennessee Department of Health and for a cooperative agreement with the Southwest Virginia Health Authority, which initiated the review processes in both states.

During this review period, we are working closely with the Departments of Health in Tennessee and Virginia and the Southwest Virginia Health Authority, which have developed a thorough process to gather community feedback and review the applications submitted for the proposed merger. We appreciate their hard work, and we should know more about the timeline in the coming weeks and months.

This would be a significant step forward for patient care, wellness, affordability and health education in our region. We would:

• Work to eliminate unnecessary duplication in our operations, enabling us to invest more in better coordinating patient care, improving quality and enhancing access throughout the communities we serve;
• Invest in high-level specialty services, allowing more people to receive the care they need close to home;
• Work with ETSU and our academic partners to conduct a comprehensive regional health needs assessment; then work hand-in-hand to tackle some of the most important health issues our region faces, including high rates of smoking, obesity, physical inactivity and the adverse health effects that follow, such as high blood pressure, diabetes, heart disease and cancer;
• Work to improve access to substance abuse and mental health services in the region; and
• Work with academic institutions, such as ETSU, to strengthen the pipeline of physicians and allied health professionals, and to attract research jobs and investments in our region.

Here are just a few of the ways our proposed future system will serve you, our patients:

• We’ll invest in expanding access to care and services, while also maintaining access in our rural communities, so you can get the care you need close to home – at a cost that’s affordable for you and your family.
• Wherever you go in our integrated system to receive care – no matter which doctor you see – your care team will have your medical history at their fingertips through a system-wide technology platform, ensuring the care you receive takes your overall health into account.
• Together, we’ll be better able to coordinate your care between your doctor, the hospital and outpatient services like home health and pharmacy – improving the quality of care you receive and creating a superior experience every time you visit us.
• We’ll work on improving access to important services that so many people in our region need, like substance abuse treatment to stop the cycle of addiction and improved mental health services.
• Working with East Tennessee State University, we’ll identify and tackle head-on important health issues in our region, like heart disease, addiction and diabetes.
• And much more.

We have sought many opportunities to communicate with the public since the initial announcement in April 2015. Whether through our website, through the media, or through numerous public presentations and hearings, the community has learned about our plans.

Specially, our community engagement has included:

• More than 16,000 unique visitors to BecomingBetterTogether.org and ongoing newsletter updates;

• Nearly 40 scheduled community and media events to provide opportunity for the public to learn more and ask questions;
• Our community health work groups initiative, conducted in coordination with East Tennessee State University, where hundreds of community members participated in round table meetings to discuss important health issues; and
• Internal town halls and physician meetings.

In January 2016, we were excited to share a public report that was the result of more than nine months of extensive work by physician leaders, board members and executives from our organizations, and hundreds of conversations with people all across our region about the area’s critical health needs and how best to address them.

This public report outlines a series of binding commitments the proposed new health system will make about how we will operate and uniquely serve the community together. The report also describes a series of transformational investments we will make as a combined system over the next 10 years to improve health in the region. These investments will be achieved through financial efficiencies gained through the proposed merger and the proposed new health system’s commitment to reinvest those savings for community benefit and health improvement.

The pre-submission report captures important commitments to positively impact health care in the region as a combined system. It describes specific commitments in six key areas over the next 10 years:

• Improving Community Health
• Enhancing Health Care Services
• Expanding Access and Choice
• Improving Health Care Value by Managing Quality, Cost and Services
• Investing in Health Research and Graduate Medical Education
• Attracting and Retaining a Strong Workforce

Specifically, we are committing to a series of transformational investments, made possible through financial efficiencies that will be achieved with the proposed merger, in the following ways over the next 10 years:

• At least $75 million to invest in population health improvements to meet the unique health needs of our region through a 10-year plan to be developed with the community and the public health resources at ETSU;
• At least $140 million to expand community-based mental health services, residential and outpatient addiction recovery programs, and tobacco and substance abuse prevention programs as well as to further support children’s and rural health services;
• At least $85 million to develop and grow academic and research opportunities, support post-graduate health care training, and strengthen the pipeline and preparation of health professionals in the region; and
• Up to $150 million to implement a common information technology platform to support the regional exchange of health information, connect our hospitals, physicians and other caregivers, and allow the combined system to offer higher quality, more convenient and more cost-effective care for patients.

Yes! We’re excited about the new services we can offer and the specialists we’ll be able to attract to the region when we combine our resources. In fact, we’ve committed to invest not less than $140 million over 10 years in specialty services, such as:

• Creating new capacity for residential addiction recovery services connected to expanded outpatient treatment services located in communities throughout the region;
• Developing community-based mental health services, such as mobile health crisis management teams, and intensive outpatient treatment and addiction resources for all ages designed to minimize inpatient psychiatric admissions, incarceration and other out-of-home placements;
• Ensuring recruitment and retention of pediatric subspecialists in accordance with the Niswonger Children’s Hospital physician needs assessment;
• Developing pediatric specialty centers and emergency rooms in Kingsport and Bristol with further deployment of pediatric telemedicine and rotating specialty clinics in rural hospitals to ensure quick diagnosis and treatment in the right setting as close to patients’ homes as possible; and
• Developing a comprehensive physician needs assessment and recruitment plan every three years in each community served by the proposed organization.

Today, nothing changes as both Wellmont and Mountain States continue as separate and independent organizations. It’s business as usual, and we’re committed to keeping our valued partners and the community informed along the way. We do know that any existing contracts that extend past the official closing will be honored by the proposed new organization, and anything that affects clinical services will be carefully considered with input from our physician leaders.

We have committed as part of this process that all hospitals in operation at the effective date of the proposed merger will remain operational as clinical and health care facilities for at least five years. After this time, the proposed new health system will continue to provide access to health care services in the community, which may include continued operation of the hospital, new services as defined by the proposed new health system, and continued investment in health care and preventative services based on the demonstrated need of the community. The proposed new health system may adjust scope of services or repurpose hospital facilities. No such commitment currently exists to keep rural institutions open.

The avoidance of unnecessary duplication gives us the opportunity to retain and increase access points for core services while developing new services not currently available in certain communities. Upon approval by the states, we will have a board-instituted policy related to consolidation and clinical efficiencies which requires appropriate input from physicians and members of the community who are impacted by any such decisions.

We are also committing to maintain our three full-service hospitals in Johnson City, Kingsport and Bristol as tertiary hospitals to ensure higher levels of services are available as close as possible to high population areas.

That is a major decision that has both strategic and clinical implications, and no decisions like this would be made until after the transaction closes. We will include significant input from our physicians before making any major decisions that will impact clinical care. What we do know today is that our combined organization would have a single EHR platform to ensure our facilities and providers work as seamlessly as possible with each other. We promise to share more information as soon as it’s available.

We know that in order to thrive in the future, we need a strong workforce with employees and physicians who are passionate about what they do and who are committed to providing excellent care to the people we serve. While it’s no secret health care is changing rapidly, we believe that joining our two local health systems and keeping decisions and resources in our region offers our best chance to maintain a strong and vibrant workforce. We believe the proposed merger creates the best outlook both for the people we serve and for the valued employees and team members who serve them.

Yes, absolutely – there will be a number of ways nurses from both Wellmont and Mountain States will be heard through this process. In fact, we won’t be successful in accomplishing what we hope to do without the support and input of our nurses.

Throughout this process, we encourage nursing leadership to stay closely in touch with hospital leadership to communicate questions and thoughts from nursing staff. Meanwhile, we will continue to seek the input of our team members in a variety of ways, including this website, our newsletter, internal and external town hall meetings, and more. We recognize the vital role our nurses play every day but especially in shaping the future of our proposed new system, and we’re committed to keeping our nurses updated on any opportunities to be involved.

Changes like this will be determined with input from clinical leadership in the hospitals if the proposed merger is approved.

Our goal is to ensure we have a culture that attracts and retains outstanding team members, and provides opportunity for professional growth. Learn more about our commitments to our employees here.

We understand how important these types of questions are. In the pre-submission report and our state applications, we outline many important commitments to our employees related to benefits. For example,

• We will honor prior service credit for eligibility and vesting under the benefit plans maintained by Wellmont and Mountain States, and will provide all employees credit for accrued vacation and sick leave.
• The future health system will work as quickly as practicable after the completion of the merger to address any differences in salary/pay rates and employee benefit structures.
• The proposed system will offer competitive compensation and benefits for our employees to support our vision of becoming one of the strongest health systems in the country and one of the best health system employers in the country.
• The proposed system will combine the best of both organizations’ career development programs in order to ensure maximum opportunity for career enhancement and training.

Together, we’re committed to nurturing a culture that promotes employee satisfaction and opportunity for professional growth. Learn more about our commitments to our employees here.

The new health system will honor prior service credit for eligibility and vesting under current benefit plans, and will provide all employees credit for accrued vacation and sick leave.

The new health system will work as quickly as practicable after the completion of the merger to address any differences in salary/pay rates and employee benefit structures. The new health system will offer competitive compensation and benefits for our employees to support our vision of becoming one of the strongest health systems in the country and one of the best health system employers in the country.

We will combine the best of both organizations’ career development programs in order to ensure maximum opportunity for career enhancement and training.

Together, we’re committed to nurturing a culture that promotes employee satisfaction and opportunity for professional growth.

Today, we are still early in exploring these types of specific questions. We promise to share more information when we are able.

Jobs will be impacted if we merge and if we don’t merge. There’s no way around it. We know merging with outside entities could result in significant losses. In addition, the likelihood of growth and new opportunity for all of our employees is much stronger with a merger of Wellmont and Mountain States as we invest merger savings in new and expanded services.

Both of our health systems are constantly challenged to hire great health care talent, and this will only continue. As we work together to improve access to care and expand services, we must become one of the best health care employers in the nation to attract the great professionals we will need.

In February 2016, we filed applications for a COPA with the Tennessee Department of Health and for a cooperative agreement with the Southwest Virginia Health Authority, which initiated the review processes in both states.

Over the coming weeks and months, the Joint Board Task Force will continue to oversee work on plans for integrating the two organizations’ operations, cultures and shared vision while health system officials continue their dialogue with state officials.

We look forward to continuing to solicit community input through a variety of opportunities along the way. We thank our dedicated team members, physicians and the community for their continued support and excitement about our vision to improve the health of our region. We are thrilled to continue moving forward.

We will be communicating regularly over the coming weeks and months. Stay tuned. And, be sure to check back here for the latest updates.