The health merger is approved, now comes the planning

The 120-page terms of conditions the boards of directors for Mountain States Health Alliance and Wellmont Health System signed early last week agreeing to state requirements for a proposed merger were built on years of planning and negotiating — and thousands of pages of documents.Now, the real planning and paperwork begins.With Tennessee's approval of the certificate of public advantage, or COPA, comes stipulations that the new system, Ballad Health, submit a litany of plans for the state's consideration.Everything from how the new system will tackle children's health issues to how it will share patient information with independent doctors to how it will spend money on facilities must be planned by Ballad and pre-approved by the state Department of Health.Here are the plans that will be submitted and what's required of them:Behavioral Health PlanBallad committed to spending $85 million over the next 10 years on behavioral health services. In connection with that spending, Ballad must submit a plan within six months explaining how it will develop new or improved community-based mental health resources over the next three fiscal years. Specifically, the terms mention mobile health crisis management teams and intensive outpatient treatment and addiction resources for adults, children and adolescents. The goal of the plan will be to minimize psychiatric admissions and incarcerations and keep mental health patients in their homes.Children's Health PlanThe new system's submitted plan for children's health must, among other things, detail how Ballad with recruit and retain pediatric sub-specialists, develop a regional pediatric center at Niswonger Children's Hospital in Johnson City and new emergency rooms with pediatric capabilities in Kingsport and Bristol and deploy pediatric telemedicine and rotation pediatric specialty clinics in rural hospitals. Ballad has agreed to spend $27 million on children's services over 10 years and the three-year plan, submitted within six months, will tell how part of it will be spent.Rural Health PlanHealth care goals in rural areas require Ballad to submit a three-year plan assessing the need for physicians in those areas and explaining how it will recruit and retain them in each rural community in the system's territory. According to the terms in the agreement, the plan will focus on employing physicians in underserved areas and locations where quantity and specialty needs are not being met and where independent physician groups are not interested in or not capable of providing them. Ballad committed to spending $28 million over 10 years on rural health initiatives.Health Research and Graduate Medical Training PlanOne year after the COPA is granted, Ballad must submit to the Department of Health a plan for training physicians, nurse practitioners, physician assistants and other health care professionals. This plan will be developed in partnership with East Tennessee State University and will focus on developing the infrastructure needed to train physicians to meet the needs of the communities served by Ballad. It will also include areas of investment aimed at growing research opportunities and securing other research funding from national sources. The training plan cannot reduce the number of residency positions currently supported by the separate systems. Ballad committed to spending $85 million on research and training over 10 years.Population Health PlanThe Population Health Plan must lay out the new system's plans for starting and improving health initiatives in its service area. With the plan, the system must also create a Department of Population Health Improvement and collect and analyze data that relate to the overall health of the people of the region. Ballad committed $75 million to population health improvement over 10 years.Electronic Health Information PlanWithin a year, Ballad must hand in a plan for sharing electronic health information with independent physicians and health care providers. According to the agreement, cost should not be a barrier for outside physicians serving patients in the area and providing access to those records should not be a source of financial gain for Ballad. The new system committed $8 million over 10 years on the health information sharing initiative.Capital PlanWithin six months of the granting of the COPA, the system must submit a plan for spending on capital projects within the first three years with a timeline for their construction and completion. The plan will include upgrading and replacing equipment and related software, physical plant equipment, building systems (HVAC, elevators, parking, etc.), and other machinery, facilities and non-medical equipment to a quality and technological level consistent with industry norms for similarly sized healthcare systems.Equalization PlanThe agreement also requires a plan to reduce differences in employee pay and benefits between those formerly employed by the separate systems. Ballad committed to spending $70 million over 10 years to gradually equalize employees' pay and benefits.All of the plans require approval of the Tennessee Department of Health and some require review by a COPA Monitor appointed to oversee the agreement's requirements. The Health Department can ask for changes to any of the plans within 30 days of being submitted. If Ballad objects to the changes, the plans go to a mediator to reach a compromise.Bart Hove, CEO of Ballad, said the new system will look internally to the expertise of its staff and reach out to community groups to help write the required plans."They are all generally three-year plans, a look to the horizon as to what the community's needs are in specific areas," Hove said.The schedule for completing the plans will be tight, especially with so many due at the same time, so he said the system's various committees and group hope to hit the ground running to produce them.Alan Levine, Ballad's executive chairman of the board, said the plans will be an important part of how the new system will perform and give the public and the state oversight into its operations.With such large-scale initiatives, however, he said results may not be measurable for the first few years."We can't expect to see changes in those measures right away, it takes time," he said. "The first couple of years will be established to put those process and resources into place, and we should see movement after that."