Southwest Virginia Health Authority June 2019 Final

Southwest Virginia Health Authority
June 2019
June 12, 2019

System Update
Year in Review Challenges &
Accomplishments
2 June 12, 2019

Year in Review—Challenges
• Resource intensive COPA and CA process

• Resource intensive integration of two major health systems
• Managing team member impacts
• Managing systems impact (IT, HR, payroll, etc.)
• Major change management processes (internal and external)
• Addressing the biggest areas of synergy (Largely in process
or complete with Wise County stakeholder and state process
continuing)
• Heavy lift for communications (difficult to achieve success;
key lessons learned; open to input and determined to
continually improve)
3 June 12, 2019

Year in Review—Challenges
Clinical Operations
• Declining inpatient use rates and impact to top line revenue

(2.5% of all volumes are IP)
• Shift to outpatient services (highly competitive)
• Shift to managed care (Managed Medicare)
• Decline in ED visits
4
Year in Review—Accomplishments
• Maintaining and expanding regional access to care
• Greeneville market hospital consolidation
• Unicoi County Hospital opening
• Successful Laughlin and Unicoi EPIC go-live
• Ballad domain, data center consolidation, Microsoft 10 initiatives
started
• EPIC go live dates moved to 6/1/20 for ambulatory and 10/1/20 for
the hospitals
• Substantial nurse pay increase ($10m impact annually)
• Recruited 79 new providers to the area – 65 employed and 15
recruited to independent practices
• Joined Medicaid Transformation Project
5 June 12, 2019

• $9 million operating revenues YTD compared to $1 million

last year
• Quality Improvement: Already improved in 12 of 17 areas
(www.balladhealth.org/quality-reporting for more...)
• Top 20% nationally in quality by IBM Watson
• Making strategic capital investments across the region
($160m)
• Garnered significant synergies and savings (GPO, Food
Service, Lab, and other to come…)
• Bond ratings upgraded and affirmed
• Advocated for Medicaid Expansion
• Other plan accomplishments (to be covered later)
6 June 12, 2019

Ballad Health Clinical Council established and providing clinical

leadership
• Reduced hospital-acquired C. diff infections by 45%

• Encouraging appropriate use of radiation in inpatient testing
• Development and deployment of best practices to reduce
catheter-associated urinary tract infections
• Physician led alignment of physician preference items
produces supply chain savings
• Promoting High Value Care
• Clinical Experience Project to reduce physician burnout
• 15% reduction in readmission rates
7 June 12, 2019

Physician Recruitment:
• FT Wise County-based Noninvasive Cardiologist

• FT Wise County-based board-certified Orthopedic Surgeon and
Physician Assistant
• FT Wise County-based Pediatrician
• FT Assistant Program Director, NCH Internal Medicine
Residency Program
• FT Wise County-based OB/GYN Physician
8 June 12, 2019

Lee County Community Hospital Development
Ballad Health is committed to protecting and strengthening rural

healthcare in our region and committed to re-opening LCCH.
Three key focus areas:

• Hospital infrastructure
• Community Health Needs Assessment (CHNA)
• Provider Recruitment
• Key Dates:
• 6/19 Meeting with Lee County EMS to discuss needs assessment.
• 6/20 -LCHA to review terms of Definitive Agreement
• 7/25 – meeting to complete and approve Definitive Agreement
• Early August complete CHNA
• Late August submit Critical Access Hospital application.
• September – Plan to open LCCH Urgent Care Center
9 June 12, 2019

Appalachian Highlands
Community Dental Clinic
We are proud to be launching a dental residency at Johnston Memorial
to train dentists who will help provide care to underserved parts of our
region.
• The residency program will partner with local dentists and

Mission Dental Virginia
• Throughout our region, more than 68% of residents live
without dental insurance, and we all know that dental health
plays a major role in overall wellness.
• Uninsured patients will be able to receive high-quality dental
care though the clinic, including preventive care, sealants,
crowns, fillings and dentures.
• Impact for people in addiction recovery to work programs
10 June 12, 2019

Regional Trauma Network - Treating Trauma
Trauma is an injury not to be confused with a heart attack or
stroke. All facilities will have the same high level of stroke
and heart attack care as they do today.
Major trauma (10% of all trauma cases) will be treated at

Johnson City Medical Center, currently the highest volume trauma
center for major trauma in our area.
More than 65% of our specialty consults for trauma are

orthopedic; 20% are neurosurgery. All three of our trauma
centers to include Cardiothoracic Surgery, General Surgery,
Neurologic Surgery, Obstetrics-Gynecologic Surgery and Orthopedic
Surgery.
The majority of trauma cases will be treated in the trauma

center that is closest to the patient.
11 June 12, 2019 Advancing Healthcare in our Region

Why Create this System?
New system will retain close proximity to a level I trauma
center for our rural communities
• Entire service area: Within one-hour ground transport times to
one of our trauma centers, with most residents being within 30
minutes
Able to invest in trauma-related research and outreach

• First initiative: Reduce the incidence of geriatric falls in our
region
• Approximately 50% of our current trauma patients are over the
age of 65, and 85% of the injuries in this population relate to
falls
Will seek to be verified by the American College of Surgeons

within 3-5 years
• For the first time, our region will meet this highest standard for
trauma
Specialty Trauma Coverage to Remain at
BRMC and HVMC
BRMC and HVMC will retain the coverage of essential trauma
specialties, on call 24/7 including:
• Trauma/general surgery
• Orthopedic surgery
• Neurosurgery
• Many other physician sub specialties who provide ER
coverage will continue to do so
Changing from level II to level III designation will not change
the key services that Bristol or Holston Valley currently
provides.
14
Collaborate with SWVA EMS to coordinate
transport activities
The goal of a regional trauma system is to get the patient to
the right place in the first place based on their needs.
Collaboration with EMS, flight services, the new Pre-hospital
Communications system and protocols is the goal of the new Ballad
Health Trauma System
– VP of Trauma/Emergency Services and Ballad Health leadership will work
with local and regional EMS leadership to develop protocols.
– Creation of designated Ballad Health EMS liaison position.
Overwhelming volume is orthopedics, and most will remain in center
closest to home.
Goal is to become a national model in trauma delivery.
15
Advancing Quality Pediatric Services
Level III neonatal intensive care (NICU) services at
Niswonger Children’s, the region’s state-designated
perinatal center
• State letter of support: It is Tennessee law and policy, supported by

evidence, that high risk neonatal care is provided at a regional neonatal
center.
• American Academy of Pediatrics strongly advocates for the regionalization of

NICU services by concentrating care for the sickest newborns in high volume
specialty centers. This improves outcomes and reduces cost.
• At Niswonger, high-risk newborns are supported by 25 pediatric specialties,

as well as the latest technology, advanced treatments, and 24/7 coverage by
neonatologists/neonatal nurse practitioners and pediatric residents.
• Tennessee guidelines state that newborns in level III facilities need access to
a variety of different pediatric specialists. These specialists are only available
at Niswonger Children’s Hospital.

Plan Updates
17 June 12, 2019

Population Health Plan
Re-alignment with local and

state objectives
18 June 12, 2019

Aligning Vision with State Leadership
Both Governor Bill Lee and Governor Ralph Northam have set forth compelling visions with
great application to these regional challenges.
o Governor Lee: focus on K-12 education, criminal justice, mental health, healthcare,
and rural economic development—clearly recognizes that we must start early in life
to address the root causes of educational, economic, and health success.
o “These are the challenges of our day, and history will judge us based on
how we meet them.”
o Governor Northam: “In order for every Virginian to thrive, we must invest in their
success and that requires a greater focus on issues of equity.”
o We must “lift rural parts of the state where Virginians have not seen the same
economic growth of the more populous, urban regions.”
o Commissioner Oliver: We must “tackle social issues that if unaddressed will
continue to cause health problems to fester…We’re looking at behavioral health, and
along with it I’d add substance abuse...We’re looking at women’s health and
children’s health, particularly early childhood…One of the best ways to tackle those
issues is by addressing societal issues that have their root in racism and poverty…The
department is considering ways to help children get healthy food and work through
traumatic experiences.”
o Commissioner Piercey: “When you talk about hypertension, stroke, heart disease,
and even COPD, it’s habits that start in childhood…We know when babies have a
healthier start, they’re more likely to be healthier when they grow up.”
19 June 12, 2019
Aligning Vision with Accountable Care
Community
organizations
counties
states
20 June 12, 2019

Collaborative Structure
Accountable Care Community
TN Backbone: VA Backbone:
COMMUNICATION
Healthy Kingsport United Way of Southwest VA
ACC Data and Evaluation

Leadership Council Committee
Multi-sector Organizational Membership
Health/ Business/
Education CBOs/FBOs
Healthcare Employers
Committee Committee
Committee Committee
Action Action Action Action

Action Action Action Action Action Action Action Action Action Action Action Action Action
Team Team Team Team
Team Team Team Team Team Team Team Team Team Team Team Team Team
Actions for the focus areas

21 June 12, 2019
Collective Impact-Where we are
Time (in months) 1-3 2-4 3-6 4-8
22 June 12, 2019 https://www.fsg.org/blog/navigating-collective-impact

STRONG ACC Focus Areas
STRONG STRONG
Starts Youth
Educational Success
(college and career ready)
+
Economic Vitality
+
Healthy Lives
STRONG STRONG
Families Teens
23 June 12, 2019
Proposed Approach
Ballad Health proposes working in four priority areas

which can be effectively aligned with the ACC:
Increasing positive birth outcomes

Increasing educational readiness and performance
Increasing community understanding and response to at-risk
children and families
Increasing healthy behaviors in children, youth, and their
support systems
Longitudinal Study with Center for Rural Health Research

and Access
24 June 12, 2019

25 June 12, 2019
STRONG Conceptual Model Alignment
With Other Plans
• Nearly all measures included in SWVA Blueprint
• 7 measures included in Cooperative Agreement
• Nearly all measures included in COPA
• All measures included in ACC interests
26 June 12, 2019

Consistent with Guiding Principles:
• Achieving Long-Term Impact

• Focus and Align Resources
• Focus Upstream and on Root Causes
27 June 12, 2019

Why Focus on Childhood Experiences &
Support Systems?
Dr. Robert Block, former president of the American Academy of Pediatrics:
ACEs are “the single greatest unaddressed public health
threat facing our nation today.”
• ACEs can increase a person’s risk of health, social, and economic problems throughout
life
• In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical
costs and lost productivity from employees missing work. Further, they concluded that
32% of smoking, 49% of depression, 13% of obesity, 10% of diabetes, 21% of COPD,
24% of Asthma, and 5% of hypertension was directly attributable to ACEs.
• ACEs are associated with risky health behaviors and poorer health outcomes.
28 June 12, 2019

Why Focus on Childhood Experiences and
Support Systems?
Figure 1 SAMHSA. https://www.samhsa.gov/capt/practicing-effective-

prevention/prevention-behavioral-health/adverse-childhood-experiences
29 June 12, 2019

Our Challenge
Household
-Domestic Violence
-Substance Use
-Mental illness
-Parental separation/divorce Neglect
-Incarcerated Parent -Emotional
-Physical
Abuse Children,
-Emotional
-Physical Youth,
-Sexual
Teens and
Families
ACEs/Trauma
/Stressors
Adapted from the Devereux Center https://centerforresilientchildren.org/home/about-resilience/ and CDC
https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/aboutace.html
30 June 12, 2019
Substance Abuse as a Barrier to Resiliency
• The opioid/substance abuse crisis is placing what feels like an insurmountable strain on the
systems in place to serve children and families.
• The relationship between ACEs and substance abuse is clear, and they perpetuate one
another.
• Because of the extent of the opioid crisis in our region, we cannot hope to address one
without addressing the other.
• Generational childhood trauma is an attributed root cause of the opioid crisis in America,
and a new generation is now experiencing ACEs because of the substance abuse of their
parents and other caregivers
• The number of children in foster care has risen steadily since 2012, and over 40 percent of
children in relative or foster homes are there because of substance abuse.
• As much as 86% of pregnancies among women who struggle with addiction are considered
unintended.
31 June 12, 2019

Resilience Model
Household
-Domestic Violence
-Substance Use
-Mental illness
-Parental separation/divorce Neglect
-Incarcerated Parent -Emotional
-Physical
Abuse
-Emotional
-Physical
-Sexual
ACEs/Trauma
/Stressors
Protective
Factors
Adapted from the Devereux Center https://centerforresilientchildren.org/home/about-resilience/ and CDC

https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/aboutace.html
32 June 12, 2019
Desired State
https://www.frontiersin.org/files/Articles/434838/fpubh-07-00059-
HTML/image_m/fpubh-07-00059-g001.jpg
33 June 12, 2019
34 June 12, 2019
Focus on Adult Population Health
• Strong Children and Families model includes the multi-generational health and well-
being of families.
• Adult Smoking and Drug Deaths will be important to creating models of good health for
children but will also require programmatic interventions which will support adult
health.
• There are a large number of explicit measures for evaluation in the COPA and
Cooperative Agreement which focus on adult populations. Populations impacted include
those in Medicare Advantage, MSSP, and Ballad Health Team Members. These areas of
emphasis create better access to care, prevention, and disease management services
for adults.
• Access and Quality Measures require a host of clinical interventions to improve the
health of adults especially in the realm of primary prevention and harm reduction.
• They provide an important opportunity to optimize the clinical environment to support
adult health through early identification of diabetes, hypertension, and cancer and
through better access to and management of substance abuse and behavioral health
issues.
• Behavioral Health and Rural Health plans include access to resources for adults,
including increasing primary care access, addiction recovery support, team-based care,
and navigation.
• Value Based Contracts have a significant focus on adults, including flu vaccines for older
adults, blood pressure control, diabetes management, and medication adherence. In
addition, there is an increasing emphasis on social needs for adults.
35 June 12, 2019

FY19 Population Health Plan Status Review
36 June 12, 2019

Tactical Performance Fiscal Year To Date
(FYTD) 2019
53 Action Items Tracked Through Mede
50 Accomplished To Date (through FY19Q3)
37 June 12, 2019

Line of Sight Metrics by Strategy
Focus Area Strategy Line of Sight Metrics
Develop Population 1. Develop the Ballad Inputs
Health Infrastructure Health Population • Hires vs. Staffing Plan
Health Department
• Completed Clinical Committee membership list
• Clinical Committee Charter completed
• Fill 100% of 10 Full-time Positions for Clinical Committee
• Relationship Tracking and Management System developed
• Establish and complete training with 10 end users
• Population Health Leadership Teams in place in all Ballad
hospitals and practice divisions
• Y2 milestones and metrics accepted
2. Create and activate an Inputs
Accountable Care • Completed ACC steering team list
Community
• List of members by region
• Focus areas selected
• Charter completed
• Leadership councils selected (list)
• Strategic plan developed
38 June 12, 2019

Ballad Health as a 1. Delivery system Inputs
Community Health improvement and re- • List of initial priority metrics provided
Improvement design
Organization • Identify top 3 priorities applicable to practices
• Participant Agreement(s) signed
• Completed workplan
• Plan structure outlined
• Workplan milestones met
• MSSP Deadline met (subject to CMS timeline)
• Contract signed (subject to CMS timeline)
• Program launched
Outputs
• Number of current lives under CIN/HQEP management (0)
• Number of attributed lives under a VBC (~92,500)
39 June 12, 2019

Ballad Health as a 2. Information systems, Inputs:
Community Health decision support and • Epic configuration completed
Improvement information exchange
Organization • Deadline met
(Continued) • Utilize AHA for 100% of Ballad team member health risk
assessments
• Deadline met
• EPIC LMH and Unicoi Go-Live complete
• Draft completed
• Epic configured
• Deadline met
Outputs
• Number of Ballad Health Sites on EPIC (9 hospitals)
40 June 12, 2019

Ballad Health as a 3. Self management and Inputs:
Community Health development of • Health Risk Assessment (HRA) and coaching program to team
Improvement personal skills members launched
Organization
(Continued) • Coaches assigned to qualifying participants
• Conduct biometric testing on 100% of Ballad team members
participating in employee wellness program
• Stress reduction pilot program developed
• “Ballad as An Example” charter completed
• “Ballad as An Example” strategic plan completed
• Establish 4 action teams to develop strategies in the areas of
healthy eating/food policies; physical activities; healthy plan
design; and health education and resources
• “Ballad as an Example” pilot(s) launched
41 June 12, 2019

Enabling Community 1. Strengthen community Inputs:
Resources and Sound action • Best/promising clinical and community practices document
Health Policy completed
• Completed inventory of potential community partners
• RFI distributed
• RFI evaluations completed
• RFI feedback incorporated
• RFPs distributed
2. Create supportive Inputs:
environments • Framework to leverage Ballad’s Business Health offerings
completed
• Regional awareness campaign plan completed
• Develop at least one regional awareness campaign and
establish projected reach and impressions targets
• Business Health collaborative activated
• Regional ad campaign launched
• Custom Business Health package completed
• Host 1 regional chamber of commerce forum to review needs,
current solutions and strategies
• Regional awareness campaign projected reach and impressions
42 June 12, 2019

Enabling Community 2. Create supportive Inputs (continued):
Resources and Sound environments • Business Health Collaborative plan completed
Health Policy (continued)
(Continued) • Pilots identified
3. Build healthy public Inputs:
policy • Begin development of legislative playbook to support
intervention playbook
• Gap analysis
• Plan developed
• Number of meetings with each legislative office
43 June 12, 2019

Behavioral Health Plan
44 June 12, 2019

(FYTD) 2019
45 June 12, 2019

Strategy Line of Sight Metrics
1. Develop supporting infrastructure Inputs
• Priorities for new positions established
• Job descriptions completed
• Evidence of active recruiting
• New positions hired
2. Primary Care/ Behavioral Health Inputs
Integration (PCBHI) • Summary of best practices from existing programs
• Listing of contacted PCP practices
• Approved implementation plans
• Initial 4.4 FTEs hired
• New PCBHI programs established
Outputs
• Number of referrals from a Ballad PCBHI model to a behavioral health
specialist
• Number of existing Ballad PCBHI programs in TN, VA and total (4)
• Percent satisfied with Ballad PCBHI program as indicated on their patient
satisfaction survey for the practice (initiating data collection)
• Number patients treated by a Ballad PCBHI program (initiating data
collection)
46 June 12, 2019
3. Supplement existing regional crisis Inputs
system • Mobile Crisis study completed
• Initiate plan for SBIRT pilot program
• Regional crisis planning study initiated
• Respond expansion plan complete
• Zero Suicide Gap analysis initiated
• SBIRT Pilot Program plan complete for VA and TN
• Sites and screening tool selected for SBIRT pilot and Respond expansion
• Trauma-Informed Care study initiated
• Regional crisis planning study completed
• Regional crisis implementation plan initiated
• SBIRT Pilot Program established in VA and TN
• Recommendations for Zero Suicide initiative
• Trauma-Informed Care study completed
Outputs
• Current Respond volumes (4,246)
• Current number of SBIRTs performed (1,333 at 2 sites)
• Current number of transportation vehicles (none designated)
• Number of patients benefitting from enhanced transportation services
47 June 12, 2019

4. Enhanced and Expanded Inputs
Resources for Addiction Treatment • Residential expansion: Conceptual plan completed
• Overmountain expansion findings complete
• Residential expansion: operations plan and site selection complete
• Consultant resource needs report/recommendations for pregnant women with
substance abuse disorders
• Residential expansion: approved budget and implementation plan
• Overmountain expansion: resources hired
• Overmountain service expansion underway
• Recommendations for Peer Counseling support
Outputs
• Current number of counseling FTEs focused on substance use, including peer
counselors (5)
• Current number of patients receiving medication-assisted treatment (227)
• Current number of providers receiving medication-assisted treatment
education (41)
48 June 12, 2019

Children’s Health Plan
49 June 12, 2019

(FYTD) 2019
50 June 12, 2019

1. Develop infrastructure Inputs
• Summary gap analysis including infrastructure needs and staff capabilities
• List of positions to add and budget
• Evidence of recruiting / staff hired
• Report on membership of Pediatric Advisory Council
• Evidence of staff hired
• Pediatric Advisory Council priorities
2. Establish Pediatric ED in Kingsport Inputs
and Bristol • Kingsport location identified
• Facility planning begun
• Final facility plans
• Approved budgets
• Operational plans
• Begin construction
• Initiate protocol development
• Construction complete
Outputs
• Current number of pediatric ED visits in Kingsport and in Bristol
51 June 12, 2019
• Current number of ED visits (0-4) and (5-14) for asthma
3. Develop telemedicine/specialty Inputs
clinics in rural hospitals • Summary results of gap analysis and telemedicine plan
• Evaluation analysis
• Priority listing of sites for installation of telehealth equipment
• Pilot sites identified
• Initiate implementation plan
• Pilots initiated
• Services initiated
• Children treated through school-based behavioral health telemedicine
Outputs
• Current number of pediatric telemedicine visits (617)
• Current number of children treated through school-based behavioral health
telemedicine (617)
52 June 12, 2019

4. Recruit and retain subspecialists Inputs
• Annual recruitment priorities/plan
• Report on status of partnerships discussions with other pediatric hospitals
• Physician recruitment status - % of plan achieved
• Support staff recruitment status
• Report on status of partnerships discussions with other pediatric hospitals
• Physician recruitment status
• Report on status of partnerships discussions
Outputs
• Current number of existing partnerships to access specialists
5. Develop CRPC Designation at Inputs

Niswonger Children’s Hospital • Assessment summary: quality indicators, staff needs, gaps
• Comprehensive CRPC plan completed
• Evidence of recruitment and hiring according to CRPC plan
• Evidence of recruitment and hiring according to CRPC plan
53 June 12, 2019

Rural Health Plan
54 June 12, 2019

(FYTD) 2019
55 June 12, 2019

1. Expand access to PCPs through Inputs
additional PCPs and mid-levels • Process initiated to determine priority locations for mid-levels
• Recruitment progress on PCP
• Priority locations for mid-levels determined and recruitment initiated
• Providers hired for initial sites
• New providers hired
• New provider pipeline
Outputs
• Number of patients treated by additional PC providers (30)
2. Recruit physician specialists Inputs

• Process initiated
• Priority locations determined and recruitment initiated
• Providers hired for initial sites
• New providers hired
• New provider pipeline
Outputs
• Number of patients treated by additional specialists (69)
56 June 12, 2019

3. Implement team-based care Inputs
models to support PCPs • Operational plan initiated
• Operational plan complete
• Begin staff recruitment
• Staff hired for pilot site
• Second and third rural expansion sites initiated
• Evaluation report and future recommendations
• Second and third rural expansion site plans complete
Outputs
• Number of patient lives impacted by a team-based care model (3,485)
4. Deploy virtual care services Inputs
• Deployment plan completed
• Equipment deployed consistent with deployment plan
• Initiate service planning
• Equipment deployed consistent with deployment plan
• Plan continuation
• All Ballad EDs have comprehensive telehealth equipment
• Plan for service deployment approved
57 June 12, 2019

4. Deploy virtual care services Outputs
(continued) • Number of Ballad hospitals with at least one comprehensive care for high-
acuity episodes (i.e., telestroke) and one secondary care for lower-acuity
episodes (i.e., consults) (17 hospitals)
• Number of current tele-stroke patients (1,025)
• Number of current tele-behavioral patients (155)
• Number of current tele-behavioral outpatient sites for low acuity patients (0)
• Number of current tele-pediatric patients (606 school-based; 213 virtual
peds)
• Number of current Ballad Health e-visits (239)
58 June 12, 2019

Academics & Research
HR & GME Plan
59 June 12, 2019

Update
• Plans have been submitted and approved

• Implementation to begin in new fiscal year
• Plans available online
60 June 12, 2019

Southwest Virginia Health Authority June 2019 Final

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Southwest Virginia Health Authority

June 12, 2019

2 June 12, 2019

• Resource intensive COPA and CA process

3 June 12, 2019

• Declining inpatient use rates and impact to top line revenue

• Shift to outpatient services (highly competitive)

• Shift to managed care (Managed Medicare)

5 June 12, 2019

• $9 million operating revenues YTD compared to $1 million

6 June 12, 2019

Ballad Health Clinical Council established and providing clinical

• Reduced hospital-acquired C. diff infections by 45%

7 June 12, 2019

• FT Wise County-based Noninvasive Cardiologist

8 June 12, 2019

Ballad Health is committed to protecting and strengthening rural

Three key focus areas:

9 June 12, 2019

• The residency program will partner with local dentists and

10 June 12, 2019

Major trauma (10% of all trauma cases) will be treated at

More than 65% of our specialty consults for trauma are

The majority of trauma cases will be treated in the trauma

11 June 12, 2019 Advancing Healthcare in our Region

Able to invest in trauma-related research and outreach

Will seek to be verified by the American College of Surgeons

• State letter of support: It is Tennessee law and policy, supported by

• American Academy of Pediatrics strongly advocates for the regionalization of

• At Niswonger, high-risk newborns are supported by 25 pediatric specialties,

16 June 12, 2019 Advancing Healthcare in our Region

17 June 12, 2019

Re-alignment with local and

18 June 12, 2019

20 June 12, 2019

Healthy Kingsport United Way of Southwest VA

ACC Data and Evaluation

Multi-sector Organizational Membership

Action Action Action Action

Actions for the focus areas

22 June 12, 2019 https://www.fsg.org/blog/navigating-collective-impact

Ballad Health proposes working in four priority areas

Increasing positive birth outcomes

Longitudinal Study with Center for Rural Health Research

24 June 12, 2019

26 June 12, 2019

• Achieving Long-Term Impact

27 June 12, 2019

28 June 12, 2019

Figure 1 SAMHSA. https://www.samhsa.gov/capt/practicing-effective-

29 June 12, 2019

31 June 12, 2019

Adapted from the Devereux Center https://centerforresilientchildren.org/home/about-resilience/ and CDC

35 June 12, 2019

36 June 12, 2019

53 Action Items Tracked Through Mede

50 Accomplished To Date (through FY19Q3)

37 June 12, 2019

38 June 12, 2019

39 June 12, 2019

40 June 12, 2019

41 June 12, 2019

42 June 12, 2019

43 June 12, 2019