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Certificate of Public Advantage (Tennessee) & Cooperative Agreement (Virginia)

Please read our Certificate of Public Advantage (COPA) Annual Reports. These reports are publicly available through the Tennessee Department of Health, linked below.

What is a certificate of public advantage?

Our certificate of public advantage, or COPA, is the legal agreement governing the formation of Ballad Health. Through the issuance of a COPA in Tennessee and a similar document known as a cooperative agreement in Virginia, Ballad Health was formed in 2018 through the merger of Mountain States Health Alliance and Wellmont Health System.

Ballad Health is a new health system, created specifically to address the most critical healthcare needs of communities in Northeast Tennessee and Southwest Virginia. This new kind of healthcare organization is made possible through state oversight and was created with the support of our local business community, physicians, educators, and countless other people who have a stake in improving the health of our region.

Why is Ballad Health needed?

Rural hospitals are struggling.

The natural beauty of Appalachia is part of what makes it such a great place to call home. But rural hospitals across the nation are finding it difficult to stay open in today’s healthcare environment, and ours are no exception.

More than 80 rural hospitals in the U.S. have closed since 2010, and we don’t want ours to become part of the statistic.

By creating Ballad Health, we’ll be able to generate savings and reinvest those savings to preserve access to care in rural areas. Not only that, but we’ve made binding commitments in our agreements with Tennessee and Virginia officials to keep hospitals open.

Our communities aren’t as healthy as they could be.

Access to hospital care is important when you’re sick, but even better is not getting sick in the first place.

Locally we suffer from extremely high rates of diabetes, heart disease, obesity, addiction and untreated mental illness. These problems impact our quality of life, and can’t be fixed just within the hospital.

We need to put resources in our communities that address the root causes of these problems, and that’s what Ballad Health is all about. We’re excited about what the future holds because we’re going to invest in resources that really make a difference.

How will Ballad Health invest in our region?

Before we were Ballad Health, we were two separate companies that spent money competing with each other. It resulted in a lot of wasteful duplication.

In our merger agreement, we’ve made enforceable commitments with the state of Tennessee and the Commonwealth of Virginia to make sure the public benefits from our union.

These commitments include protections for patients, employees, physicians and insurance companies.

Other commitments we have made include:

  • Keeping all hospitals operated by Ballad Health today open as health care institutions for at least five years, and maintaining essential health care services in all counties where we currently operate.
  • Bringing a pediatric trauma center to our region.
  • A comprehensive and enforceable set of conditions that will ensure the rate of growth in healthcare prices will be lower in our region than the national average. These commitments to limit pricing growth are one reason our merger received such strong support from the region’s chambers of commerce and its largest self-insured employers.
  • Negotiating in good faith with all insurance providers and working together with independent physician groups to develop a regional clinical services network. The health system will not require independent physicians to practice exclusively at its hospitals or limit their ability to contract with insurers of their choice.
  • Publicly measuring our quality information and focusing on becoming one of the top performing health systems in the nation.

COPA-related complaints

The COPA Compliance Office will provide an initial step for resolution of complaints that are believed to relate to the requirements of the COPA / Terms of Certification and the Cooperative Agreement.

Any suspected breaches of the COPA or Cooperative Agreement requirements can be reported directly to the COPA Compliance Office by email ( or anonymously through the Alertline (1-800-535-9057).

COPA reporting

View our current Quality COPA Scorecard [PDF, 0.3 MB] and Priority Metrics Scorecard [PDF, 546 KB].

Metrics by MS-DRG

MS-DRGs are Medicare Severity Diagnosis Related Groups. Posted below are fiscal year 2023 (July 2022 to June 2023) metrics.

MS-DRG metrics by Ballad Health facility

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