Ballad Health · Post-Acute Network Intelligence · TN & VA
Executive Narrative — April 2026
Ballad Health operates eight acute care hospitals across northeast Tennessee and southwest Virginia. Our analysis of Medicare fee-for-service discharge data (Q4 2024–Q3 2025) identifies approximately 2,400 FFS patients discharged annually to more than 120 unique skilled nursing facility destinations. The data reveal a post-acute footprint with meaningful variation in performance, limited system-level visibility, and a concentration of risk in the highest-volume relationships that is invisible without unified monitoring.
This analysis is not a summary of problems. It is a map of opportunity. Across your eight hospitals, there is an active downstream SNF network — 120+ facilities, thousands of patient relationships, and an entirely unmanaged performance signal. Several high-volume SNF partners carry Very High facility-specific risk scores. Cross-system SNFs appearing at three or more hospitals present both the greatest risk concentration and the greatest opportunity for improvement.
Puzzle Healthcare can help Ballad gain visibility into that network, prioritize where intervention matters most, and establish a structured presence in the facilities where your patients are most at risk. Health systems that have taken this step — including OSF HealthCare, which introduced Puzzle to 60 of their downstream nursing home partners — have seen it transform their post-acute relationships into a shared performance feedback loop that neither organization could have built independently.
The analysis surfaces five findings that collectively define the risk profile of Ballad Health's downstream post-acute relationships.
Receiving patients from six of eight Ballad hospitals, Life Care Center of Elizabethton posted a 75.7% hospitalization rate at JCMC (11 patients) with a 31.8% 90-day readmission rate. Facility-specific risk scores range from 2.56 to 6.98 (Very High) depending on the sending hospital. At Sycamore Shoals, 13 patients show a 58.5% hospitalization rate with a facility risk of 4.94. This pattern is consistent across hospitals and represents the highest-risk cross-system SNF relationship in the Ballad network.
Ridgecrest Manor Nursing and Rehabilitation carries a facility-specific risk score of 13.39 when assessed through Johnston Memorial Hospital — more than triple the Very High threshold of 4.0. The facility also appears in the JCMC, Holston Valley, and Sycamore Shoals networks. While individual patient volumes are suppressed (<11), the extreme risk signal and cross-system presence warrant immediate review.
Mountain City Care carries the second-highest facility-specific risk score in the Ballad system (9.77 at Holston Valley), with a 25.0% 90-day readmission rate. The facility appears at five of eight Ballad hospitals with Very High risk scores at four of them (ranging from 3.53 to 9.77). This JJLA-operated facility presents a concentrated, cross-system quality concern that cannot be detected or managed from any single hospital's perspective.
Four hospitals (JCMC, Holston Valley, Johnston Memorial, Greeneville Community) operate above their respective state average for SNF utilization, while four (Bristol Regional, Indian Path, Franklin Woods, Sycamore Shoals) operate below. Greeneville Community leads at approximately 21.0%, while Indian Path is at just 9.96%. This variation suggests different discharge practices and market dynamics across the system — and different types of opportunity for post-acute optimization at each hospital.
Johnston Memorial concentrates 58.3% of its FFS SNF volume in just two facilities. Greeneville Community concentrates 54.0% in its top two. Franklin Woods sends 53.9% to two partners. This level of concentration creates both dependency risk and outsized impact opportunity — performance improvement at a single high-volume partner can move hospital-level readmission metrics. It also means that without monitoring, a quality decline at one facility exposes hundreds of patients before anyone on the hospital side has visibility.
Johnson City, TN · 501 beds · Opportunity Score: 78
JCMC is Ballad's highest-volume SNF-discharging hospital, sending 724 FFS patients to 70 unique destinations — creating significant monitoring exposure across the network. The top partner, Princeton Transitional Care (21.8% share), carries a Very High facility risk score (3.67) and Life Care Center of Elizabethton shows an alarming 75.7% hospitalization rate and 31.8% 90-day readmission on 11 patients. The 18.4% 30-day readmission rate exceeds both county (17.5%) and state (17.9%) benchmarks, signaling a preferred network optimization opportunity.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| Princeton Transitional Care & Assisted Living | 158 | 21.8% | 35.4% | 13.8% | 3.67 | Very High |
| NHC Healthcare-Johnson City LLC | 76 | 10.5% | 22.5% | 6.8% | 3.47 | High |
| Abundant Christian Living Community LLC | 53 | 7.3% | 20.0% | 7.3% | 3.05 | High |
| Hilllview Health Center | 33 | 4.6% | 32.4% | 13.3% | 2.98 | Medium |
| Christian Care Center of Unicoi County LLC | 32 | 4.4% | 35.9% | 12.8% | 3.55 | High |
| Lakebridge A Waters Community LLC | 27 | 3.7% | 42.6% | 14.3% | 4.36 | Very High |
| Four Oaks Operating Group LLC | 27 | 3.7% | 32.8% | 17.3% | 4.38 | Very High |
Kingsport, TN · 303 beds · Opportunity Score: 65
Holston Valley shows high SNF concentration: the top facility (NHC Healthcare Kingsport) alone accounts for 26.9% of volume, while Brookhaven Health & Rehabilitation — the #7 partner — carries a 58.8% hospitalization rate and a Very High facility risk score of 4.52. The hospital's 30-day SNF readmission rate (18.9%) exceeds the state average (18.0%), and Mountain City Care & Rehabilitation carries the system's highest facility risk at 9.77 — a critical red flag warranting immediate preferred network review.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| NHC Healthcare, Kingsport | 128 | 26.9% | 24.7% | 8.2% | 3.2 | High |
| Asbury Place Kingsport | 57 | 12.0% | 38.1% | 16.5% | 3.45 | High |
| Holston Manor SNF Operations LLC | 51 | 10.7% | 40.2% | 13.2% | 4.35 | Very High |
| Nova Health & Rehab Center | 33 | 6.9% | 36.1% | 17.8% | 3.74 | Very High |
| Lee Health & Rehab Center | 25 | 5.3% | 30.2% | 11.5% | 2.76 | Medium |
| Church Hill TN Opco LLC | 24 | 5.1% | 28.9% | 10.0% | 4.68 | Very High |
| Brookhaven Health and Rehabilitation | 23 | 4.8% | 58.8% | 17.9% | 4.52 | Very High |
Abingdon, VA · 116 beds · Opportunity Score: 59
Johnston Memorial Hospital shows severe concentration risk: the top 2 SNF partners (Abingdon Health & Rehab and Valley Rehabilitation) account for 58.3% of all FFS SNF volume. Ridgecrest Manor carries the highest facility risk score in the entire Ballad system (13.39), while Durham-Hensley's 6.38 score is similarly alarming. The hospital's SNF utilization (~19.5%) exceeds the VA state average (~17.5%), making it a high-priority market for a structured preferred network strategy focused on quality and outcome improvement.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| Abingdon Health & Rehab Center | 101 | 38.0% | 30.2% | 8.9% | 3.19 | High |
| Valley Rehabilitation and Nursing Center | 54 | 20.3% | 39.3% | 13.4% | 3.6 | Very High |
| 301 Village Holdings LLC | 30 | 11.3% | 53.3% | 17.4% | 4.03 | Very High |
| Deer Meadows Rehabilitation and Nursing | 24 | 9.0% | 44.2% | 19.2% | 4.17 | Very High |
| Mountain City Care & Rehabilitation Center | <11 | — | Suppressed | 16.7% | 3.24 | High |
| NHC Healthcare-Bristol LLC | <11 | — | Suppressed | 4.5% | 2.7 | Medium |
| Maple Grove Healthcare Center | <11 | — | Suppressed | 14.4% | 4.55 | Very High |
Greeneville, TN · 140 beds · Opportunity Score: 50
Greeneville Community Hospital's top 4 SNF partners account for ~88% of all FFS volume — the highest concentration ratio in the Ballad system. Durham-Hensley Health & Rehabilitation shows a troubling 58.9% hospitalization rate on 33 patients with a Very High facility risk score (4.04). The hospital's SNF utilization (~21%) exceeds the state average (17.82%), suggesting a highly SNF-dependent discharge pattern that warrants a strategic preferred network to redirect volume toward higher-quality partners.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| Signature Healthcare of Greeneville | 48 | 27.6% | 46.9% | 15.3% | 3.51 | High |
| Life Care Center of Greeneville | 46 | 26.4% | 35.5% | 16.4% | 3.36 | High |
| Durham-Hensley Health and Rehabilitation | 33 | 19.0% | 58.9% | 12.1% | 4.04 | Very High |
| Laughlin Healthcare Center | 27 | 15.5% | 26.5% | 12.5% | 2.99 | Medium |
| Princeton Transitional Care & Assisted Living | <11 | — | Suppressed | 13.8% | 1.99 | Very Low |
| NHC Healthcare-Johnson City LLC | <11 | — | Suppressed | 6.8% | 1.79 | Very Low |
| Four Oaks Operating Group LLC | <11 | — | Suppressed | 17.3% | 1.77 | Very Low |
Bristol, TN · 312 beds · Opportunity Score: 45
Bristol Regional's top 4 SNF partners account for 65.1% of all FFS volume — extreme concentration risk in a limited set of facilities. The #1 partner, 301 Village Holdings LLC, shows a 48.7% hospitalization rate on 88 patients with a High facility risk score (3.57). Greystone Health Care Center carries a 63.6% hospitalization rate and Very High facility risk (4.41). The hospital's SNF utilization (14.23%) is well below the state average (17.82%), suggesting underutilized SNF capacity or premature discharge patterns.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| 301 Village Holdings LLC | 88 | 22.6% | 48.7% | 17.4% | 3.57 | High |
| NHC Healthcare-Bristol LLC | 70 | 17.9% | 20.6% | 4.5% | 3.25 | High |
| Waters of Bristol A Rehabilitation & Nursing Center LLC | 52 | 13.3% | 48.0% | 17.1% | 3.67 | Very High |
| Abingdon Health & Rehab Center | 44 | 11.3% | 28.1% | 8.9% | 3.55 | High |
| Maple Grove Healthcare Center | 18 | 4.6% | 38.3% | 14.4% | 3.68 | Very High |
| Valley Rehabilitation and Nursing Center | 13 | 3.3% | 35.3% | 13.4% | 3.71 | Very High |
| Greystone Health Care Center | 11 | 2.8% | 63.6% | 15.7% | 4.41 | Very High |
Johnson City, TN · 80 beds · Opportunity Score: 39
Franklin Woods discharges 38.3% of its FFS SNF patients to a single facility — Princeton Transitional Care — creating significant concentration risk (High facility risk score: 3.20). Multiple Very High risk SNFs appear in the tail of the network including Ivy Hall Nursing Home (fac risk 5.57), Life Care Center of Greeneville (7.60), and Four Oaks Operating Group (6.66). Despite below-average SNF utilization (~16.1% vs 17.82% state), the quality risk in the existing network makes Franklin Woods a priority for preferred network development.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| Princeton Transitional Care & Assisted Living | 54 | 38.3% | 29.1% | 13.8% | 3.2 | High |
| NHC Healthcare-Johnson City LLC | 22 | 15.6% | 22.9% | 6.8% | 3.17 | High |
| Abundant Christian Living Community LLC | 12 | 8.5% | Suppressed | 7.3% | 2.55 | Medium |
| Christian Care Center of Unicoi County LLC | <11 | — | Suppressed | 12.8% | 2.99 | Medium |
| Hilllview Health Center | <11 | — | Suppressed | 13.3% | 3.46 | High |
| Hermitage Health Center | <11 | — | Suppressed | 13.9% | 3.88 | Very High |
| Ivy Hall Nursing Home | <11 | — | Suppressed | 15.8% | 5.57 | Very High |
Elizabethton, TN · 121 beds · Opportunity Score: 37
Sycamore Shoals sends the majority of its SNF volume to local Elizabethton-area facilities, with Hillview Health Center (21.9%) and Ivy Hall Nursing Home (18.4%) dominating referrals. Life Care Center of Elizabethton — a key local partner — posts a 58.5% hospitalization rate and 31.8% 90-day readmission with a Very High facility risk score (4.94). Berkeley Springs Healthcare Center carries the highest fac risk in the hospital's network (7.70). Below-average SNF utilization (~16.1%) combined with high-risk partners creates a clear case for a curated preferred network in this market.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| Hilllview Health Center | 43 | 21.9% | 41.5% | 13.3% | 2.97 | Medium |
| Ivy Hall Nursing Home | 36 | 18.4% | 37.4% | 15.8% | 2.91 | Medium |
| Princeton Transitional Care & Assisted Living | 21 | 10.7% | Suppressed | 13.8% | 3.15 | High |
| Hermitage Health Center | 15 | 7.7% | 55.9% | 13.9% | 3.9 | Very High |
| Christian Care Center of Unicoi County LLC | 15 | 7.7% | Suppressed | 12.8% | 2.95 | Medium |
| Life Care Center of Elizabethton | 13 | 6.6% | 58.5% | 20.9% | 4.94 | Very High |
| Signature Healthcare of Elizabethton Rehab & Wellness Center | 13 | 6.6% | Suppressed | 11.6% | 3.36 | High |
Kingsport, TN · 239 beds · Opportunity Score: 6
Indian Path Community Hospital has the lowest SNF utilization in the system (~9.96% vs 17.82% state average), sending FFS patients to only 8 SNF destinations — all with <11 patients each due to CMS suppression. The hospital's 30-day FFS readmission rate (11.61%) is well below the state average (15.04%), indicating strong overall performance. Despite low current volume, the hospital's Kingsport location — shared with Holston Valley — presents an opportunity to formalize a high-quality preferred SNF network as FFS volume grows.
Indian Path's FFS SNF volume is the lowest in the Ballad system. All 8 SNF destinations show fewer than 11 patients each, triggering CMS privacy suppression for most metrics. The hospital's overall 30-day FFS readmission rate (11.61%) is well below the state average, indicating strong overall performance. Despite limited current actionability, the hospital's Kingsport location — shared with Holston Valley — presents an opportunity to formalize preferred SNF relationships as volume grows.
| SNF Partner | Pts | Share | Hosp Rate | 30d Readmit | FR | Risk Cat |
|---|---|---|---|---|---|---|
| NHC Healthcare, Kingsport | <11 | — | Suppressed | 8.2% | — | — |
| Nova Health & Rehab Center | <11 | — | Suppressed | 17.8% | — | — |
| Asbury Place Kingsport | <11 | — | Suppressed | 16.5% | — | — |
| Holston Manor SNF Operations LLC | <11 | — | Suppressed | 13.2% | — | — |
| Brookhaven Health and Rehabilitation | <11 | — | Suppressed | 17.9% | — | — |
| Life Care Center of Elizabethton | <11 | — | Suppressed | 20.9% | — | — |
| The Wexford House | <11 | — | Suppressed | 0.0% | — | — |
| Lee Health & Rehab Center | <11 | — | Suppressed | 11.5% | — | — |
These facilities represent the greatest concentration of system-level risk — and the greatest opportunity for Puzzle to create measurable impact through coordinated quality improvement.
| SNF Partner | Hospitals | Peak Hosp Rate | 30d Readmit | 90d Readmit | Peak FR | Priority |
|---|---|---|---|---|---|---|
| NHC Healthcare, Kingsport | 8 | 24.7% | 8.2% | 12.4% | 3.57 | High |
| Princeton Transitional Care & Assisted Living | 7 | 35.4% | 13.8% | 16.4% | 4.27 | High |
| Life Care Center of Elizabethton | 6 | 75.7% | 20.9% | 31.8% | 6.98 | Immediate |
| Durham-Hensley Health and Rehabilitation | 6 | 58.9% | 12.1% | 21.2% | 6.38 | Immediate |
| Brookhaven Health and Rehabilitation | 5 | 58.8% | 17.9% | 26.8% | 8.7 | Immediate |
| NHC Healthcare-Johnson City LLC | 6 | 22.5% | 6.8% | 9.9% | 3.62 | Near-Term |
| NHC Healthcare-Bristol LLC | 5 | 20.6% | 4.5% | 9.3% | 5.51 | Near-Term |
| Asbury Place Kingsport | 4 | 38.1% | 16.5% | 22.6% | 5.34 | Near-Term |
| Waters of Bristol A Rehabilitation & Nursing Center LLC | 4 | 48.0% | 17.1% | 22.7% | 3.67 | Near-Term |
| Signature Healthcare of Greeneville | 3 | 46.9% | 15.3% | 19.0% | 3.64 | Near-Term |
| Mountain City Care & Rehabilitation Center | 5 | Suppressed | 16.7% | 25.0% | 9.77 | Immediate |
The 11 cross-system SNFs listed above represent Ballad Health's most interconnected downstream relationships. Three carry Immediate priority designations based on extreme risk signals: Life Care Center of Elizabethton (75.7% hospitalization rate, 6 sending hospitals), Mountain City Care & Rehabilitation (facility risk 9.77, 5 sending hospitals), and Brookhaven Health and Rehabilitation (58.8% hospitalization rate, facility risk 8.70 at Bristol). These are the relationships where Puzzle's embedded quality improvement model would generate the most immediate and measurable impact — precisely because the risk is concentrated, cross-system, and currently invisible at the hospital level.
Ballad Health discharges to 120+ unique SNFs across Tennessee and Virginia — this creates a structured post-acute partnership opportunity.
For Puzzle to establish a meaningful operational presence in your downstream SNF network — dedicated staff, performance feedback loops, facility-level data relationships — we need sufficient facility coverage to justify that investment. Based on our experience, 10 or more facilities is the threshold where embedded resources become economically viable and clinically impactful.
Ballad Health's network of 120+ SNF destinations across eight hospitals provides that scale — many times over. Even focusing only on the facilities where you send meaningful volume, there are dozens of relationships where a Puzzle presence would improve post-acute performance and give your clinical transformation teams real-time data they currently do not have.
When OSF HealthCare introduced Puzzle to 60 of their downstream nursing home partners, it created a shared performance infrastructure that neither organization could have built independently. Ballad Health has the same opportunity — a regional network of downstream partners, active patient relationships spanning two states, and the scale to make it matter.
The ask is simple: introduce us to your SNF partners. We will take it from there.
These hospitals carry Opportunity Index scores of 45–78 and collectively represent the largest volume, highest risk concentration, and greatest downstream quality improvement potential. JCMC alone sends 724 FFS patients to 70 SNF destinations. Immediate engagement with these hospitals' top SNF partners — and system-level review of cross-system high-risk facilities — is the recommended starting point.
Both hospitals score 37–39 on the Opportunity Index, with below-state-average SNF utilization but notable quality risk in their existing networks. Franklin Woods shares the Johnson City market with JCMC, creating natural preferred network leverage. Sycamore Shoals' Elizabethton market links directly to several of the system's highest-risk SNFs. Engagement should follow the Immediate tier.
Indian Path's FFS SNF volume is fully suppressed (<11 per facility). The hospital's overall 30-day readmission rate (11.61%) is well below the state average, and SNF utilization (~9.96%) is the lowest in the system. Indian Path is not an immediate engagement target, but its Kingsport location — shared with Holston Valley — positions it to benefit from any system-level preferred network formalization.
A structured path from current-state visibility to active network management.
Life Care Center of Elizabethton, Mountain City Care & Rehabilitation, Brookhaven Health and Rehabilitation, and Durham-Hensley carry Immediate priority designations based on extreme hospitalization rates, elevated facility risk scores, and cross-system presence. These reviews should establish consistent performance expectations, applied uniformly across all Ballad hospitals. Puzzle's network prioritization capability provides the data structure and monitoring logic to operationalize this without adding burden to existing staff.
Eight hospitals independently routing patients to overlapping SNF networks — with no shared visibility — makes it impossible to detect system-level patterns before they become adverse event patterns. A unified view of facility risk, hospitalization rates, and readmission trends at the network level is the foundational capability that every other step depends on — and it is the core of what Puzzle delivers.
This is the step that creates leverage. A warm introduction from Ballad Health gives Puzzle the credibility to begin building data relationships, embedding quality improvement resources, and creating the performance feedback loop that hospitals cannot build from the hospital side alone. Ballad's 120+ downstream SNF relationships provide more than sufficient scale for a meaningful Puzzle presence. We are not asking to replace existing relationships — we are asking for the introduction that lets us make them better. The facilities where your patients go most frequently are the right place to start.
Puzzle Healthcare is a post-acute intelligence and quality improvement company that works at the intersection of health systems and skilled nursing facilities. We embed quality improvement resources directly inside downstream SNF partners, creating a shared performance infrastructure that reduces readmissions, improves patient outcomes, and gives health systems real-time visibility into the facilities their patients rely on after discharge.
Our model has been implemented with health systems including OSF HealthCare, where Puzzle was introduced to 60 downstream nursing home partners to create a structured post-acute performance network. The result is a feedback loop that neither the hospital nor the SNF can create independently — one that transforms post-acute oversight from a reporting exercise into an active management capability.
Puzzle works because it starts where the patient goes — not where the patient was.
Ballad Health's eight-hospital system discharges approximately 2,400 Medicare FFS patients per year into a post-acute network with meaningful variation, limited system-level visibility, and no shared performance management infrastructure. The findings in this analysis represent what is visible from the hospital side. What becomes possible — for your patients, your clinical transformation teams, and your downstream SNF partners — when Puzzle is embedded in that network is the conversation we are asking to have.
We are ready to move quickly. The next step starts with an introduction.