By Jeff Keeling
It’s been no secret that East Tennessee State University expects long-term gains in research funding from a Wellmont Health System-Mountain States Health Alliance merger. That was a selling point as proponents advocated such a move toward a united “academic health system.”
ETSU President Dr. Brian Noland speaks during the merger announcement. (Photo by Adam Campbell)
What wasn’t known in the lead up to Thursday’s official announcement that the systems hope to merge, though, was just how important ETSU’s role in laying the groundwork for that merger will be. The results of an ETSU-led health assessment this summer and fall will underpin the hospital systems’ pitch to regulators: that the benefits to patients and payors of a system aimed at addressing the region’s chronic health woes “upstream” of the hospital setting will outweigh any negative impacts caused by reduced competition.
“We will conduct a health assessment, a needs analysis of the region,” ETSU President Dr. Brian Noland told The Business Journal and Johnson City News & Neighbor April 3, the day after the merger announcement. “That needs analysis will then provide the pillars upon which interventions and research are based.”
Noland, who called the current situation “very fluid,” said Dr. Randy Wykoff, the dean of ETSU’s College of Public Health, will lead the assessment, with input from deans of other health-related ETSU colleges, including medicine, nursing and pharmacy. He met with Dr. Wilsie Bishop, ETSU’s vice president for Health Affairs, April 3 along with the deans of the respective colleges.
“What I’ve asked them to do is outline what they see as the critical questions for their respective colleges, and then all of us to meet together as a leadership group to put together our base to begin the conversations with Mountain States/Wellmont.”
While he didn’t yet know whether the still-separate health systems planned to help fund the initial research, exactly what data would be sought or how it would change faculty and staff’s scope of work, Noland seemed unruffled by the lack of details at this point. He said Wykoff and his colleagues already have much of the data that will probably be used.
“This is not something we’re not already engaged in and think about every day, but we need to get a sense of the research questions, the expectations, the lens that Mountain States and Wellmont have, so that our faculty and staff can get to work.”
Noland said he sees little reason to doubt that down the road, the “Health Improvement Organization” that would result from the merger will yield three distinct benefits to ETSU’s health sciences schools and divisions. In addition to increased research funding, these include the likelihood of more residency slots being funded and the ability to recruit more doctors in specific “sub-specialty” areas of care not currently available in the metro area.
More subjects, more coordination, vexing problems: A research bonanza.
That Northeast Tennessee and Southwest Virginia have relatively unhealthy populations is no secret. Since arriving as founding dean of the College of Public Health in 2006, Wykoff has sounded the drum about the region’s need to improve its population health. Noland said the planned merger sets the stage for far greater opportunities to fund and succeed in those efforts than was possible previously.
With the systems no longer competing and close to a million people within the new system’s area, “just the scale we’re working with is going to make us very competitive with organizations, individuals and other entities that are interested in rural health care, rural education and those issues that impact everywhere from Appalachia to places on the West Coast,” Noland said. “Rural poverty’s rural poverty. This helps us be very competitive in a national environment and a national market for research.”
Noland believes ETSU’s rural and population health focus on issues such as obesity, drug dependency, diabetes and others – and its broad array of health sciences programs matched by only one other school in the country (Ohio State University) – will create a funding niche that will augment traditional research funding. Right now, ETSU handles an average of $38 to $50 million of externally funded research annually, depending on grant cycles.
“I think we can double that number easily within the next 10 years based upon the things that will present themselves here,” Noland said. He mentioned a handful of private foundations, the Appalachian Regional Commission and even corporations who do business in the region as potential funding sources beyond the traditional National Institutes of Health, National Science Foundation and other federal agencies that come to mind.
Noland also said he hopes to see the state of Tennessee step forward eventually with financial backing similar to what it has dedicated to academic health efforts in places like Memphis, Nashville and Knoxville. “This may not be something that we move this session, it may be something we look at downstream, but these two systems … staying here and looking to build together, that’s pretty good job protection and job creation for East Tennessee.”
Noland also expects the research focus and effort to improve population health to eventually help ETSU attract more sub-specialists, which will allow more people to have complicated medical issues treated close to home. “Those sub-specialties will be tied to the needs of the region, which link back to the mission. So every aspect of the institution is linked towards serving the needs of the people of the region. I call us the land grant institution for Appalachia, so as we grow research areas and grow sub-specialists, they will be in areas that are identified as areas of needs within the population health study that Dr. Wykoff will present.”
Noland said what makes it all possible – from increased sub-specialist recruitment and research funding to more capital available to pay for more residency slots – is the hospital systems’ decision to beat their proverbial swords into plowshares.
“When you have two of everything, but not enough of anything, there’s not the opportunity to provide the base for those things. By coming together, the entire game’s changed.”
Job one for ETSU, though, is the health study that will contribute to a “definitive agreement” the hospital systems present to Tennessee and Virginia for regulatory approval.
“Our challenge is going to be insuring that as this moves forward we are building and basing everything off of the population health work, the baseline study, that will be conducted by Dr. Wykoff and other faculty across campus,” Noland said. “As that identifies prescription drug abuse, then we’ve got to direct our resources towards that pillar. As that identifies diabetes, then that becomes an area that we align our resources to. I can’t say what the five, six, seven, eight areas are that we’ll identify, but we could all sit here and pretty quickly come up with the top four or five challenges that face the region. Dr. Wykoff will validate that and put it to a level of granularity upon which we can plan our hires and plan the development of our research.”
