Ballad Health announced Wednesday that it will partner with the Harvard Medical School and East Tennessee State University Center for Rural Health Research on an independent study of hospitals in rural areas.

Dr. Michael Chernew, the Leonard D. Schaeffer professor of health care policy and director of healthcare markets and regulation lab at Harvard Medical School, will lead the study in collaboration with the ETSU Center for Rural Health Research. Ballad is providing funding to support the research.

“The acute care hospital industry has undergone substantial restructuring during the past few decades and in recent years this frequently involves health systems that stretch across markets and state lines,” Chernew said in a statement from Ballad on Wednesday.

While several studies have examined the effect of mergers and acquisitions on prices and quality, most have focused on urban markets, Chernow said. He added that small rural and non-urban markets differ in ways that could affect the social benefits and costs of hospital consolidation.

The study will explore hospital competition, services and expenses in rural areas that have few hospitals and fairly small populations.

“Hospitals in these markets typically employ a substantial proportion of the local population and have a significant influence over the local economy,” Ballad Health said in the statement.

“Recent data suggest that many hospitals in these small markets are struggling financially and failing to keep pace with the adoption of the latest technology and best practices,” the company added.

According to the statement, the study will research how small hospital markets in rural areas have changed, and will also look for “predictors of hospital closure and acquisition.” It will also investigate how hospital services and expenses in those markets have evolved and how they’re impacted by closings and mergers.

“Health policy should be driven by the facts, and this analysis will provide much-needed information about the dynamics in rural and non-urban markets and what happens to health care in those markets due to a variety of pressures these hospitals face,” said Alan Levine, CEO of Ballad Health.

“Given the massive number of rural and non-urban hospitals that are failing financially, we hope this study, wherever the data takes it, will inform future policy decisions by Congress, the administration and other enforcement agencies as we try to better understand why so many hospitals are struggling,” Levine added. “Once we have this information, it could prescribe a new path forward.”

ETSU’s Center for Rural Health Research was launched last July through a partnership between Ballad, Tennessee Gov. Bill Lee and the Tennessee legislature. Ballad Health made a $15 million contribution commitment to fund the center, and the state made a $10 million commitment.

“We know that health is driven not only by health care services, but income, education, race and a host of other so-called social determinants,” Dr. Randy Wykoff, dean of the ETSU College of Public Health and director of the Center for Rural Health Research, said of the collaboration with Harvard.

“ETSU’s highly ranked public health program will combine with the best health care economics team in the country at Harvard to build knowledge that will help bridge research and policy gaps in rural and non-urban health,” he added.

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