American health care cities: Nashville, Tennessee

Gabriel Perna | May 4, 2021

American Health Care Cities is a new recurring feature at Health Evolution examining the health care market in different cities and regions across the country. How does the health care industry vary across this country? How does it look the same? What are the opportunities and challenges in each city? We’ll be talking with key leaders in some of the most active health care cities in America to better understand if health care, as they say, is truly local.

First up: Nashville, Tennessee.

Unsplash/Lauren MacNeish

City: Nashville, Tennessee 

Metro area population: 1.95 million 

Health care economic benefit: $46.7 billion, 270,000 jobs  

Number of companies:  500+, including 16 publicly traded organizations 

Interviewee: Hayley Hovious, President of the Nashville Health Care Council 

Here’s a surprising statistic about Nashville: Music comprises approximately $10 billion of the city’s economy but health care accounts for $46 billion. Enough health care innovation is happening in Music City, in fact, that Nashville Health Care Council President Hayley Hovious likens its history, development and current status to Silicon Valley.  

A Nashville native, Hovious has served in that capacity since June of 2015. Prior to joining NHCC, she was Executive Director of the Council Fellow, which educates senior health care executives, a Trade Director and the Tennessee Department of Economic and Community Development. Hovious also worked as a Marketing Manager for software startup Consensus Point and a brand manager at E.J. Gallo Winery, among others.  

Health Evolution interviewed Hovious about Nashville’s history, challenges, prominent organizations, and how she is anticipating the city’s health care businesses will emerge from the COVID-19 pandemic.  

How has Nashville evolved as a health care market? 

Hovious: The Nashville health care industry started when HCA was founded about fifty years ago. In fact, they just have their 50th anniversary in the last three years. That founding was really the start of the Nashville health care industry. The industry in Nashville grew much the same way Silicon Valley grew over time. You had that reinvestment by the people who founded the industry into other businesses. The people from HCA started the Health Trust Purchasing Group and that becomes a huge business as well.  

You see things happening here that are very similar to Silicon Valley. Over time that creates this huge ecosystem. For many years, it was different models and health care services. The ambulatory surgery center model as a viable business began here in Nashville.  

There’s a lot of rubber meets the road in health care in Nashville. Huge companies are headquartered here that have facilities all over the country. And when you think about it from that perspective that means we have a ton of purchasing power here and we also have a ton of data. And I think it’s still up for grabs and trends with how that data gets used most effectively. But you can imagine the clinical data here is just incredibly deep when you’re talking about so many different health systems. Vanderbilt has the largest genomic database in the country and that’s funded by the NIH. They have over a million patients in it and they’re pairing the genomics data with the clinical data.  

What are some of the big challenges facing organizations in the Nashville health care market? 

Hovious: Change management. You’ve got so many companies here that are in the direct provision of care for patients that people don’t adopt technology as quickly as we’d like. That’s a real challenge for systems everywhere to overcome even if you have the best system and have a pandemic to move things along.  

But from Nashville’s perspective in the last ten years, what I’d say is there a lot more emphasis on the tech-enabled services. Nashville is good at understanding how care is delivered and then [finding] a much more efficient way of delivering that care. And then finding our unmet needs in the market. Senator Bill Frist along with Brad Smith, who was most recently running CMMI, started a company called Aspire Health that was really focused on palliative care and it was a tech-enabled model and had a very strong tech platform but then it also met an unmet market need at the time. You’re seeing more and more of that just because there’s such a deep understanding of health care delivery and a focus on the patient. 

Where they are now in a post pandemic world, we’re talking a lot these days about diversity, equity, and inclusion. We are a southern city and that means we’ve been at the epicenter of a lot of the civil rights movement over time.

Hayley Hovious, , President of the Nashville Health Care Council 

What does the post-pandemic Nashville health care industry look like?  

Hovious: For a long time, we’ve been talking about innovation and how to speed up the pace of that innovation. The pandemic loosened a lot of that up. From the standpoint of companies, they had to move quickly, and I think they’ve seen the benefits of moving quickly. That innovation hesitancy in a way was very real here.  I can see why. There is a large population of people in your organization but also people’s lives at stake.  

Where they are now in a post pandemic world, we’re talking a lot these days about diversity, equity, and inclusion. We are a southern city and that means we’ve been at the epicenter of a lot of the civil rights movement over time. Obviously, in other parts of the country this is something that everyone is dealing with. The inequities of care. But Nashville, being a center for health care just across the country, is really looking at itself in a way that takes on health equity differently. I think a lot of our companies are really committed to reinvesting in this and investigating how they can do better.  I think that’s a challenge that they’re very eagerly taking on right now that the pandemic highlighted. 

The fact that so many people are located here and they’re so tightly connected and willing to work together makes this a really unique place. The Nashville health care ecosystem is a really connected place. I’ve talked to executives recently who said, ‘We decided to make the move to Nashville to start our new fund because it’s easy to become a part of a community there.’  

I think the innovation that happened as a result of the pandemic is going to yield dividends in terms of people’s willingness to think about disruption.  With Vanderbilt and personalized medicine, I think they’re going to be turning out a lot of really interesting companies and that’s really exciting.  

Because of HCA’s size and scale, they were able to use data to treat patients around COVID in a way that not many organizations could. They were working very closely with the federal government, the CDC to make sure that they had the latest updated information about what was working in their facilities. With HCA’s scale, you can do work on medical trials that might take another organization years to do just because they have so many patients that they can work with. That ability of theirs was highlighted in the pandemic. From an innovation standpoint in Nashville, it’s really an exciting time.  

Given that excitement, what are some of the notable companies/organizations centered in Nashville? 

Hovious: Music has a $10 billion economic impact in Nashville. Health care has a $46 billion impact. People are surprised when they hear that statistic because they typically think of Nashville as a music town. If they haven’t dealt with the companies here, I think it’s surprising for them to realize just how big the health care industry is here. It’s huge. Nashville, we’re the 36th largest MSA, but when it comes to revenue in health care, we’re the fifth largest behind San Francisco, New York, Minneapolis, and Philadelphia. After that, it’s Nashville. We’re above Chicago, Atlanta and Los Angeles. We punch well above our weight. 

HCA Healthcare delivers more babies, trains more doctors, and does more ER visits than anyone else in the country. You also have companies’ like LifePoint Health, which has more hospitals in rural areas than anyone else. Amsurg is here, they do more colonoscopies than anyone else in the country. They were one of the original ambulatory center providers in the country. Acadia Healthcare is here. They are the largest behavioral health company in the country. Change Healthcare, which was recently acquired by Optum, is located here. Home health company Amedisys was moved here by CEO Paul Kusserow. Nava Health is here. They also got acquired by Optum too. Aspire Health is here, they got acquired by Anthem. Brookdale Senior Living, the largest senior living provider in the country is here. You got a really deep well of talent here too. People that have a lot of knowledge as operators in health care. It makes Nashville a really unique city that way.  

We have an entrepreneur center that does something called “Project Healthcare,” which is meant to help integrate [startups] into Nashville and give them the understanding of how to win here. The nice thing about Project Healthcare is when you talk about how many providers there are here, it’s a great opportunity for these companies. We also have a growing investment community. From the investment standpoint, Heritage Group is here. Council Capital is here. It’s a growing part of the ecosystem here. More and more funds are starting to have offices here. Starr Holdings moved here about two years ago. It’s a close-knit community of health care providers, even though it’s very large. Meharry Medical College is here and it is one of the five historically black medical schools in the country.   

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email at or on Twitter at @GabrielSPerna