Ballad Health, an Appalachian company with the nation’s largest state-sanctioned hospital monopoly, may soon be required to improve its quality of care or face the possibility of being broken up. Government documents obtained by KFF Health News reveal that Tennessee officials, in closed-door negotiations, are attempting to hold the monopoly more accountable after years of complaints and protests from patients and their families. Ballad, a 20-hospital system in northeastern Tennessee and southwestern Virginia, was created six years ago through monopoly agreements negotiated with both states. Si…