Ascension moves to expand nonhospital and digital services

March 1, 2020

CEO says a central focus is improving services for those who are poor or otherwise vulnerable


Ascension is several years into its "dual transformation strategy" that involves strengthening its core health care operations while also investing in new models and methods to help grow the health system's footprint and impact.


Joseph Impicciche, who has headed Ascension's 150-hospital system since July 2019, has said Ascension is moving away from being a hospital-centric company. He's tasked Ascension's next generation of leaders with finding new ways to meet the health needs of patients and communities in a service area that spans 20 states and Washington, D.C.

Impicciche joined Ascension in 2004 as executive vice president and general counsel, became its president and chief operating officer early in 2019, and was elevated to president and chief executive last summer.

He spoke to Catholic Health World about Ascension's "mission-inspired transformation" and the challenges the system faces in today's complex health care environment.

What are your early impressions as chief executive of a sprawling system with over 2,600 care sites and 150,000 employees?
As I've traveled across our ministry and I've spoken to our associates, I'm really impressed with the commitment to our mission and the compassionate, personalized and high-quality care.

The commitment to the mission is very, very real and very deep within our organization. So that's really where I have felt the most joy in the role, seeing that deep commitment and all the good that we're doing in our communities.

What is Ascension focusing on in the near term?
Number one is building on our commitment to the mission — to the healing ministry of Jesus. In our last fiscal year we provided over $2 billion in care for persons living in poverty and other community benefits, and our community benefit programs are really designed to reach some of the most vulnerable people in our communities. That's been our mission ever since Ascension was formed.

I've challenged my team to open 50 clinics in our communities over the next three years. We think that will help align our efforts around solidarity with the poor in our communities. These clinics would be primarily aimed at meeting the health care needs of the poor and vulnerable in communities where they live.

How is Ascension organizing how it does this work?
We launched our "mission-inspired transformation" a little over two years ago, and it was primarily aimed to accelerate our advanced strategic direction. Its focus is on delivering compassionate, personalized, high-quality care in our communities where, when and how it's needed. This work is being done in eight design teams. Each team is being led by one of our senior leaders and there are approximately 150 associates working across these design teams. (See below.)

How is Ascension ensuring improved care for the poor and vulnerable is part of its transformation?
All this work is about providing better care to our patients, especially the poor and vulnerable. As an example, the 2025 consumer experience design team is building out our digital platform. We have someone on the team who's focusing on access issues for the poor and vulnerable. We recognize that many folks that we care for may not have access to the technology, and may not be comfortable with the technology we're offering to patients to ease their access to medical services. So even as we deliver that experience, we are paying close attention to how we can provide better access to those who may not be able to access our system in that manner.

What's the purpose and goal of Ascension's collaboration with Google and how will it impact patient care? Were you surprised by the criticism related to the sharing of patients' private medical information with Google?
First of all, I'm very excited and proud of the work that we're doing with Google. The health care environment is rapidly evolving, and we have to adapt; we have to find better ways to meet the needs and expectations of our patients and caregivers. The simple truth today is that electronic health records systems don't talk to one another, and that adds unnecessary challenges to providing patient care.

Today caregivers are spending too much time hunting through fragmented, poorly organized records, and trying to distill those records together. It's a very frustrating experience. For us it's even more acute because we are a system of legacy systems — we have five different electronic health records systems within Ascension that don't talk to each other.

We've had hundreds of clinicians working with Google over the last several months, to provide a solution to this complex problem. And we believe the solution will empower our caregivers to provide better, safer care to our patients.

The one thing that I also want to highlight is that patient data will be protected just as it is today. And under no circumstances is Google allowed to use this data for other purposes or to combine it with Google consumer data. We take our responsibilities seriously.

Of course the interoperability challenge isn't Ascension's alone; it's true for all health care participants. Across the board, health records are very fragmented, which is why Ascension very much supports the U.S. Department of Health and Human Services initiative to promote interoperability and we are doing our best in our work with Google to do just that. We think this will be a game changer for clinicians and patients alike in a secure and safe way.

How is Ascension planning for the increase in care needs of the growing population of senior adults? What innovative services are being considered?
There are a number of things. We've been looking at home care for example. As part of this work, we're beginning to "admit" patients to their home: We're providing that same hospital care within the home in a much more comfortable environment, in a very safe environment. We think this could have a major impact on the care of many in our communities.

What are top challenges Ascension expects to navigate in achieving its priorities?
One is that there's still a lot of uncertainty with respect to health care reform. Providers are caught in the middle right now as we move from a fee-for-service to a fee-for-value platform — many providers have a foot in both worlds, which is very difficult. I think the uncertainty around health care financing continues to be a major issue and I think health care policy is going to continue to be a robust debate.

Rising consumerism is another major factor. People are used to the type of convenience that they have with the Amazons, the Ubers, online banking and so forth and they are beginning to demand the same access and convenience in their health care system. The consumer experience team is focused on delivering that integrated, seamless, branded experience.

Six months ago we made some changes in our senior leadership team and brought in next generation leaders with various backgrounds and talents. We flattened the organization and, I think, that's enabled us to make decisions more quickly and to be more aligned throughout the organization.

Finally, we're facing a lot of nontraditional players entering the health care space, including big box retailers, technology companies, retail urgent care and so forth. These nontraditional players are forcing all health systems to change and adapt and become more consumer centric.

What are some of the public policy priorities for Ascension advocacy?
I've written on gun violence and we see it as a very serious public health issue in our country. We feel obligated because of who we are as a Catholic organization to speak out on this subject and encourage others to speak out. We have asked members of Congress to address this issue.

Price transparency is another very important issue. I think consumers have the absolute right to know what health care services are going to cost. And, so, we support price transparency, but it needs to be meaningful and informative for consumers, and also needs to apply to all the providers within that health care ecosystem. Otherwise the information can be misleading. We encourage Congress to convene all the players, so that we can solve this problem in a meaningful and integrated way.

What is Ascension doing on its own to increase price transparency?
As a first step we're focusing on our own associates. We have our own health plan, SmartHealth, and we have 150,000 associates that we cover and some 300,000-plus lives. We are doing what we can to help our associates understand the pricing of health care through that plan.

Are there any other public policy issues you'd want to highlight?
The other issue I wanted to mention has to do with drug pricing. We've got to be able to rein in drug prices because otherwise it creates very painful choices for many of the patients that we serve.

Ascension design teams undertake transformation work

Ascension has tasked eight cross-disciplinary design teams with ideation and development of its "mission-inspired transformation." The system describes the teams this way:

  • Building socially integrated systems of human flourishing is focused on building socially integrated systems of care with primary attention to addressing the underlying social determinants of health — such as housing instability, education, access to healthy foods — that lead to disparities of health outcomes.
  • Delivering the 2025 consumer experience aims to expand Ascension's reach through technology that is aimed at improving convenience and access to health care akin to the consumer convenience offered by Uber, Amazon and online banking.
  • Bringing health and healing to the home is developing the hospital at home model and other services to improve the access, quality and experience of patients by caring for them in their homes.
  • Redesigning the front door to Ascension's health system is addressing traditional, telehealth and other new "front doors" or entry points for those seeking care.
  • Designing the caregiver experience of the future is focused on redefining how caregivers operate as an interdisciplinary team and find joy in their work.
  • Redefining excellence in surgical care will design a proactive surgical services growth strategy in key service lines and explore innovative approaches to supporting surgical efficiency, consistency and data transparency.
  • Reimagining our presence and capacity is planning the repurposing of some facilities in a way that improves health care access while addressing social determinants of health. It is doing this by congregating such services as education, job training, transportation, retail and social services. Ascension is using this "Healthy Village" concept in the reset of one of its facilities in Washington, D.C.
  • Growing covered individuals through strategic purchaser contracting is expanding Ascension's population health models and capabilities to address the needs of self-insured employers and other strategic purchasers of value-based care.


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