Joseph Cacchione, MD, became CEO of Thomas Jefferson University and Jefferson Health in September, and he brought with him experience as an executive with St. Louis-based Ascension.
Before joining Jefferson Health, an 18-hospital system, he served as a leader with Ascension since 2017. He most recently served as executive vice president of clinician and network services at that health system.
Dr. Cacchione told Becker's Hospital Review he's excited to be part of Jefferson Health's legacy. He shared his top priorities for his first year on the job, discussed Jefferson Health's plans to go from five divisions to three and offered some advice for his peers.
Editor's note: Responses were lightly edited for length and clarity.
Question: What has you most excited about your new role as CEO of Jefferson Health?
Dr. Joseph Cacchione: The legacy of what Jefferson is and has been is exciting for me to be part of. The second thing is, I see three really important pieces of a puzzle that I think come together to give us a strategic advantage. And that's our outstanding healthcare delivery system. Our community hospitals are some of the best community hospitals in Southeast Pennsylvania, and South New Jersey. And our academic centers are also really high functioning. So that clinical quality is really exciting. For me, I think that's an important piece.
The second is the fact that we have a university that really helps to become part of the supply line for our health personnel. We also firmly believe that the Jefferson College of Population Health will be really important in the future. And we think our school for population health really helps to solidify the resources that we have around this subject.
The third piece is a focus on government public payers. And, frankly, I think it's a way for us to create a better care delivery model for patients by having a capitated environment, and at the same time is better financially for the health system.
What excites me the most is the three legs of the stool all contribute to all the things we're trying to achieve. And that the level that they function at currently, I think, we have a lot of things to do. But I feel really good about the foundation that exists in all three.
Q: What are a few of your top priorities for your first year at Jefferson Health?
JC: Integrating the three legs of the stool to make sure that our health plan is talking to our university, our university is talking to our health system, our health system is talking to the university. Each has to stand on its own, but integration is going to be important.
The second piece is integrating the health delivery system. Jefferson Health plans to go from five divisions to three. That integration is not just about cost cutting. In fact, it's less about cost cutting, and more about the efficiency of integration so that we can optimize care delivery. So, for example, are we duplicating procedures that we do, where hospitals that are just five miles apart are competing with one another for the same patients? That's just duplicative, and it's not an efficient use of our resources. And, candidly, when you can specialize and super specialize within hospitals, you can become more efficient, and you'll become safer and higher quality. So I'm excited about this. It's about becoming more efficient. But it's really about optimizing the revenue line in a way that's different and integrating the health system across the entire organization. And the way it's now set up, these hospitals in three different regions have the most benefit from integrating, and really complementing one another rather than competing with one another.
Q: Jefferson Health's plans to go from five divisions to three will affect some executive jobs. Specifically, Richard Webster, president of Thomas Jefferson University Hospital in Center City and Magee Rehabilitation Hospital in Philadelphia, and Alison Ferren, president and COO of Abington (Pa.) Health, are exiting the organization. What does this move mean in terms of leadership at hospitals?
JC: It's a regional approach so that we're not going to duplicate all the things we have. We went down to three regional presidents. And so now they have more to do. They have more to do, but they're going to have a team below them. It's going to be more grassroots or more on-the- ground type people.
You're talking about having a regional seat president, and then having that regional president start to build the team underneath them, that sort of matches their regional responsibilities, in some ways. There will be originality to the infrastructure below that. So, your regional chief nursing officer, regional CEO, a chief medical officer, all those things start to make more sense under a leadership team in that area. You start to think about, "Well, if I have the right chief medical officer, do they now know what clinical programs need to be knitted together across the region?" And then, even more importantly, than just knitting it across the region, we also need our physician leader, and administrative leaders of the service lines need to knit this agreement and need to knit these hospitals together in these critical programs together, across the region. But then, between the regions as well.
So, I think the service line is going to be really important moving forward. So patient safety indicators management, in particular in some of our our high functioning service lines like cardiology, cardiac surgery, neurosciences, orthopedics and cancer, and so it will become more of an integrated delivery network around cancer so that we're not doing the same sort of cancer services in every spot in our health system. We start to complement one another, and so that we can become more efficient that way.
Q: If you could pass along a piece of advice to other hospital CEOs, what would it be?
JC: I think if we're waiting for what used to be hospital volumes that come back, like orthopedics and simple spine, they are not coming back into the hospitals. They're just not going to come back. They're going to be for the most part outpatient procedure. You must plan for a day without those things. That's No. 1.
Also, the fee-for-service environment continues to be challenging. And fee-for-service continues to be pushed from the inpatient to the outpatient, and the reimbursement is much lower. So, finding ways to make up that revenue is very difficult in a fee-for-service world. You have to think about diverse revenue streams moving forward.
Additionally, I would also say empowering the physicians is really important. The plans can't come from the CEOs office. The plan to optimize cardiovascular must come from our cardiovascular leadership, which needs to have strong physician input. But the physicians, the front-line physicians of a physician leadership team need to own these plans, and they need to help develop them and be seen as owners. And we feel like they're owners. I want the administrative leadership of the service lines working with physicians, empowering them to help make these decisions and to help us grow our business in a way that is physician led.
Q: Anything else to add?
JC: As much as we're integrating our system, across the three legs of the stool, each leg of the stool also needs to be sort of independent. Some pieces and parts need to be independent, and so that they stand on their own two feet. As much as integration is very important, they also need to be independent, independently successful. We're not going to the university to help support our health system. The university itself needs to be independently successful, the health plan needs to be able to work with other providers. It's really important for the health plan to be in some ways integrated, but also have an independent state so that it can work with other health plans, because we're not going to solve this problem, just Jefferson.
Also, we always need to remember those people who are getting left behind, and health equity will always be a part of what Jefferson is. It's part of our mission to care for everyone. And, I think in particular, in the city of Philadelphia and its surrounding communities, we have a responsibility to make sure that everybody has access to affordable quality healthcare, and in a more proactive and not reactive way. And that's why we think some of the things that we're doing will help make us more proactive and reach into those communities that in a lot of ways get left behind.