The landscape of health systems' organizational strategies varies, encompassing everything from reorganizing portfolios and offloading hospitals in different markets to making acquisitions.
There is no one-size-fits-all approach for organizations when deciding which hospitals to divest, retain or build. However, a common goal underpins these decisions: delivering more meaningful benefits to patients and communities.
With this in mind, Becker's continued its discussion with Ascension President Eduardo Conrado about the St. Louis-based health system's portfolio strategy.
Becker's caught up with him as he was fresh off celebrating the completion of the East Tower and surgery expansion projects at Ascension Alexian Brothers, a critical care hospital and ED in Elk Grove Village, Ill. He was in attendance as the hospital hosted a ribbon-cutting ceremony for the new neurosciences institute there Aug. 28.
"We continue to make investments on the sites we're maintaining," Mr. Conrado said. "That was a $107 million investment we made. It went into one of our newer towers there. We ended up adding six operating rooms. We have two additional floors. This newer unit, [the neurosciences institute], is one of the floors, and the second floor is shelled for expansion, for additional components."
The neurosciences institute has 36 patient rooms, 16 of which have patient lifts from the ceilings.
The patient lifts make "it easier for patients with mobility challenges to be moved from a bed to a car, or bed to a wheelchair," Mr. Conrado said. "It also helps the nurses. We also have some attached quiet rooms for the families. It's neat in terms of seeing the unique design for that floor.
"Then when you go downstairs, there are six ORs, [which opened a few months earlier than the neurosciences institute]. Four of them are operational and two we left shelled for expansion."
The Ascension Alexian Brothers projects, along with other recent projects, such as an expanded Center for Eating Disorders at Ascension Saint Joseph-Chicago, are only part of Ascension's strategy.
Mr. Conrado noted that the health system began a close examination of its strategy about two and a half years ago. He said it involves an operational rigor component.
"Running the markets much better, both in terms of the programs we had in place to generate additional volume, have differentiated clinical programs, and focus on efficiency, discharges or rotations," he said. "Combined with that is the focus on clinical quality and safety."
As part of this two-pronged approach, Ascension "evaluated exiting markets where it had only one hospital and where combining with a larger system made sense," Mr. Conrado said.
For example, the University of Alabama System plans to acquire Birmingham-based Ascension St. Vincent's Health System for about $450 million. And St. Louis-based Mercy announced in February its intention to acquire ownership of Ascension Via Christi Hospital in Pittsburg, Kan.
"There was a hospital in Kansas that was too far from Wichita to leverage our assets there, so we combined it with another Catholic system that was closer," Mr. Conrado said.
Ascension also looked at markets that had good quality, engagement and low cost for discharges, but a more difficult payer environment.
"Alabama would fall under that category," he said. "St. Vincent's had phenomenal quality, lowest cost across Ascension, so high quality, low cost, high engagement with employees, high net promoter scores with patients. But it's a market dominated by one payer, and there's no way to negotiate higher rates.
"So we looked at what’s best for the community. UAB, which had been a partner with us for a while, needed additional capacity. They're an academic, phenomenal system. So it made sense to combine St. Vincent's and UAB."
Meanwhile, Ascension decided not to sell in Michigan. Instead, Ascension's proposed joint venture with Detroit-based Henry Ford Health, which is expected to launch later this year pending regulatory approvals, would fold Ascension Michigan's care sites in the southeast region of the state under its brand.
"There are phenomenal clinical programs in that market, and it ended up creating a super regional similar to others you see in markets where you have differentiated clinical programs and then a nice footprint to serve the community," Mr. Conrado said. "So that made sense when combining."
Mr. Conrado said Ascension has no additional transactions planned in the immediate future. At the same time, it continues to invest in its existing markets, like at Ascension Alexian Brothers.
Ascension is also preparing to open a women's center in October next to Peyton Manning Children's Hospital at Ascension St. Vincent in Indianapolis. In spring 2025, the health system plans to open the Ascension St. Vincent Brain and Spine Hospital in Indianapolis. And in fall 2025, Ascension will open its new women's tower on the Ascension Seton Medical Center campus in Austin, Texas.
"You're seeing us shrink geographically based on the criteria I mentioned, and in the communities we're in, we're putting in new clinical programs that are differentiated and needed, similar to what we just did in Elk Grove," Mr. Conrado said.
He said Ascension will also continue to expand in the communities it is in with an ambulatory footprint. Ascension has 84 ambulatory surgery centers and seeks to see that number grow to at least 100.
Another area of growth is outpatient rehabilitation centers, Mr. Conrado said.
"We see a need in the community for that, keeping seniors or patients out of surgery rooms through outpatient physical therapy," he said. "That complements the inpatient rehab expansion we're doing where it makes sense. We're also expanding access to imaging, mostly through de novo sites."
On the pharmacy side, Ascension has invested in patient preference for mail order. The health system opened a large mail order distribution center in Austin a couple of years ago that serves all its markets, "and it will continue to ramp up," Mr. Conrado said.
Ascension has also been expanding in terms of the specialty pharmacy space, including the opening of a distribution center in Detroit and a second one in Austin.
Additionally, the health system is heavily expanding at-home modalities. This includes a joint venture with Compassus for Ascension at Home.
"We continue to invest in emergency departments, as well," Mr. Conrado said. "We see millions of patients going through them.
"Our clinical experience team is working with their clinical and operational teams to rethink the physical environment of the ED. Last year, we focused on reducing wait times, cutting door-to-doc times in half to minimize wait times and get patients into the EDs as soon as we can. We're also focusing on discharge, either to the hospital or home, once they're in the ED.
"But we realize that’s a major traffic area, especially the waiting room, so our teams are redesigning seating, access to Wi-Fi, ambient music, and information we provide in terms of wait times. This effort started last fiscal year and will continue this year. I'm pretty excited about it. I think it will have a big impact on the communities."