Episode 84:
Telemedicine: A Convenience Patients Expect From Us
Joseph Impicciche, President and CEO, Ascension
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In this episode of Fireside Chat, we sit down with Joseph Impicciche, President and CEO, Ascension, to talk about the explosion of telemedicine and virtual care among health systems. We also talked about the next generation of healthcare CEOs and how the COVID crisis will impact that generation in leadership.

Joseph Impicciche, JD, MHA, serves as President and Chief Executive Officer of Ascension, leading the Ascension Leadership Team to advance the health system’s mission of providing compassionate, personalized care to all, especially those most in need. He previously served as President and Chief Operating Officer and earlier as Executive Vice President and General Counsel. Read more


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Joe Impicciche 0:03
I think it already has. During COVID we saw probably a 40 times increase from January to April. And I just heard this week we topped the million visit mark, so it’s a very significant increase in demand. And while that may fall off some, I really think it’s here to stay. I think it’s a convenience that our patients really will expect from us.

Gary Bisbee 0:27
That was Joe Impicciche president and CEO Ascension speaking about topping 1 million telemedicine encounters since the COVID crisis began. Ascension is hearing clearly the voice of the consumer asking for the convenience of virtual visits. I’m Gary Bisbee and this is Fireside Chat. Ascension is one of the largest Catholic health systems in the US. Joe was proud of the fact that in 2020 Ascension provided $2.4 billion in care to persons living in poverty and other community benefit programs. Ascension is active in administering vaccines and as of our interview date of March 4, it had provided over 500,000 shots. Joe shared Ascension’s focus of accelerating its transformation to an integrated health ministry, providing improved health outcomes for patients and the communities that Ascension serves. Strategic pillars include the clinical enterprise, the inpatient footprint, ambulatory care, and post-acute and home care. When it comes to the next generation of CEOs, Joe believes that they will be influenced by the COVID crisis and they will be more empathetic, transparent, and connected to the communities that they serve. Let’s listen.

Joe Impicciche 1:43
The COVID crisis and experience will have a long-lasting impact on the role of the CEO. I mean, for one, just being able to connect with associates in our communities has taken on even greater importance. I think it also reminds us of the importance of empathy as a leadership trait. Associates want to know that their leader is standing shoulder to shoulder with them and understand what they’re going through. And I think we’ve learned that during the pandemic and I don’t think it’s a lesson that’s going to be forgotten anytime soon.

Gary Bisbee 2:13
I’m delighted to welcome Joe Impicchiche to the microphone. Well, good afternoon, Joe, and welcome.

Joe Impicciche 2:25
Hey, thanks, Gary, thanks for having me.

Gary Bisbee 2:27
Well, we’re pleased to have you at this microphone for the third time, so we give you special credit for going through this three times, Joe, we appreciate that. Why don’t we begin with an update on COVID? It’s certainly evolved since our first interview last April. Ascension, of course, is a national health system, so maybe difficult to answer the question, but I’ll ask it anyway. What is the status of the current COVID surge in Ascension service areas?

Joe Impicciche 2:55
In most of our markets we’ve seen a pretty significant decline in cases of new infections over the past few weeks, which of course is very encouraging. Yesterday, we had a little under 700 inpatients, where just a few weeks ago we were averaging over 2000 patients a day. So the recent trends are very encouraging, but, of course, we know that our communities and our nation are not out of the woods yet. And it’s important that we continue to encourage everyone to maintain the distance from one another, wear a mask, and wash your hands regularly.

Gary Bisbee 3:27
I mean that’s a very interesting point. Certainly, you hear it from the CDC and other places. How active can you be, Joe, in that regard? I mean, do you actually talk individually to people about that or do you put information on your website of, “Hey, it’s too early not to wear your mask and so on”?

Joe Impicciche 3:45
We do. We communicate that message every single day in about every medium that we have. We just continue to reinforce the message that we have to continue to maintain safe practices, probably for several months yet – wear masks, practice social distancing, wash your hands regularly. We continue to preach that message.

Gary Bisbee 4:03
Well, one other question of interest here, among many, but that is the employees, physicians, the caregivers in Ascension hospitals. How are they holding up? They were under a fair amount of stress for multiple months. Now it seems to be relaxing, but how’s it working out with your caregivers?

Joe Impicciche 4:23
Most are exhausted. We’ve been at this now for over a year. And it’s been emotionally, physically taxing on them. I can’t begin to say how honored and humbled I am to work with such dedicated and compassionate people that serve in our ministry. I mean, they’ve really been incredible. We’ve tried to support them as best we can, to relieve and ease their burden, especially in the height of the surges. We provided financial hardship funds for associates that had some financial challenges. The other thing we did, we made a decision pretty early on that we were going to continue to employ everyone and not cut any salaries, so we put a pay protection program in place. And we continued to support them, really in a time when I thought they needed us the most. And that was a very important expression of our mission. We provided other support as well like daycare support, and then provided a number of self-help tools that address their spiritual, physical, and emotional well-being. So, again, we’ve done as much as we can to support our associates. But they’ve just been incredible, really incredible.

Gary Bisbee 5:31
Well, what are the most important lessons learned through this time, through this virtually, as you pointed out a year long? Now you made the point of all the support that you’ve provided over that time, but what lessons as you kind of stand back a bit and reflect, what lessons have you learned from these surges, Joe?

Joe Impicciche 5:50
There’s so many things to focus on early, but we decided to keep it simple and straightforward. And that is we were going to take care of our associates and our patients, and everything else we felt would be just fine. If we did that well, we felt like we would get through this. And thankfully, I think that approach worked well for us. We’re fortunate as a Catholic ministry to be guided by our mission that dates back several hundred years and it always reminds us where to put our emphasis, and that’s on caring for those most vulnerable in society. I think that’s really what got us through this very difficult, challenging period.

Gary Bisbee 6:24
Well, let’s turn to a happier note, which is the vaccination process. And we were talking about that earlier, how it seems to be uplifting spirits across the country. How is the vaccination process unfolding across Ascension’s multiple states and regions?

Joe Impicciche 6:42
It’s going pretty well. I think as of yesterday, we’d had administered over 550,000 doses across 19 states. We’re working to vaccinate as many people as we can as fast as we can. And I’m really appreciative, once again, on how our caregivers have really responded and the many sacrifices they’re making to put as many needles in arms as possible. We’ve stood up a lot of infrastructure in many of our ministries to provide a broader community support. I think to date of roughly 200,000 associates and aligned providers, nearly 121,000 have received their first doses, including more than 100,000 who have been fully vaccinated. And at our last count, I think we’ve provided over 230,000 doses to community members. So I think it’s going very, very well. We, like everyone else, we’re very, very hopeful that over the next couple months that everyone will have had an opportunity to be vaccinated.

Gary Bisbee 7:37
What about, there’s a term being used “vaccine hesitancy”? What about that and how is that affecting both your employees and the community? Has there been any way to gauge that, Joe?

Joe Impicciche 7:49
I’ll tell you, vaccine hesitancy is very real. Starting in January, we conducted a survey among more than 70,000 of our patients to assess their likelihood to receive the vaccine. I think roughly 40% of the non-vaccinated respondents were unlikely or undecided about getting vaccinated. We’ve found, for example, like essential workers, were actually the least likely to get vaccinated – corrections officers, postal service workers, public health workers, etc. So it’s very real, it’s very real in our ministry, even our caregivers. Again, to date, I think only about a little over 40% have completed the two shot series. We’re probably about anywhere from 55 to 60% an adoption rate at this point. So we’ve still got a lot of work to do, both internally and in our communities. And what we’re finding is, we’re going to have to go out and reach these people. We do that with our own caregivers, having one-on-one conversations. And we need to do that with our community members as well.

Gary Bisbee 8:54
Vaccine supply will continue to pick up over the next several months, now that the J&J vaccine has received emergency use authorization. But have you noticed any pickup in supply yet, Joe, or is it a bit early for that?

Joe Impicciche 9:08
It has been picking up. I’d say over the last few weeks we have noticed a steady increase in supply. And I agree with you, I think over the next several weeks it’ll improve even more. But again, we’ve been experiencing an increase.

Gary Bisbee 9:22
Why don’t we turn now to Ascension, if we could, Joe? Ascension is obviously a prominent name nationally and regionally, internationally, actually. But can you describe Ascension for our listeners, please?

Joe Impicciche 9:35
Sure, happy to. We’re one of the largest, nonprofit Catholic health systems in the US. We’re committed to delivering compassionate, personalized care to all with a special attention to persons living in poverty and those most vulnerable. We have over 160,000 associates and 40,000 aligned providers. We have more than 2,600 sites of care, which includes 145 hospitals, more than 40 senior living facilities, and we’re in 19 states and the District of Columbia. But I would tell you, probably the fact that I’m most proud of is that in the last fiscal year, we provided over $2.4 billion in care of persons living in poverty and other community benefit programs.

Gary Bisbee 10:20
Good for Ascension. That’s just awesome to hear. Obviously, a huge operation, and maybe at our next interview, I’d love to dig deep into how you, as a leader, even can lead that large an organization. Let’s move by that now, but what are Ascension’s top goals for 2021 and then the follow-up, Joe, is, has COVID influenced those priorities at all?

Joe Impicciche 10:47
We are focusing on accelerating our transformation to an integrated health ministry that delivers improved health outcomes, not only for our patients but also the communities we serve. And again, with a special attention to persons who are poor and vulnerable. We’re focusing on a number of strategic pillars. The first, always, is living out our mission and our Catholic identity. That really frames everything we do. It’s who we are and it’s why we serve. So that is always at the forefront, again, of everything we do. We’re also looking to optimize our clinical enterprise by delivering improved health outcomes for individuals and communities. We’re looking to optimize our footprint, which includes reimagining our acute care presence by growing ambulatory sites and optimizing ancillary services. We’re focusing on our post-acute care at home strategy and our consumer centered, flexible care delivery platform, as well as our workforce and our IT platform. So we have a lot of work underway, but in our view, it’s very transformative work.

Gary Bisbee 11:56
Joe, could ask a follow-up question there about your at-home work. Do you see that having been accelerated because of COVID?

Joe Impicciche 12:06
I think COVID has certainly had an impact on that. And I think the post-acute care strategy is becoming even more important as a result of what we’ve been through, as a result of the pandemic. So yeah, I think that’s correct, Gary.

Gary Bisbee 12:21
Has scale mattered to Ascension, or let me ask it differently, how has scale mattered to Ascension during the COVID crisis, Joe?

Joe Impicciche 12:28
I think scale has mattered. I especially believe our scale helped when it came to supply chain management and the acquisition of PPE and other essential supplies to keep our caregivers safe. Thankfully, we always managed to stay a few steps ahead of the demand curve. Although, just like everyone else, there were certainly days when we weren’t sure whether that next shipment would arrive in time. But I think our scale really served us well in that regard.

Gary Bisbee 12:54
Do you expect that the pandemic will cause more M&A among health systems, I’m talking now nationally?

Joe Impicciche 13:01
I don’t think anybody would be surprised to see that. There certainly have been a number of individual hospitals and rural hospitals that have been hit hard by this pandemic. And so I would suspect that we will see an increase in M&A.

Gary Bisbee 13:15
Well, the next question would be in terms of Ascension. Do you see over the next several years Ascension finding itself in a position to be accelerating M&A?

Joe Impicciche 13:26
We’re always open to discussing ways we can strengthen Catholic healthcare. So I don’t think COVID has necessarily changed that for us, but it could accelerate some of those discussions. But again, we’re always open to looking for new ways to strengthen Catholic healthcare.

Gary Bisbee 13:41
Well, let’s turn now to leadership impact due to COVID. And one of the questions that I’ve been interested in, love to get your opinion, which is, have the changes that COVID caused among our health systems, will those changes influence the characteristics for CEOs of the next generation of CEOs? Do you think that the boards of directors will be looking for different characteristics in CEOs going forward?

Joe Impicciche 14:10
I think it will. The COVID crisis and experience will have a long-lasting impact on the role of the CEO. I mean, for one, just being able to connect with associates in our communities has taken on even greater importance. I think it also reminds us of the importance of empathy as a leadership trait. Associates want to know that their leaders are standing shoulder to shoulder with them and understand what they’re going through. And I think we’ve learned that during the pandemic and I don’t think it’s a lesson that’s going to be forgotten anytime soon.

Gary Bisbee 14:41
Turning now to telemedicine. Over time do you think that the forced use of telemedicine that we went through during COVID will accelerate consumer demand for more convenience and affordability?

Joe Impicciche 14:55
I think it already has. During COVID we saw probably a 40 times increase from January to April. And I just heard this week we topped the million visit mark. So it’s a very significant increase in demand and while that may fall off some, I really think it’s here to stay. I think it’s a convenience that our patients really will expect from us.

Gary Bisbee 15:19
The follow-up question is do you think that the health insurance companies will pay for telemedicine and pay for it at the proper rate?

Joe Impicciche 15:29
Well, we hope so.

Gary Bisbee 15:31
Yeah, right? Turning to public health agencies, how closely has Ascension worked with local and state public health agencies across your states and regions?

Joe Impicciche 15:42
We’ve worked very closely with the state and local agencies, really both in our COVID response now and the vaccination process, especially focusing on those members of our community who are more difficult to reach due to health disparities or access. And it’s really key that we be a partner in the communities we serve, especially in getting everyone vaccinated.

Gary Bisbee 16:03
Will health systems play a larger role in public health going forward, do you think given the important role that they’ve played, let’s just say in terms of vaccine administration, for starters. But do you think that the health systems will play a larger role in public health going forward?

Joe Impicciche 16:20
I do believe, at least for Ascension, you know, as a Catholic health system, we’re uniquely positioned to play a key role in public health. And our mission and Catholic identity really speak directly to understanding the unique clinical and social needs of the poor and vulnerable. So again, I think we’re uniquely positioned to make a difference.

Gary Bisbee 16:38
Well, let’s turn to leadership in a crisis. Obviously, you’ve had, along with your CEO peers, a lot of experience with this over the last year, but what are the most important characteristics of a leader during a crisis? And you actually referred to that earlier, Joe, but let me ask that question directly. What are the most important characteristics of a leader during a crisis?

Joe Impicciche 17:01
Well, I think there are several. One, I think you have to be fully engaged, you have to trust the team you’ve assembled, and you have to be transparent in your communications. Ascension’s really blessed to have a strong leadership team throughout our ministry and that’s really been a source of strength for us over this past year. You also have to make decisions quickly, but you can’t make rash decisions or you can’t panic. And again, I think that’s where having a broad, talented group of leaders across Ascension has really made a difference.

Gary Bisbee 17:33
This has been a terrific interview, Joe. Let me ask one last question, if I could, which is, has the COVID crisis changed you as a leader and a family member?

Joe Impicciche 17:44
Well, it certainly has and I’m sure it’s changed most everyone. As a leader, I’m probably more empathetic now. You can’t help but to be moved and really changed by the stories of our caregivers and the many, many sacrifices they’ve made. And I guess personally, it’s reinforced something I’ve always known, and that’s the importance of family and friends and staying connected. It’s been a little bit more difficult to do that over the last 12-18 months, but it’s something that you certainly cannot take for granted. You have to find ways to be able to keep those bonds strong.

Gary Bisbee 18:14
Joe, this is a good place to land. We do appreciate your time with us, as always, so many thanks and good luck in the future.

Joe Impicciche 18:22
Thanks, Gary. Thanks again for having me.

Gary Bisbee 18:25
Fireside Chat with Gary Bisbee is a Health Management Academy podcast produced by Think Medium. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review Fireside Chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we’ve found that podcasts are known through word of mouth and we appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington, DC, where we explore the strategies of leading health systems through conversations with CEOs and other interesting leaders. For questions and suggestions about Fireside Chat contact me through our website firesidechatpodcast.com or gary@thinkmedium.com. Thanks for listening.