February: Plain talk on quality care, pandemics and burnout
Dr. Joseph Cacchione, CEO of Jefferson Health, talks to club members in February.
By Chris Satullo and Eileen Kenna
Ask Joseph Cacchione, CEO of Jefferson Health, why his 42-000-worker, eds-and-meds behemoth felt compelled to merge with Lehigh Valley Health Network, a regional giant with another 18,000 employees, and you'll get a simple, surprising answer:
Insurance.
Cacchione, who spoke to about 90 Sunday Breakfast Club members and guests last Wednesday at the Fitler Club, will then explain his answer by asking you a question:
Who's the largest employer of doctors in America?
OK, stop guessing. You're wrong.
It's UnitedHealthCare, an insurance company. It employs more than 100,000 doctors nationwide.
As health insurers have increasingly horned in on hospitals' turf (i.e., providing care), hospital CEOs like Cacchione have decided turnabout is fair play - as well as a needed survival strategy.
"Jeff is now a three-headed enterprise," Cacchione told club members. "Jefferson Health, with our 17 hospitals, you know. Also, Jefferson University, including the graduate schools and medical schools associated with it. But the third and increasingly vital leg is what used to be called Health Plan Partners, now the Jefferson Health Plan."
The United States spends the most of any nation on health care, $9,000 per capita, $2,000 more than No. 2 Switzerland. That money buys some high-quality care, Cacchione said, but it also pays for a lot of middlemen, bureaucracy and unnecessary procedures, without achieving either equitable care or universal coverage.
"If we’re going do what's best for patients and be more affordable, we think combining care delivery with the financing arm makes all the sense in the world," he said. "The way healthcare has been, with the insurance system we have, the more we do to you, the better it is for us, financially. But more in health care is not always better. The system today now incentivizes us to do more and that’s not always good.
"Getting into insurance helps us manage the wellness side of it. We have to transform away from just sick care to preserving health, to incentivizing healthy behaviors."
Jefferson's insurance business focuses on what Cacchione called "government care": Medicare, Medicaid and, recently, plans offered on the Obamacare website.
That's where Lehigh Valley Health Network comes in - bringing a fresh stream of potential customers for the Jefferson Health Plan from a region where lots of residents use government plans. LVHN is also a high-quality system that shares many values with Jeff, Cacchione said.
"We signed a letter of intent to merge last December, and our FTC nod just came through, so we expect to close this deal by the end of the calendar year."
Here's what Cacchione had to say about other topics during a wide-ranging, candid interview and in response to some frank questioning from the audience:
What's the status of evidence-based medicine?
"One of the great stories in health care since the Nineties has been how we've learned to solidify care processes based on the evidence we gather on outcomes. Now, every hospital will tell you they do evidence-based medicine. But does it occur every day, in every health system? No. But we're fortunate around Philadelphia to have some really great, cutting-edge health systems: Penn, Temple, Main Line, St. Chris. I think Jeff is in that same ballpark."
What lessons did you take away from the pandemic?
"When the pandemic hit, I was chief physician for Ascension Health, the second-largest health system in the United States, with 8 percent of all inpatient COVID patients in America in our hospitals. We learned a lot.
"I knew at the time the biggest mistake we made was this: We shut the hospitals down to everything else because we were so worried we’d be overrun with COVID. But very few hospitals actually were overrun with COVID. We scared people out of our emergency rooms; scared them out of getting needed procedures, and some died because of it. In NYC, there were lots of DOAs during two years of COVID because people with strokes or heart attacks weren’t calling 911 and they’d arrive and the person would have already passed."
Cacchione said he's worked a lot with predictive models. He concluded the ones used to forecast the spread of the pandemic early on were deeply flawed and led to damaging hyperbolic predictions.
That said, he described the COVID vaccines as a great achievement and huge lifesaver. He still shakes his head over the breadth and persistence of vaccine reluctance.
"You want to talk about hate mail? Ascension had hospitals in states like Alabama, Kansas, Texas and Oklahoma. I got lots of love notes from folks in those states. One was 10 pages long. I was going to be struck down by the Almighty because of my marriage with Satan.
"We’re now seeing measles for the first time in many years. That's a direct effect of people not getting their children vaccinated. We'll start seeing mumps. And then Rubella. It causes severe birth defects. We’re going to start seeing things we haven’t seen since the '60s."
If you could be czar of the 2024 election debate about health care, on what would you have it focus?
"We need to talk about: How are we going to insure health equity across our current system of care? You know, when anybody is anywhere in the world and they want the best care, they come to the U.S. The problem is not how good our care can be; it’s that it's not good for everybody. Your ZIP code should not dictate how well you are or your chances of having a good outcome. We have to do better on health equity. Because the model today is not working. It should incentivize well-care. Instead, the more sick people there are, the better it is for the health system financially. We have to have a better financing system."
After the strains of the pandemic, how do you recruit and retain health workers?
"It’s one of the things that keeps me up at night. We have a burned-out work force. They’re recovering somewhat. We’ve put programs in place to address burnout, programs and group sessions, both virtual and in person. One of the big things that happened in the pandemic ... well, it used to be when you were treating people with critical illnesses, you could compartmentalize. When I went home at night and I'd lost a patient, I left it at work. During COVID, there was no compartmentalization. During COVID people got home and were worried about their families, about bringing it into the home, about the people they loved suffering what they'd seen at work. They were burned out and couldn’t leave it at work any longer.
"We turned over 24 percent of nurses annually over the last few years. Used to be 7-8 percent. We've got to create a vigorous pipeline. ... That’s one beauty of our three-legged stool: At Jefferson University, we have new majors in things like health insurance management. We're trying to create ancillary positions on care teams that reduce the administrative burden on nurses, that mean we don't have to have more nurses than we can hire."
What's it been like being a new university president during a rough season for university presidents?
"Early on, [after the violence in Israel and Gaza] I said we will not answer moral questions with legal answers. What is wrong is wrong, regardless of who’s saying it or how they’re saying it. ... We supported our faculty and our students. We did not tolerate any behaviors that were anti- anything. We fired one professor for antisemitic comments. We had 2 prayer services , one hosted by the Jewish community, one hosted by the Arab American, particularly Palestinian, community. And both sides came to both.
"I don’t know that we have all the right solutions. I don’t want to be caught up in a geopolitical discussion. Thomas Jefferson University is the most diverse in the city. We want a feeling of belonging-ness Our university team has spent a lot of time talking to our students; I don’t think you can talk to them enough at this point. They think they know a lot, but they’re really confused when you peel the onion back."
Club President Oscar Wang (center, with microphone) opens February’s progam at the Fitler Club.