The incoming president and CEO of Jefferson Health, Cacchione talked with Chief Healthcare Executive about creating a better work environment, the changing role of hospitals, and what he has learned from the COVID-19 pandemic.
Joseph Cacchione says the “historical nature” of Jefferson Health holds great appeal.
“It’s been part of medicine for a long time in this country,” he says. “It’s coming up on our 200-year anniversary. It’s a storied organization.”
However, Cacchione is looking to the future, and he’s excited as he prepares to take over as president and CEO of Jefferson Health and Thomas Jefferson University.
Cacchione, who departs a key executive post in the Ascension system, will assume his new role at Jefferson on Sept. 6. In an interview with Chief Healthcare Executive, Cacchione says he sees Jefferson as well equipped to thrive in the rapidly changing healthcare industry.
“The collective assets of Jefferson, including the multiple hospitals, the university, the medical school and our insurance company, all those things are a great recipe for success,” Cacchione says. “I think there’s been a lot of success at Jefferson in the past, and we’re looking to take it to a new level of success.”
During the interview, Cacchione talked about his hopes for Jefferson, the future of healthcare, the lessons of the COVID-19 pandemic and more. (See part of his conversation with Chief Healthcare Executive in this video. The story continues below the video.)
A cardiologist, Cacchione has spent the last five years at Ascension, the Catholic nonprofit health system that operates more than 140 hospitals. Most recently, he has served as Ascension’s executive vice president, clinical & network services since 2019. He previously led Ascension Michigan’s statewide health system. Before joining Ascension, Cacchione spent eight years at the Cleveland Clinic and was chairman of operations and strategy for the Heart and Vascular Institute.
In a news release, Ascension hailed Cacchione as “a key driver of transformational change, helping to position Ascension for the future.” The system praised his work to expand virtual care options and improve infection controls.
Cacchione says Ascension is “a great organization.”
“This was about running to something,” he says of joining Jefferson, adding, “I couldn’t pass up an opportunity like Jefferson.”
Jefferson operates 18 hospitals in the Philadelphia area and in New Jersey, along with the Sydney Kimmel Medical College and the Jefferson Health Plan. In October 2021, Jefferson completed a long-planned merger with Einstein Healthcare Network, bringing four hospitals in the system.
Cacchione says he’s looking to help incorporate the hospitals it has acquired more fully into the Jefferson system.
“There’s been a lot of pulling together of assets, of hospitals that have come into the system over the last 3-5 years.I don’t know that Jefferson has totally integrated those into seamless care,” he says.
“I think that would be something that would be a priority for us, is to make sure that the communities that have entrusted us with their precious asset of their hospital, or their health system, that we show a value to being part of something bigger like Jefferson, that this becomes a place known for its high quality and at an affordable price.”
‘Create a better environment’
After more than two years in the COVID-19 pandemic, hospitals continue to battle staffing shortages. As many as 1 in 5 healthcare workers have left the industry during the pandemic. Only 24% of nurses said they have adequate staffing more than 75% of the time, according to a study released last month by the American Association of Critical-Care Nurses.
Cacchione didn’t mince words about the difficulties of hospital staffing.
“This is the biggest challenge in healthcare right now,” Cacchione says. “Thousands of nurses have left the workforce. It’s not just nurses. It’s a lot of other professionals, respiratory therapists and physical therapists and people have left health systems, not just Jefferson, but they've left the entire workforce.
“It’s a challenge because the labor costs are significantly higher for us as a health system. Candidly, nobody wants to pay more for their healthcare,” he adds. “They already pay a lot for it. So we’re going to have to thread the needle on that one.”
Cacchione says he’s looking to develop “a more flexible and inviting work calendar” for nurses and other healthcare professionals.
“I think we have to create a better environment for our nurses, and more flexible scheduling,” he says. “We’ll be working with our nurse leaders and our operators to figure out how we can create a better environment for our nurses.”
Cacchione acknowledges giving nurses good pay is an important part of the equation.
“We’ve got to create a better environment for them to work in, and a more inviting environment for them to work in, and pay them fairly,” Cacchione says.
In addition, Cacchione says he wants to find ways to take some tasks away from nurses so they can focus more on patient care.
“We're going to have to think about how we deliver care differently, because I don’t see the nursing shortage changing anytime in the near future,” he says. “So we're going to have to think about how we work in a way that is making sure that nurses work on the things that nurses should work on, and providing them with support staff to take those tasks away from them that doesn’t necessarily require a nursing degree to perform.”
The changing role of hospitals
Cacchione says he sees Jefferson doing more with remote patient monitoring as fewer people are treated in the hospital setting. He also says hospital-at-home programs will be part of the mix, although he says there are unanswered questions about delivering acute care at home.
“That model has yet to be determined whether that’s going to reduce staffing requirements or if it’s going to be more effective from a cost standpoint,” Cacchione says. “Most importantly, we don’t really have great data on quality. It will be part of the continuum of care. I think there will be growth. But I do not think it will replace the hospital.”
Cacchione says patients in hospitals today are sicker than even a few years ago, but more people are being treated on an outpatient basis, a trend he expects to continue. “That’s probably the biggest change. We’re going to see less people in the inpatient arena than we’ve seen before,” he says.
“What’s left in the hospital today is much different than what was in the hospital five years ago,” he explains. “I think we’re seeing an overall erosion of inpatient admissions across the country. That’s why health systems are struggling.”
While hospital-at-home programs are going to be a piece in the puzzle, Cacchione says, “It is not the solution to this problem.”
“The solution is really rightsizing our health system for a reduced number of admissions, and making sure we have a continuum of care, which includes care in the home, but also includes care in multiple other venues, surgery centers, and things like that,” he says. “That’s where I believe it’s going.”
Cacchione says he wants to work with Jefferson’s health plan, and other health plans, on managing population health, particularly for Medicaid patients. “Their care, up until now, has been often times fragmented and episodic,” he says. “How do we engage them in our practices better? How do we get them before they have to show up in an emergency room and have more advanced illness?”
He says helping patients get care earlier is a better economic model. “Most importantly, it’s a better care model for the patients,” he says.
Lessons from the pandemic
When asked about what he learned in healthcare leadership during the pandemic, Cacchione describes the importance of collaborating on decision making “and how it is best done in a team.”
“We were in uncharted waters,” he says. “We needed everybody’s input. We needed legal’s input, we needed our human resources people, we needed finance to weigh in, we needed our supply chain people, our clinical people, our operating people. Everybody had to come together in a way. And I think it galvanized people. We weren’t fighting another health system. We were fighting the virus.”
Cacchione also says an enduring takeaway is recognizing fatigue in staff.
He cited Ascension’s work to provide workers with counseling, group therapy and meals. The system offered housing assistance during the early stages of the pandemic “when we weren’t sure if they were going to be taking infectious agents back into their home,” he says.
“The staff is so important during these times,” Cacchione says. “Their commitment to delivering care for our patients. We can’t lose them and so we have to do better for them. I think that’s another thing that was evident was how fragile our healthcare personnel can be. They’re humans just like everyone else.”
Cacchione says he’s excited about getting to know the Jefferson system and immersing himself in Philadelphia.
“I am additionally excited about the fact that we have a strong academic program, with great hospitals that are part of that system,” he says. “The two of those things together with an insurance plan, really, I think, allows us a competitive advantage in a lot of ways. I think we can do a lot for the community that way. We can also really elevate Jefferson in terms of its academic prowess as well as its care delivery prowess.”
When asked what he’s most worried about, Cacchione cited his focus on patient care.
“The things that keep me up at night, other than everything, I would say in order of priority is number one, the quality of care that we deliver,” he says. “Are we always delivering our best care to the patients? Do patients come to the Jefferson health system and understand they’re getting the best care available for their condition? And that really is a direct reflection of our physicians, and our other staff, our other professional staff, and are they burned out?
“Quality will be much easier if we have a workforce that is engaged and fresh,” he says. “We’ll have to figure out those things. If we’re successful that way, all the other things will follow, and that includes the finances that challenge every health system today. And Jefferson is no different.”