Becker's Hospital Review

13 CEO / STRATEGY 'That approach is no longer good enough': Ascension CEO rethinks care delivery model as uninsured volumes rise By Alan Condon S t. Louis-based Ascension is redesigning its care delivery model as looming Medicaid cuts and the expiration of enhanced ACA premium tax credits are expected to increase the number of uninsured patients, strain emergency departments and intensify financial pressure on hospitals, President and CEO Eduardo Conrado wrote in a Feb. 16 LinkedIn post. Mr. Conrado, who assumed the CEO role in addition to his role as president effective Jan. 1, said healthcare has historically been designed around brick-and-mortar facilities rather than patients' real-world experiences — particularly moments when they are "scared, in pain or unsure where to turn." "For too long, healthcare has been designed around buildings instead of those moments," he wrote. "at approach is no longer good enough. "We spend a lot of time talking about access in strategy discussions. But strategy only matters when it turns into real change for people trying to get care. at change shows up in simple ways. How easy it is to get an appointment. How far someone has to travel. How much medication costs. How clear the next step feels. When those things break down, care is delayed, conditions worsen, and even the best care inside our walls cannot make up for it." Ascension, which serves more than 1 million patients each year who rely on Medicaid or are uninsured, expects that number to grow as federal Medicaid policy shis and ACA subsidies expire. "We will continue to care for everyone who comes through our doors … but honoring [our mission] requires rethinking how care is designed and delivered," he wrote. "What we are changing is not just where care happens, but how people enter the system, how they move through it, and how they stay connected aer a visit." Shiing care beyond hospital walls Mr. Conrado said avoidable emergency department use among Medicaid and uninsured patients oen reflects gaps in access, not patient choice. "When primary care appointments are hard to secure, specialty referrals are delayed, medications are unaffordable or coverage is unstable, the emergency department becomes the default option," he wrote. To address those gaps, Ascension is strengthening partnerships with federally qualified health centers to improve primary care attachment and streamline referrals to specialty services. It is also moving care into community clinics, virtual platforms, home-based settings and ambulatory surgery centers. Ascension is expected to acquire AmSurg — an ASC operator with more than 250 facilities across 34 states — in a deal valued at about $3.9 billion. Amber Sims, Ascension's executive vice president, chief strategy and growth officer, told Becker's the move will be transformational for the health system. "We really tightened our portfolio and recognized that we have to get ahead in the ambulatory business, because that's where care is going," Ms. Sims said during a Nov. 3 panel at Becker's CEO and CFO Roundtable in Chicago. "It's where patients want to receive care, where payers want to seek care, and where providers want to provide care." Ascension is also expanding same-day and next-day primary care access, improving front-door navigation and adding supports such as transportation, extended hours and virtual care options to reduce delays. "When care is closer and easier to reach, people are more likely to get help earlier," Mr. Conrado said. "ey avoid unnecessary trips to the emergency department. And care can be delivered safely at a lower cost." Additionally, the system is investing in medication access infrastructure, including its Dispensary of Hope program and Ascension Rx, to help uninsured patients obtain prescriptions and reduce medication-related emergency visits. e programs are now scaled across all Ascension markets, including home delivery options for patients unable to reach a pharmacy, according to Mr. Conrado. Redefining performance and growth e strategy builds on Ascension's broader operating reset, which has included strategic divestitures, market exits and portfolio consolidation over the past couple of years. e system has reduced its hospital footprint from roughly 140 hospitals three years ago to 90 wholly owned or consolidated hospitals, while maintaining minority interests in 29 additional facilities, according to financial documents published Feb. 13. Mr. Conrado said Ascension is now measuring success "not by the size of our facilities, but by our reach," pointing to reduced avoidable emergency department use, stronger primary care attachment and expanded medication access as early indicators. "If we can show that this approach keeps Medicaid and uninsured patients healthier at a lower cost, it becomes more than an internal strategy. It becomes proof," he wrote. Mr. Conrado said Ascension plans to work with federal and state policymakers, payers and providers to align incentives around earlier intervention, chronic disease management and lower-cost care settings. "Our focus on Medicaid and uninsured patients is not just about serving those with the greatest needs. It is about leading the transformation of healthcare itself," he wrote. "If removing friction improves lives and lowers costs for those facing the greatest barriers, it becomes proof that healthcare can be designed differently and a roadmap to improve care for everyone." n

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