Ascension CEO Joseph Impicciche will retire at the end of the year and be succeeded by the Catholic health giant’s current president, Eduardo Conrado.
The handoff, announced Tuesday, was described as a “long-planned transition” that comes as Ascension shifts its strategic focus toward more care delivered outside of the hospital.
Impicciche has been with Ascension for more than two decades, joining back in 2004 as senior vice president of legal services and general counsel. He’s been in the top spot since 2019 and is credited with guiding the system through the COVID-19 pandemic, expanding care access and driving public health advocacy.
Impicciche, who has also served on the board of the American Hospital Association and as chairperson of the Catholic Health Association, will “remain actively engaged during the transition to support continuity and momentum.”
“As I conclude this chapter, I am filled with gratitude for the opportunity to walk alongside so many dedicated associates, caregivers and an exceptional leadership team whose partnership, support and friendship have meant more than I can express,” he said in the announcement. “I have every confidence in Eduardo as he carries our Mission forward with purpose, integrity and a clear vision for what compassionate, personalized care can be.”
Conrado, whose appointment is effective Jan. 1, has held the president role since 2023 but joined the 121-hospital system in 2018 to serve in digital, strategy and innovation positions. Prior to that, he’d spent 26 years at Motorola Solutions and served on Ascension’s board for five years.
The CEO-in-waiting has been an active player in Ascension’s $2.6 billion post-COVID financial recovery as well as recent changes to its operating model, employee engagement efforts, hospital portfolio and outpatient-focused investments.
Ascension, which reported $28.6 billion in total operating revenue and a $1.4 billion loss from recurring operations (-4.9% margin) during its 2024 fiscal year (ended June 30, 2024), whittled its hospital portfolio down from 136 hospitals at that fiscal year’s close to 121 hospitals as of March 31. Though it also made some acquisitions during that time, such as the $460 million acquisition of the majority stake of a Texas hospital to bolster its presence there, the system has made a bigger push toward fleshing out its outpatient presence—most notably through last week’s multibillion-dollar deal to acquire AmSurg and its 250 outpatient ambulatory surgery centers.
In an interview with Fierce Healthcare, Conrado said Ascension will maintain that strategy following the handoff.
“We both selected the management team that’s in place right now, so when Joe retires at the end of the year, the management team that’s in place is my management team,” he said. “You’re not going to see a change of direction, but more a deepened commitment on what we’re doing right now and the strategy that we already set.”
Now nine months into its 2025 fiscal year, the system is down $466 million from operations (-2.3% operating margin) but notes that every sequential quarter has brought “significant improvement” from the final quarter of fiscal 2024, when it suffered a debilitating cyberattack. Conrado said the system has largely recovered from that event but is still working to secure some payments in its backlog.
Outside of the strategic shifts, Conrado said he wants the organization to continue targeting patient safety and experience while expanding Ascension's impact in communities through improved access to primary care, medications and other wraparound services.
Read on below for a Q&A with Conrado outlining these efforts and other topics like federal funding advocacy and cybersecurity.
Editor’s note: The below has been edited for length and clarity.
Fierce Healthcare: Could you explain your role in Ascension's recent strategy shift and how that will continue once you take the reins?
Eduardo Conrado: There's three key areas. One of them is to continue to be good at what we do. Three years ago when I was heading strategy and we were coming out of COVID, we looked at the operating model in terms of both the footprint and rigor on driving volume efficiency within the sites of care. We put a special focus on associate engagement and retention. You know, out of COVID, you saw most systems had [low] retention, especially under nursing, right? So we looked at what do we need to do to improve that, and we've been tracking our retention and our engagement over the last five years. Right now, we've got retention at a five-year high, and engagement also improving year over year [during] that same period.
When you look at associate engagement, you also look at patient experience, right? So, two and a half years ago, we hired a senior VP of consumer experience, we started tracking our [Net Promoter Scores] across all the sites of care. We've seen a steady climb over the last two years [as we] take the friction out, and then our clinical teams continue to focus on the quality and safety. So, continue to do what we do: operational rigor, quality, focus on the associate and on the patient.
That's all part of the portfolio in terms of our footprint, but then, second, what do we do in terms of investment on the inorganic side? That's the AmSurg announcement that you saw [and other recent acquisitions]. Then, about a month ago, internally, we announced that we were going to do $2 billion [of] investments on our current sites of care. ... It's the Golden Gate approach, you know? You paint it, and then once you're done, you paint it, and paint it, and paint it. That's what you have to do with your physical plant, right, your hospitals? We're looking at updating the look and feel of some other sites of care, but also we're going to accelerate some medical equipment, refresh it.
...That's going do do a a couple of things. On the clinical side, we're definitely seeing our doctors and our nurses giving us feedback that they like what they're seeing. That should continue to improve engagement, but it should also improve quality care in our patients. As the technology has improved, you should see that in the equipment.
And then the third piece is expanding our impact on communities. So, not only looking at what the portfolio should look like as a preferred set of care for the patients on it, but tying back to our mission, we're especially looking at the Medicaid uninsured segment. That segment has over utilization of emergency rooms for multiple reasons. There's a lot of avoidable ED visits that we could solve through medication adherence and access to medication for chronic conditions. But also, part of it is improving access to community clinics.
So we're looking at [whether] we have any gaps in community clinics that are available in the ministry? Should we partner with the community clinics that are there to be able to navigate patients better, or should we open some clinics ourselves to fill the gap? We've got Dispensary of Hope, which is free [and] a phenomenal nonprofit that sits parallel to us and offers free pharmaceuticals for unemployed people. We want to make sure that we're maximizing access to that vehicle, and then between access to primary care and access to medications and some wraparound services, I think we can improve the health of the communities we're at.
FC: Between policy changes with the new administration, Congress' potential changes to Medicaid and other macro trends like inflation, there's a lot of external headwinds and uncertainties. Will this plan for Ascension address that, or will there be a need for more flexibility?
Conrado: We will be taking two approaches to this. On the policy side, myself, our chief medical officer and our advocacy team were spending a lot of time in Washington just talking about Medicaid itself, right? Around many fronts—provider tax, we don't like some of the recommendations that are in the bill in that area, and work requirements. When you put it all together, you'll be shifting lives from the Medicaid segment into uninsured.
We probably serve over a million people in our communities that are either Medicaid or unisured, about a 70-30 mix. And even on the Medicaid side, we subsidize 38% of the costs with the current payment model. If we're a proxy for all the other nonprofits, decreases in payments from the government side on Medicaid is just going to increase the subsidy that nonprofits are going to do. But on top of that, if you've got a population shifting from Medicaid to uninsured—we cover 88% of their costs.
We'll continue to do that, because we provide access to everybody. ... We definitely agree that we need to minimize waste and any abuse that's out there. But we also think we've got to protect access to the program [for] those populations. So we've been voicing our concerns as Ascension, and then voicing our concerns as Catholic healthcare in the U.S. at the same time.
And there's things we've got to do to prepare for it. That's part of what I was talking about [earlier] in terms of [looking] at the data about those million lives that we serve. Can we actually improve access and medication adherence, and over time keep those populations healthier and lower cost? Long-term, we [and Congress] have got the same objective. It's just how we get there.
FC: About a year ago Ascension was hit by a cyberattack in a very big way. Recent financial statements suggest that the organization is still feeling some of those long-tail effects—could you give an update on where Ascension is in that recovery, and how the system as a whole is now looking at cybersecurity?
Conrado: In general, as an industry, cyber continues to be an area that we've got to watch out for. It was about nine months ago I provided comments in the U.N. Security Council, I represented providers, ... and said 'This is critical infrastructure for any country, so we've got to treat it that way.' So, I think everybody's vigilant in terms of the cybersecurity component of healthcare.
As we brought our hospitals and our sites of care live, a couple of areas I think we learned as an industry is just reconnection time. It's not so much the identification and recovery, but you tend to disconnect everybody from the system and then you've got to get everybody reconnected. After some of the other prior cyber events that happened in the industry, there was a trend to require attestation for reconnection. If you've got 300 connections that you do, you're almost negotiation 300 attestations. That's what takes the longest. So as an industry, an area for us to focus on is, once you solve [the breach] how you reconnect so you can bring the system back up.
And that long tail you refer to—as you can imagine, if you're down for a month, you're going to paper charting for a month, you're not billing for a month. By the time we got done with the large number of hospitals that we have, we probably had a mile-high stack of paper that we had to digitize, you know? And once you digitize it and you put it back on the [electronic] records, then you've got to be able to work with the insurance company to bill. The longest tail is actually getting paid for the work and the service that was provided to the patients during the event. ... Unfortunately, that part is still lingering [for us].
FC: Any other thoughts on the transition?
Conrado: I feel good on where we are. I feel we've got the right strategy—a continuation of our strategy—we've got the right teams in place so there's not a major change, and then our momentum. I feel energized in terms of where we are right now, what we can do, and like I said, it's not going to be a major disruption. That's the beauty of a long-plan transition, right? It should be seamless.