John Mordach is eight months into his role as CFO of Philadelphia-based Jefferson Health, an 18-hospital system that includes Thomas Jefferson University and Health Partners Plans.
He arrived at Jefferson in March after serving as CFO of Durham, N.C.-based Duke University Health System from 2020. Before that, he spent almost a decade at Rush University System for Health in Chicago, where, as CFO, he helped the system achieve six ratings upgrades and six positive outlook upgrades, among many other achievements.
Becker's caught up with Mr. Mordach to discuss Jefferson's top strategic priorities in 2024, the biggest challenges on its horizon and how the system aims to ensure long-term sustainability while tackling various financial headwinds.
Question: What are the top three strategic priorities for Jefferson in the next fiscal year? How do these align with the health system's overall mission and goals?
John Mordach: Financial strength is critical to Jefferson's ability to fulfill its mission of improving lives through healthcare, higher education and discovery. Our top three strategic priorities this fiscal year are:
1. Financial stewardship: To continue on our path to pandemic recovery by restoring our institution's financial health. One step toward that is the achievement of the FY2024 operating budget. Another step is to drive revenue growth which comes down to expanding our services to attracting new patients into our system, as well as improving payer relations and exploring additional revenue streams.
2. Operational rigor and growth: Next is to execute on numerous operational initiatives underway designed to drive efficiency and cost control, such as reducing length of stay, improving supply chain efforts, implementing revenue cycle enhancements, and more. Streamlining processes is a part of cost control and becoming a nimble, efficient system.
3. Community impact: Jefferson is committed to providing the right level of care at the right time and in the right place so improving population health is a key enterprise priority. We’ll achieve this by creating greater access to healthcare, lowering costs for patients, and ultimately improving patient outcomes.
Q: What are the biggest financial challenges facing Jefferson today? On the other hand, what are the most promising financial opportunities?
JM: Health systems across the country are facing the same challenge when it comes to inflationary pressures impacting the bottom line. Everything from labor costs, supplies and pharmaceuticals have increased in recent years at a pace that exceeds revenue growth.
There are also reimbursement challenges impacting healthcare systems throughout the country. Private payers are looking to pull back on reimbursements while healthcare costs are actually increasing. Finally, a growing population of uninsured and underinsured patients puts pressure on our system because we serve all patients, regardless of their ability to pay.
Fortunately, we have a strong leadership team and 42,000 employees committed to converting these challenges into opportunities. Jefferson Health is part of a unique enterprise that also includes Thomas Jefferson University and Jefferson Health Plans. Thomas Jefferson University is celebrating its bicentennial, having been founded in 1824 as the Jefferson Medical College, one of the nation's first medical schools and the first medical school to open a teaching clinic for the poor so students could care for patients as they earned their degrees. This model has become the bedrock for medical education today.
Today, Thomas Jefferson University is a national doctoral research university with a growing global footprint, and a pioneer in transdisciplinary, professional education. Home of the Sidney Kimmel Medical College and the Kanbar College of Design, Engineering and Commerce, Jefferson is a preeminent academic institution delivering high-impact education in over 200 undergraduate and graduate programs to 8,400 students across 10 colleges.
Jefferson Health leverages this unique relationship in several key ways, including:
Talent pipeline: The university serves as a key talent pipeline for medical, nursing and allied health professionals for the health system. In 2022 alone, more than 60 percent of the graduating class of Thomas Jefferson University's Jefferson College of Nursing chose to start their careers with Jefferson Health. Thomas Jefferson University's new bachelor in respiratory therapy program will graduate its first cohort of students in spring 2025 and we anticipate hiring these students upon graduation. Jefferson Health also has a surgical tech training program with dozens of students in the six-month program, and all graduates are expected to transition to Jefferson Health upon completion.
Growth and optimization: In terms of Jefferson Health Plans, we're the only health system in Greater Philadelphia that also has an insurance company, which allows us to diversify revenue as we continue to grow the health plans. We're also looking for ways to be interactive and creative in terms of improving care delivery for both our providers and Jefferson Health Plans' members.
Q: How is Jefferson leveraging technology and digital health platforms to enhance patient care, improve operational efficiency and generate revenue?
JM: First and foremost, we've made a major investment into integrating a single EHR at most of our facilities. This integration supports better coordination of care, cost control, data utilization and standardization which ultimately improves clinical care delivery and making informed financial decisions.
Next, Jefferson grew in scale from three hospitals to 17 over a relatively short period of time. As we integrated we saw that scale is an opportunity to harness. We're a market leader so when it comes to recruiting and deploying talent and finding ways to leverage the cost of care, our size as a system is an opportunity. We're also investing in new management technology to help manage people, budgeting, business planning and other corporate functions.
Jefferson integrates proven external technologies to amplify our dedication to quality and safety. Some examples:
Patient wellness nudges: Jefferson Health's clinical operations partnered with the information systems and technology department to improve patient well-being by making it easier for patients to adhere to their wellness plans with the implementation of automated "nudges." These messages are delivered to patients according to their communication preferences via SMS text or telephone calls.
Jefferson sends SMS reminders to patients overdue for their annual routine mammography screenings based on clinical and scheduling data in the EHR, prompting patients to self-schedule screenings. The text has a secure link into the EHR that allows the patient to self-schedule their screening, ask Jefferson to remind them later or let Jefferson know that they received their screening elsewhere.
The text nudge resulted in 48.3 percent of the recipients scheduling and attending their mammography screening. Jefferson uses the same automated text and voice technology to remind patients of scheduled Radiology procedures, which resulted in a 30 percent reduction in no-shows across the system.
We expanded the use of automated text and voice technology to remind patients of scheduled appointments with the opportunity to confirm or cancel on the same day. Data collected from patient responses is uploaded upon receipt into the EHR which drives downstream workflow.
Canceled appointments trigger automated "fast pass"’ messages to patients with appointments scheduled for a later date giving them the opportunity to be seen sooner. All of this results in more patients being seen, better utilization of open appointment slots, fewer missed appointments and a rise in patient satisfaction. Since enhanced appointment reminders were implemented last month, no show rates have declined 5 to 18 percent across the system.
Jefferson also uses automated text/voice reminders for scheduled colonoscopy procedures. Common reasons for scheduled colonoscopies to be missed or canceled are because patients did not follow prep instructions, arrive without a ride home or miss their scheduled procedure time. To mitigate these errors and ensure our patients can successfully complete their procedures, we automated the reminder process. Each patient can receive up to six messages reminding them of their appointment and how they can prepare for a successful colonoscopy.
Alexa from AIVA – aiding in rehabilitation: Jefferson Moss-Magee Rehabilitation specializes in the treatment of people recovering from brain and spinal cord injuries, stroke, amputation and other life-changing injuries or illnesses. Its goal is to help people recover and return to their best possible way of life. Jefferson partnered with AIVA to enrich the patient's quality of life and provide them with greater independence while at Moss-Magee with a tool that can be implemented at home.
We sought to do this with the use of a HIPAA compliant hands-free voice assistant, Alexa, to enable greater independence, protect patient confidentiality and automate workflows. Voice-activated data is ephemeral and not stored.
Alexa activated eight room commands enabling a patient to control the lights, blinds, music and obtain general information. The use of Alexa enables greater patient independence, frees-up nurses to focus on higher-value patient care, all translating into quality and safety improvements including reduced falls risks. An unexpected benefit was a sizable soft ROI, with over 5,000 nursing hours saved per year on room controls alone.
ADA symptom checker – improving diagnosis: With Ada Health we've incorporated a symptom checker into our website to bolster care navigation. Ada's tool has improved our patient intake process by ensuring efficient preliminary assessments and directing patients to suitable care pathways.
Ada Health's evidence-backed algorithm aids in swiftly identifying urgent symptoms, ensuring that critical conditions receive timely intervention. Since its introduction in June 2023, the tool has seen over 280 assessments with a 68 percent completion rate. Remarkably, 52 percent of those completing assessments acted on the recommended care options, with 49 percent guided to telehealth and 25 percent to urgent care centers.
Moving forward, we're refining the user experience with Ada and integrating it in the EHR. This will give providers a view of a patient's self-reported symptoms and Ada's recommendations, fostering richer provider-patient interactions.
Q: What partnerships, joint ventures, mergers or acquisitions is Jefferson exploring to strengthen its financial position or expand service offerings?
JM: Our scale in the marketplace has allowed us to attract major partners interested in doing business with us, which has been great. This year alone we forged partnerships or joint ventures with LabCorp, Solis Mammography and Jefferson Health at Home by Bayada to name a few. These efforts are not simply about cost savings, though. It’s about looking at the best way to deliver services to meet the evolving needs of our communities. Sometimes that's in-house and sometimes it's through a partner that has expertise in a certain area. We continue to examine all opportunities on a case-by-case basis to do what's best for Jefferson and the communities we serve.
Q: Given the unpredictability of events like global pandemics, what are you doing to ensure financial resilience and sustainability in the face of unforeseen challenges?
JM: Jefferson's financial philosophy is to never make short-term decisions that jeopardize the long-term sustainability of the enterprise. We are focused on creating a long term financial plan, including multi-year capital planning and quarterly forecasting, so we can create long-term sustainability and ultimately invest in what matters most — our people, our facilities, in technology and our priorities. We're focused on increasing philanthropy and other sources of funding. While this will not inoculate us from future challenges altogether, it will put us in a stronger financial position to weather whatever headwinds we face.