Northwell Health will fend off the inflationary and reimbursement headwinds facing healthcare providers by pairing operational discipline with an “aggressive growth mentality,” John D’Angelo, M.D., told Fierce Healthcare as he steps into a new role as the nonprofit’s CEO.
The physician-executive, who succeeded longtime President and CEO Michael Dowling on Oct. 1, comes into the job amid major changes for Northwell as well as the broader industry.
The organization recently completed the largest merger in its history upon joining with Nuvance Health to form a 28-hospital nonprofit that, for the first time, provides acute hospital care outside of its home state of New York.
“We have 30 to 40 different work groups working with folks from both sides of Nuvance and Northwell, in a really systematic approach to integration of the organization,” he said. “It's not a sprint, it's really more of a marathon. It's a long journey, and we're identifying a lot of opportunity, and there's real excitement on both sides—so that's a critical priority for me right now.”
Meanwhile, a tidal wave of inflationary labor and supply pressures, reimbursement challenges, reductions in government funding, regulatory changes and likely increases in uninsurance has many large nonprofit systems already scrambling to reassess the footprints via head count reductions, service line reviews, outsourcing and other cutbacks on nonessential operations.
Though the organization is still in the black and hasn’t been forced to make significant cuts amid the past few years of curveballs, the new top executive knows that he’ll be spinning plates to maintain Northwell’s financial stature and its work bolstering community health.
“I joke with people saying that’s why they picked an ED doc as the CEO—because I’m really good at navigating many different things simultaneously, and navigating uncertainty,” he said.
D’Angelo is a homegrown leader with a quarter-century tenure under his belt. Initially joining Northwell as an emergency department doctor, he began to pick up a system-level reputation after helping lead a sepsis task force that cut the organization’s sepsis-related mortality in half within three years.
“We won the highest quality award from the Joint Commission, the Eisenberg Award, and got a lot of other accolades, but what I really learned during that time [was] enterprise change management, proper use of data to drive change and those sorts of things,” he recalled.
D’Angelo was then tapped for the first class of Northwell’s Physician Leadership Development Program, which led to a role as the head of emergency medicine across the full system starting in 2012. Alongside running disaster preparedness efforts and leading Northwell’s adoption of new emergency care models, D’Angelo said he used the role to pull together tech experts to pitch and build roughly 100 different technology products optimizing emergency medicine, some of which are still being used at the organization today.
“The culmination of all that work—emergency medicine, technology, disaster preparedness—led me to be the operations chief for our response to the COVID pandemic,” he said. “So I ran all of our operations in coordinating, staffing, supply, testing, operational capacity, surge units.”
For the past few years, D’Angelo has headed Northwell’s Central Market, its largest market with 24,000 employees and six hospitals. His appointment was announced in May, just days after the close of Northwell and Nuvance’s merger.
D’Angelo spoke with Fierce Healthcare about his strategy to navigate healthcare’s macroeconomic challenges including Medicaid cuts, pursuing efficiency through technology without eliminating staff and how Northwell will continue his predecessor’s focus on social and community issues like gun violence.
The below interview has been edited for length and clarity.
Fierce Healthcare: You’re entering the CEO role amid unprecedented inorganic growth for Northwell with the Nuvance merger. Can you give an update on that process and any of your other immediate focus areas?
John D’Angelo, M.D.: There’s a number of things, but one is the transition itself. It’s not just the transition [of a] CEO, there’s a number of senior executives that have been with Michael [Dowling] from the beginning that are on similar timelines. So there’s a number of transitions going on that I have to manage, but also an opportunity there to set my team, set our structure, set our operating model.
That operating model has to evolve, because the second high priority for me is this merger, the Nuvance merger. It’s the largest merger, as you alluded to, in the history of our organization. It expands our geography tremendously and it expands on the hospital side, for the first time, out of state [and] into Connecticut. We’ve had ambulatory practices in [New] Jersey, Connecticut, a little down to Florida, but the hospital side of our portfolio is now in another state.
So that merger is critically important, and I think it’s going to be hugely successful. The cultures of the two organizations are very aligned, which makes it nice, and it’s really since that May 1 signing that we were permitted to , after all the regulatory work that had to occur first, to really roll up our sleeves.
FH: For other forward-looking priorities, could you talk about your perspective of the current economic situation? Northwell isn’t operating at a loss, but there have been a lot of financial statements coming out the past few weeks from other nonprofit systems and it’s a lot of, ‘we have inflationary pressures, we have reimbursement hurdles …'
JD: You’re correct, Northwell is still in the black and has been, and it’s not by accident. It takes a lot of discipline, a lot of expertise. I truly believe we have one of the best CFOs out there, but we are used to navigating the reality of healthcare—which is that reimbursement trends and all the things that feed into them don’t keep up with expense trends.
So the way we’ve been able to maintain our stability is leveraging our size and scale and systemness to continually look for efficiencies, economies of scale. And we’ll continue to do so.
Two, we believe our aggressive growth mentality helps us with that, especially in areas that we know are going to be accretive and support the organization. Some of that is in clinical programs. We have one of the fastest-growing transplant programs in the country, with some of the best outcomes in the country [in] cardiovascular and other kinds of specialties that really help us in our stability.
At the same time, we’ve been very aggressive over a decade or more in really thinking about alternative revenue streams that counter the dynamics of the traditional business of healthcare. So, meaning our Northwell Ventures and Northwell Holdings, where we’re investing in startup companies or spinning things that we do very well out as a for-profit company to … serve other healthcare organizations and providers but also drive revenue back into the organization.
So all those things have helped us, and that’ll be the playbook going forward. Ultimately, we don’t lose sight of first and foremost delivering patient care, and taking care of patients and communities. So despite all of that, we’re very proud that we’ve also been able to continue to do the things that don’t improve the margin. Behavioral health, a lot of stuff we do with communities, and food as health, and substance use disorder—these are all things that are critically important to use and we’ve been able to still do both.
FH: As we’re speaking, there’s a funding face-off happening in Congress and very key to that is healthcare issues, like the summer’s One Big Beautiful Bill Act’s Medicaid eligibility and funding and the Affordable Care Act enhanced premiums that are expiring at the end of the year.
JD: At a higher level, we’re the second-largest provider of Medicaid in [New York]. We’re very much paying attention to the dynamics coming out and the potential impact. We’re already working on strategies, like we do every budget cycle through the year, to mitigate the risk and will continue to do so. It’s the same discipline I talked about earlier, when it gets to specific programs and the size and scale of the program.
FH: And on ACA premiums, or those downstream effects of uninsurance?
JD: Well, what are we concerned about? It’s that more people are going to come off Medicaid, and there’ll be more uncompensated care, more uninsured patients, and they will likely not seek care until they really need it.
Where I’m more worried about is the overall health of the communities and people delaying care when they wind up in our EDs.
We do a fair amount of uncompensated care now; we have, I think, the gold standard as far as how we manage charity care and how we deal with the impact of that. We’re just going to have to continue to navigate and offset [spending] where we can, but we’re not going to stop providing the care. We do a lot in the community today that we’re not reimbursed for, and the intention of that is to keep people healthy. Again, that’s not going to change.
Will we see more uncompensated care? We’re actually seeing the opposite a little bit, currently. We’re seeing less patients that are uninsured or showing up at our EDs, and we think that’s due to hesitance to present for care. So I’m more worried about the longer-term impact on the overall health of the communities, with people delaying care as a result of all that’s happening.
FH: On a similar subject, your predecessor Michael Dowling is very well known within the healthcare industry for being outspoken on social and community issues, such as gun violence, housing insecurity, immigration, racial equity. I don’t think it’s shocking to say some of those focuses are less in vogue at the moment—can you tell me if that sort of work will stay at the forefront for Northwell going forward under your tenure?
JD: Yeah, I think they’re staying at the forefront. It’s what makes Northwell special, and it resonates with our communities, our patients, our team members. We’re fully engaged through community partnerships. We work with faith-based leaders, we’re in the schools, we’re in the colleges where Michael has been very passionate, rightfully so.
We all agree that if we’re truly going to impact overall health, we can’t stay on the sidelines as it relates to a lot of these topics you’re listing that truly impact health. And we never take the position from a political standpoint, we take it from a position of it being our responsibility to drive healthier communities.
Gun violence, as an example, if you look at our messaging it’s very much geared on the impact to communities, to families, to patients as it relates to gun safety and starting those difficult conversations. That is a real important part of Michael’s legacy—and he’s going to continue to be present in that arena—but the organization is not going to shy away from what we feel is our overall societal responsibility to health and wellness.
FH: Back to operations, some of your peers are targeting efficiency through service line reviews, layoffs and reductions in nonclinical roles, outsourcing when it makes sense. Particularly for larger organizations with the capital, that’s also been paired with pushes into new technologies they believe can help with efficiencies and stave off some expense pressure. Is Northwell thinking about these types of strategies?
JD: It’s critical to do so. How we optimize our resources doesn’t necessarily correlate directly with people [losing] their jobs. That’s one of the advantages of being in a continual growth kind of mode like we’ve been for so long. We’re still bringing in new employees, we’re still hiring for programs that we’re starting up or successful in growing.
That doesn’t mean we’re not always looking at everything, and sometimes we do shut down business units or turn the dial down on how much we need, whether it’s shrinking or stopping doing something. But that’s part of our everyday operations, which is why we don’t need to do any sort of mass layoffs. Typically, when you have 100,000 employees there’s always attrition, and with growth there’s always new needs. We’ve been very good at avoiding mass layoffs because we shift people and we create opportunities for people, [saying] ‘Here are all the opportunities we can move you into.’ We spend a lot of time doing that, it’s a year-round process. We still hire every single week for the programmatic and growth needs and to backfill attrition, so we’ve been fortunate in that regard.
To get to technology, I think it’s going to help us amplify the capabilities of the workforce. I think there’s going to be a clear shortage in a lot of different critical workforce needs [where] we can leverage technology to not shrink the workforce, but continue to grow their capacity to do more and more. So, we may be hiring less and less long term because our workforce can achieve more. I think that’s ultimately the goal.
FH: Anything else?
JD: We talked a lot about business, but the real essence or soul of this organization is the commitment to purpose. It’s what’s kept me here for 25 years, and a lot of my team members. So despite all the things we have to be very sophisticated with in order to be healthy as an organization, we are here for the patients that we serve and the communities that we serve for generations to come. We’re fully committed to be on the tip of the spear and driving to a future that actually serves everybody.