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Michael J. Dowling
Editor’s note: Michael Dowling, president and CEO of Northwell Health, was the keynote speaker at the Westchester County Association’s Sept. 20 “Toasting to a Healthy Westchester” dinner. The following is adapted from those remarks.
Too often, those of us in health care get so caught up in our day-to-day business challenges that we forget to put some of our greatest accomplishments in context.
Sure, there are opportunities for improvement, and we must find solutions to the biggest issues facing our industry and society in general, such as closing disparities in care, doing our part to curb gun violence and utilizing technology to expand access to care. All of this must happen to secure healthier, safer lives for future generations.
But all of us in health care should also reflect on our industry’s extraordinary accomplishments, because they’ve been truly life-altering for so many people. There are few professions where you can make a direct impact to make life better for somebody else. The science that too many people mistakenly mistrust has led to more cures for more illnesses, more-effective vaccines and longer life spans, despite recent declines caused by the Covid-19 and opioid epidemics.
We shouldn’t lose sight of those accomplishments. Today, we can replace a heart, lung, kidney and liver. We can actually do multiple organ replacements at once. This was unheard of 20 years ago. We created an effective vaccine months after a pandemic killed millions globally. A half-century ago, it took decades to develop a vaccine that eradicated polio.
More people live longer, and in most cases, healthier. More of our patients have learned the importance of healthy habits — for example, the smoking rate in the United States is at a historic low. In the 1940s, about half of adults in the nation said they smoked cigarettes. Today that’s at around 11%. Health care education works, and health care systems play a major role in raising awareness and promoting wellness.
But health care education, like health care itself, faces major obstacles, as well as major opportunities.
As the largest healthcare provider in New York with one of the nation’s most diverse patient populations, Northwell Health knows from experience that people of color and those living in low-income communities need more help than ever.
This became more evident after the pandemic reached our shores and impacted communities of color at an alarming rate, shining a light on the wide inequities in care that have existed in the United States for generations.
It’s a crisis that elected officials, community activists and health care executives are aggressively trying to eliminate, because too many Americans live in a health care desert due to their zip code or the size of their bank account. At Northwell, we’ve made inroads by connecting with houses of worship, community centers and schools in these communities. This is a good first step.
However, as New York State’s second-largest provider of care to Medicaid recipients, we see the built-in financial gaps caused by low reimbursement rates. Medicaid only covers about 60% of hospitals’ total costs in treating Medicaid recipients – Medicare covers about 85% of those expenses. To partially offset those losses, commercial insurers pay higher reimbursement rates to healthcare providers, but that doesn’t help financially distressed hospitals, where about 90% of their patients are covered by Medicaid and Medicare. Regardless of how well public hospitals and those serving low-income communities are managed, they lose tens of millions of dollars annually (if not more) caring for their patients.
This is the hard reality of health care finance — and these inequities can only be solved if elected officials do the right thing.
This fundamental imbalance perpetuates health care deserts and leads to greater health disparities. Last year, we worked closely with Gov. Hochul to increase Medicare payments for the first time in about a decade, but that happened while labor costs rose nearly 7%, further accelerating payment imbalance and the two-tier system of financing that supports our nation’s health care providers. This is a great challenge for government at the federal and state level, but it’s one they must fix.
The responsibility for correcting these inequities rests with everybody, including business leaders and, yes, those of us in health care.
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We are investing millions of dollars to better use technology to improve efficiency and narrow the equity gap. Artificial intelligence is here, and it’s a key piece of the puzzle. AI enables us to use data science to diagnose and treat patients earlier and develop solutions that are more effective and less costly.
One clinical condition that underscores the disparities affecting people of color is pre-eclampsia, a pregnancy complication characterized by high blood pressure that threatens both mother and fetus. Pre-eclampsia affects Black women at three times the rate of whites. Our clinicians and data science teams are examining hundreds of past cases to better forecast expectant mothers who could benefit from additional specialized care and early intervention in the future. Notably, we are investigating how socioeconomic factors impact the care of Black women during this critical juncture of their lives.
AI can also help identify patients who have conditions that are undertreated or undiagnosed. By combining health screening and assessment with predictive models for conditions like obesity, hypertension and diabetes, AI can forecast which patients are likely to develop health problems in future years and whether they could benefit from immediate intervention now.
But we can’t forget the human element either because AI is only as smart as the people who feed it. We also can’t expect machines to solve our problems — in fact, it would be dangerous to do so.
Human compassion remains a key piece to health care, and it’s why we should be proud of where we’ve come from and where we are headed.
Michael J. Dowling is the president and CEO of Northwell Health, New York’s largest heath system.
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