Northwell CEO reflects on his first year on the job

It’s been almost a year since emergency department physician John D’Angelo took the reins as CEO of Northwell Health, the largest healthcare system in New York state.

D’Angelo took over from Michael Dowling, who served as Northwell’s first president and CEO for 23 years and helped to build Northwell into a healthcare giant with a $22.6 billion operating budget. After a recent merger with Connecticut-based Nuvance Healthcare, Northwell now operates 28 hospitals and employs 104,000 people.

In a recent interview with Healthcare Brew, D’Angelo—who has been at Northwell for more than 25 years and most recently served as EVP, market president, and chief of integrated operations—said he had three main priorities in his first year.

The first was to assemble a new C-suite, as a number of senior executives also retired around the same time as Dowling. Second was to navigate the Nuvance merger, the largest in the health system’s history. And third was to convert all of Northwell to Epic’s electronic health record.

D’Angelo also spoke with us about the hard parts of becoming CEO and how Northwell is navigating both federal policy changes and the current economic environment.

This interview has been edited for length and clarity.

What have been some challenges you’ve faced in your first year?

Like everyone else in healthcare, it’s a very challenging economic environment. We run a health system with a 1% operating margin, and we’re fortunate, in that it’s a positive operating margin, unlike half of New York state’s hospitals. But it’s still razor thin and, like everyone…our expenses continue to outpace the revenue trends. Since 2023, it’s been much more pronounced, that gap between the growth of your expenses and the rate of your revenue growth from the services you provide.

What’s your strategy been in navigating this economic environment?

It’s not something that’ll get fixed overnight with a single regulatory fix.

We need to address the chronic disease burden—80% of that is really driven by people’s choices in life, not necessarily what happens when they’re a patient in a bed. How do we use our influence on the economic engine of healthcare, and be more intentional about supporting things that are going to drive better health?

I’ve been networking with some of the CEOs of the direct-to-consumer wellness space. I think about the peripherals that people wear. I think there’s an intersection in the future of traditional healthcare and those in the wellness arena. The consumers are much more savvy now, and they’re wearing devices that give them continuous data about their health.

I think if we can bend the curve on chronic disease long term, it will drive better health and will lower the cost of care because less people will need hospital beds.

Health systems are starting to deal with a rise in uninsured patients due to changes in the ACA marketplace and Medicaid. Is that something you’re seeing the effects of yet?

It’s early. We’re anticipating a pretty significant impact financially from the folks that fall out of coverage from the new regulations. I’m concerned more about overall health. These are the types of challenges that especially the nonprofit providers of care are constantly battling, these challenges with reimbursement. But in the bigger picture, I worry about the people that have no coverage that wind up in a more expensive venue like an emergency department. That doesn’t drive down overall cost of care.

On top of that, I worry about people avoiding care. I talked about that chronic disease burden—people not seeking care means that they’re going to delay things that ultimately wind up being more costly down the road. I think we haven’t seen the full impact of that yet, but that’s my concern as we go through some of this shift.

Is there anything Northwell can do strategically to mitigate that or be prepared for it?

We need to take a proactive approach. We’ve been partnering with a lot of community, faith-based organizations, and federally qualified healthcare organizations. We’ve been partnering with both the city and the state on how to build infrastructure internally inside the healthcare system, but also working with those entities around helping people not fall off if they meet the [Medicaid] criteria and the work or volunteer criteria. We feel a strong sense of responsibility to help people navigate the administrative component of this so people don’t fall off that shouldn’t…It’s not something we can just throw our hands up and act like we’re the victims. It is what it is.

On the other side, we’re constantly working with our politicians and our regulatory colleagues, trying to influence not only current but future regulations and how things get deployed or implemented.