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Preston Duren is vice president of threat services at Fortified Health Security.

As attacks grow in frequency and sophistication, the ability to respond quickly is critical. 

Minutes matter: Why health care must move faster against cyber threats | Viewpoint

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

Some of Northwell Health’s employees weren’t born when 

 became president and CEO of the New York health system.

After leading Northwell for more than 23 years, Dowling is stepping down. Starting Oct. 1, he will transition to the role of CEO emeritus and will continue to advise the organization. He also plans to do some writing and teaching.

When asked about having a few employees who may have been born after he became CEO, Dowling laughs that there are “a lot of them.” He continues to meet all of Northwell’s employees when they are hired, and met more than 190 on a recent weekday earlier this month.

“Everybody knows who I am, but a lot of them are younger,” he tells Chief Healthcare Executive.

Dowling has been working to ease the transition to 

Northwell’s new CEO, Dr. John D’Angelo

, an executive vice president who has served with the system for 25 years.

Northwell Health's new CEO outlines top priorities

Based in Long Island, Northwell has seen remarkable growth under Dowling’s leadership. Earlier this year, 

Northwell completed the acquisition of Nuvance Health

, a system with seven hospitals in New York and Connecticut, expanding Northwell’s footprint beyond New York state for the first time. Northwell now operates 28 hospitals and boasts more than $22 billion in revenue.

Dowling, who will be 76 in November, says he’s comfortable in his decision to step down as CEO. He says he essentially came to the decision two years ago, when he told Northwell’s board at the time that he would serve two more years. He joined the system three decades ago, serving as chief operating officer before becoming president and CEO in 2002. He says the system is in good hands.

Still, Dowling says, “It's not an easy decision. This has been my life.”

(See part of our conversation in this interview. The story continue below.)

Michael Dowling, Northwell Health's CEO, talks about leading the system for 23 years

Northwell Health CEO reflects on career as he nears retirement

With 23 years as CEO, Dowling’s tenure is far longer than the typical chief executive in the healthcare industry. The average healthcare CEO serves for 7.6 years, according to a 2024 

 by Crist Kolder Associates, an executive search firm.

Part of Dowling’s decision-making process in his retirement plan was to ensure Northwell was well positioned for future success.

“I have been around long enough to see CEOs that just stay too long, and they don't realize that they may not be completely on the ball, and they haven't made plans for succession,” Dowling says. “And then the organization, when there is no plan of succession, the organization gets very, very concerned about it.”

D’Angelo was selected by the board who interviewed candidates from outside the organization, as well as a few internal candidates. They’ve had plenty of discussions, and Dowling says he’s available to be a sounding board.

But Northwell is having an orderly transition to its new leader, Dowling says.

“This one is unbelievably smooth, no dissension, no disruption, and no second guessing,” he says. “The organization keeps moving forward, and that's the goal. It's all about the health of the organization. It's not about ‘he,’ and it's not about me. It's about the organization.”

Why Northwell Health, Cold Spring Harbor Laboratory expanded their partnership

Even as Northwell has grown substantially over the course of Dowling’s career, he says he has wanted to maintain the feeling of being small and preserving the system’s unique character.

He says the key to doing that is “emphasizing relationships, being seen in person, walking the floors, meeting with employees, having demos, having breakfast, having lunches.”

“There is a big tendency these days to focus on the hard issues, the budgets, the infrastructure, the technology, the AI,” he says. “All of that is important. But what's more important is the building of relationships, building trust, getting people to know one another, sharing information, being transparent, shortening the distance between the CEO suite and the front line.”

As Northwell has grown, Dowling says he has worked to avoid a widening chasm between top leadership and the workforce.

“We have done everything possible over the years to make the gaps smaller. So I walk the floors all the time, and I take employees out to dinner every month. I meet employees for breakfast in the mornings,” he says.

As Northwell has worked to bring Nuvance into the organization, Dowling has taken that same personal approach.“I can walk into a Nuvance hospital now, even though they're not fully integrated with us yet. And I guarantee you, everybody will know who I am. And the same with our senior leadership. It’s not just me, by the way, it's our senior leadership, and they know who we are,” he says.

Dowling says that he is “big into relationships and the soft issues.”

“Texting doesn't do it. Emails don't do it. AI won't do it. They all have their benefits, but the power of relationships is what makes it work,” Dowling says.

And that’s why Dowling says he doesn’t text or email, as he favors face-to-face conversations.

“Most of what I do, if it's anything serious at all, is in person,” he says. “It requires you work longer hours. It means you're out at night. It means you have early morning meetings. But if you want to do it right, in my view, this is what you have to do. And if you have a job like this, you have an obligation to put into the time to do it right. Otherwise, don't do it at all.”

Over the course of his career, Dowling has seen significant changes in the delivery of care, including more services on an outpatient basis and the expansion of care at home.

He also says the education of medical schools has evolved, and he touts the work of the Zucker School of Medicine, a partnership of Northwell and Hofstra University.

But he points to Northwell’s work during the COVID-19 pandemic, when New York served as ground zero for the virus in 2020. Northwell treated more than 300,000 Covid patients.

Dowling marvels at the “passion” of Northwell’s staff.

“I saw what employees did,” Dowling says. “I saw the danger they put their own lives in, the danger they put their families in as they did everything possible to protect others from a terrible virus. Those things give you hope and confidence. There's a lot of criticism today by people about Covid, but most of those people that criticize you today were never in the arena.”

Even in the harrowing early days of the pandemic, Dowling maintained confidence that Northwell’s staff would endure, and that the nation would overcome an unprecedented threat. He told 60 Minutes in the spring of 2020 that “the virus is not going to win.”

“There's going to be no retreat, and there's going to be no putting up the white flag,” Dowling recalls of that time. “We win and we move forward despite how difficult it was.”

In a crisis, Dowling says it’s important to prevent a negative attitude from making matters worse.

“It's your attitude towards problems that sometimes is the biggest problem,” he says. “Now the problem is not the problem, it's people's attitude to the problem that becomes the problem. They look at a challenge rather than looking at opportunity. They look at what can go wrong rather rather than what can go right.”

Dowling has been a passionate advocate on addressing gun violence. Northwell hosts 

 to confront it as a public health problem.

the leading cause of death among children

, Dowling says healthcare leaders can’t afford to stay silent on the issue.

“Every healthcare organization across the United States is building up cancer treatment services for kids, but cancer is the third leading cause of death for kids,” Dowling says. “If you're interested in kids' health, then focus also on the leading cause of death for kids.”

The Trump administration has been staunch opponents of efforts to tighten regulations of gun ownership, and Dowling concedes there are some new headwinds to tackling gun violence. But he points to the growth of the National Health Care CEO Council on Gun Violence Prevention and Safety, which he helped establish.

“There's all of the tailwinds of people's compassion and dedication and resilience and willingness to speak up,” Dowling says, adding, “We need more people to be part of the tailwind movement.”

He also says he’s concerned about the federal government creating 

, which he fears will lead to more illnesses.

“That worries me when you undermine the infrastructure on public health. That worries me when you create distrust of vaccines,” he says.

Even as he moves into a different role, Dowling says he plans to continue to speak his mind about gun violence and the need for federal health policies based on science.

“I hope to be involved in some of these issues going forward,” Dowling says. “Silence is the worst possible thing now, and it's not about politics. It's about health, because health is affected by everything.”

After leading the New York health system for more than two decades, Dowling is moving to an advisory role. He reflects on his remarkable tenure.

Topic

Northwell Health CEO Michael Dowling prepares to step down: ‘This has been my life’

Congress is moving closer to a partial government shutdown, as lawmakers remain at odds on a deal for a short-term spending plan.

Healthcare advocates are pressing Congress on some key priorities, including telehealth programs, because waivers authorizing those programs are poised to expire at the end of the month.

And it’s a situation that’s been all too familiar for hospitals and providers utilizing telehealth programs.

Here’s a rundown of what’s happening.

last approved a short-term spending bill in March

, the legislation only funded government programs through the end of September. And the clock is ticking.

As part of that legislation, Congress also approved the extension of telehealth programs, which were poised to expire. But the extensions only run through the end of September.

Former President Biden and Congress brokered a two-year extension

 of telehealth waivers in 2022, but it expired at the end of 2024. And since then, lawmakers have granted only short-term extensions, 

Q: Are telehealth programs truly at risk?

A: While healthcare groups have expected that telehealth waivers will ultimately be granted, advocates are getting nervous, because there’s only a week left before the government runs out of money. Congress is out of session this week and isn’t set to return until Sept. 29.

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, says the situation is causing anxiety.

“We are asking – urging – Congress to not leave millions of patients and beleaguered healthcare providers dangling on the telehealth cliff while they deliberate over dynamics around a government shutdown,” Zebley said in a statement.

A: The waivers cover all telehealth programs, including 

programs providing acute care at home via telehealth

. While the government requires hospital-at-home programs to provide some in-person visits from nurses, these programs also involve virtual care.

If there’s not a resolution and waivers aren’t extended, Zebley said, health systems offering hospital-at-home programs could see “major disruption.”

“Hospitals and clinicians will struggle to sustain telehealth-based care if reimbursement disappears. It’s untenable,” Zebley said.

As of Sept. 22, there are 419 hospital-at-home programs operating in 39 states, according to 

 from the Centers for Medicare & Medicaid Services. There are 147 health systems operating those programs.

A: Republicans and Democrats in Congress have shown strong support for telehealth in the past.

Zebley told Chief Healthcare Executive® in July

, “There’s essentially universal support on Capitol Hill,” Zebley says.”

As part of the sweeping tax package approved in July 

that is expected to leave millions without Medicaid coverage

, telehealth scored a win. Lawmakers inserted a provision that reinstates first-dollar coverage for telehealth for Americans using High-Deductible Health Plan-Health Savings Accounts.

Telehealth isn’t preventing lawmakers from reaching a spending deal. The issue of 

extending Affordable Care Act tax credits

, however, is very much a key part of the Clash in Congress.

President Trump has been a supporter of telehealth, Zebley has said.

A: Hospitals are pressing Congress to extend waivers for telehealth programs.

The American Hospital Association placed telehealth programs high atop their priorities in Washington in 

 sent to congressional leaders in both parties.

“Telehealth provides a tremendous ability to leverage geographically dispersed provider capacity to support patient demand,” the association said.

Q: Is there any chance of a long-term extension for telehealth programs?

A: In all likelihood, Congress will probably sign off on another short-term extension, tied to a temporary spending bill, advocates have said.

Healthcare groups have been pushing for lawmakers to approve permanent waivers, or, at minimum, a multi-year extension of those programs.

“Congress should permanently adopt telehealth waivers and expand the telehealth workforce,” the hospital association said in its letter to Congress.

The American Hospital Association has said the inability of Congress to approve permanent or even long-term waiver have deterred some health systems from launching hospital-at-home programs.

A: The American Telemedicine Association is hoping a deal will be reached that includes extending telehealth programs. But the group is also hoping that providers and patients won’t pay the price if there is a shutdown.

“We should at least give providers some reassurance that they will receive back payment for essential healthcare services delivered during this shutdown,” Zebley said.

Congress has yet to agree on a spending plan, and one of the big healthcare priorities centers on telehealth, including hospital-at-home programs.

Telehealth waivers are poised to expire: Questions and answers

A little over a year ago, Michael Charlton, president and CEO of AtlantiCare, outlined an ambitious vision to transform the health system in Atlantic City, N.J.

 of improving the life span of residents in the region, many of whom have low incomes. 

 with Oracle to revamp the system’s technology and Cleveland Clinic to expand cancer care. AtlantiCare is partnering with the Drexel University College of Medicine to build a new medical school in Atlantic City.

In an interview with Chief Healthcare Executive®, Charlton says he’s pleased with the system’s progress in its Vision 2030 plans.

“We are right on track,” Charlton says. “And you know, the momentum is building every day.”

“There's so many initiatives out there that are really fundamental that we put in place last year, that we're really starting to get and see the benefits of now. So that's been incredibly impactful, not just for the health system but the community,” he says.

(See part of our conversation in this video. The story continues below.)

Michael Charlton, AtlantiCare's CEO, talks about working with Oracle and the Vision 2030 plan

AtlantiCare CEO talks about teaming with Oracle 

Charlton launched the Vision 2030 initiative not long after becoming CEO of AtlantiCare, a system which operates two hospitals with a total of about 600 beds, along with more than 100 healthcare locations across southern New Jersey. 

, after serving in an interim capacity for a few months.

The health system has been trying to tackle some of the stubborn problems affecting the region, including food insecurity and boosting the low health rankings in Atlantic County. 

The health system’s partnership with Oracle is “probably the biggest initiative that AtlantiCare has ever had,” Charlton says.

Investing almost $100 million, Oracle has completely overhauled the health system’s information technology systems.

“Oracle has just been an incredible partner for us,” Charlton says. “This is transformational.”

AtlantiCare has started deploying AI-powered clinical documentation for primary care physicians, becoming one of the first to use Oracle’s new solution. The technology records the conversation between doctors and patients and provides a summary of the visit in the electronic health record, saving a lot of time for the physicians.

In early testing, the technology is cutting clinical documentation time for those physicians by more than 40%, which is saving them 90 minutes to two hours per day.

“That is time charting at the end of the day that they no longer have to do,” Charlton says. “We have literally seen physicians ecstatic, because they get to go home on time. They get to see their kids’ games and plays and sports. They have family time, downtime. They're not home doing typically what we're calling the pajama time documenting. So that's been incredible.”

As the new documentation tools are implemented in the hospital, Charlton says AtlantiCare is expecting documentation time to be reduced by 40% to 50% in the nursing units, “which is going to solve many problems.”

“From a patient perspective, it puts a nurse back to the bedside doing what nurses are engaged to do, take care of patients. That's what's in their heart. That's the heart of the organization,” he says.

Providers aren’t the only ones who have enjoyed the new documentation system. Patients are giving it high marks, Charlton says.

“We've had comments like, you know, ‘Love my doctor, but it's the first time here she has looked at me in three years that she hasn't been typing, or he hasn’t been typing.’ So, on both sides of the equation, we see the positive benefit of what's coming, and that's only going to get better,” Charlton says.

AtlantiCare is also phasing in Oracle tools that can query the electronic health records and provide an executive summary of patients coming in for outpatient appointments. Eventually, the tools will be incorporated for inpatient stays, as well.

A year into the partnership with the Cleveland Clinic, Charlton says, “It’s been phenomenal.”

“Both organizations communicate on a daily basis at the deepest levels, on behalf of our patients,” Charlton says.

Cleveland Clinic brings a global perspective in the latest in cancer research and treatment, he says. And he says the organization has delivered on its pledge to bring top-notch cancer care to southern New Jersey.

Plus, this helps the system provide better services to patients closer to home, and helps AtlantiCare keep patients who may be looking for cancer care at hospitals in Philadelphia, about 60 miles away.

“We take care of a large portion of southern New Jersey, and this gives us the ability to really take our game to a higher level without transitioning out of the community,” he says. “So it's been a phenomenal relationship so far.”

AtlantiCare is also getting another boost with the affiliation with the Cleveland Clinic. The health system is attracting more top talent, including the recruiting of two top surgical oncologists recently.

“The ability to build out key programs with world-class physicians and teams because of this affiliation has been impactful,” he says.

More broadly, AtlantiCare has also seen more success in finding and keeping talent because of the Vision 2030 initiatives, which includes the plans for a new medical school in partnership with Drexel and Stockton University. AtlantiCare is also expanding its main campus with a new cardiac tower, emergency department, and post-acute rehabilitation center.

Newly recruited staff are excited about the Vision 2030 plans, and the goals are resonating with employees who have been with the system.

“I think Vision 2030 has really redefined the purpose of this organization, and we've seen a significant decline in people that are leaving the organization,” Charlton says.

, MD, the administrator of the Centers for Medicare & Medicaid Services, 

 and spent several hours in the region. Oz met with staff across the system, and he also visited a Federally Qualified Health Center, where Oz questioned and listened to a host of staff members.

Charlton says they spoke about the need for better funding, and 

he voiced his concerns about looming reductions in Medicaid

. About 40% of AtlantiCare’s patients rely on Medicaid, Charlton says. Oz has said the goal is to reform Medicaid, and that he aims to protect the program for those in need.

Still, Charlton says he’s concerned about the impact of reduced funding from Medicaid. But he also says there needs to be wider changes in federal support for health care.

“What I will say, and I will yell it from the top of the mountain, the funding mechanism for all of health care is broken,” he says.

Charlton says he was impressed with the probing questions that Oz asked doctors and staff at AtlantiCare. While he says there were some points of disagreement, Charlton says he has met other CMS administrators, and Oz impressed him as someone who is “looking to move the needle."

“Dr. Oz did not come off as somebody who's looking just to solve the problem where the symptom is,” Charlton says. “He's looking to get to the root cause. So right now, I am highly optimistic that we'll have our opportunity to reshape the future.”

Charlton is also optimistic about AtlantiCare’s prospects of meeting its goals in the Vision 2030 initiative.

Michael Charlton, head of the New Jersey system, discusses work to improve the region’s health, partnerships with Oracle and the Cleveland Clinic, and a day with Dr. Oz.



Preston Duren

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