As we kick off 2019, it’s important to understand that the business of health care has never been more challenging, from navigating state and federal regulation to ever-increasing competition and integrating emerging technologies. These demands make the mission of delivering world-class health care to the communities we serve a test of resolve that requires discipline and focus from everyone at Northwell Health, beginning with the frontline staff on up.

That said, I believe we’re in a good place. There are phenomenal things going on. Very positive things will continue to happen, so long as we continue to adapt and be creative. We are the number one provider of care in New York, with a market share of nearly 30 percent – almost double our next-closest competitor. That’s a credit to the staff and leadership throughout the health system. You can only succeed if you have great passion and a dedicated staff. Because we have both, I’m bullish and optimistic about our future.

We will meet these challenges by being innovative, providing the best service and delivering the best quality.

Fundraising and philanthropy need to be an important component for the health system to thrive. In the past, philanthropy accounted for one-third of the funding required for any capital expansion project. Debt and operations made up the rest. That’s no longer the case.

Thankfully, the launch of the health system’s “Outpacing the Impossible” fundraising campaign in October and its $1 billion goal puts us on track to fund the projects that will move Northwell forward over the next decade. Philanthropy is increasingly important, especially for a nonprofit operating on a one percent margin. Our greatest contributors remain the employees. No gift is too small.

Our focus is targeted growth. We need to make investments in infrastructure, technology and clinical excellence, including new physicians along with new capabilities. There needs to be an emphasis on building alternative funding streams to offset the continuing reduction in insurance reimbursement from Medicare, Medicaid and commercial payers, as well as a focus on efficiency and productivity.

We suffer from a legacy problem. The health system right now encompasses 17.8 million square feet of real estate with more than half accounting for the hospitals themselves. Most of our hospitals date to before 1950, which means when you try to modernize, you’re doing it in a space that was originally built 70 years ago or even longer.

We currently spend nearly $500 million to maintain our infrastructure with no return on investment – that’s just to maintain our facilities. That money is built into our budget every year. None of the new technologies we take for granted existed when these hospitals were constructed. Obviously, the expectations that existed back then are different than today. The leaders back then who planned these projects couldn’t possibly have anticipated the current state of health care delivery. That’s why we have projects in various stages of completion happening at facilities throughout the health system. Modernization is expensive but necessary to our survival.

It’s our civic responsibility to help communities where a lack of access and health disparities exist. These efforts may have any financial benefit to us, but it’s the right thing to do. It’s easy to be successful by being selective and only investing in programs and services that make money, but our mission is to improve the health of our communities, especially those where there’s a high proportion of people at risk for chronic disease and other socio-economic factors that contribute to poor health.

For example, we’re currently lending our support in Brooklyn to help Brookdale, Interfaith, Kingsbrook and Wyckoff hospitals, as well as providing management and operational expertise to Nassau University Medical Center. These are all financially distressed hospitals that care for people in medically underserved communities. We have an obligation to run our own health system well and to be successful as an organization. But we also have an obligation to use our resources to help others who are less fortunate. We can’t walk away from difficult challenges. Other health systems do that. That’s not us. Our mission is imbedded in our culture.