Northwell Health's new CFO talks financial goals, challenges

Michele Cusack is new to her role as senior vice president and CFO of New Hyde Park, N.Y.-based Northwell Health — but she's no stranger to the world of healthcare finance.

Appointed to the position Nov. 1, Ms. Cusack is responsible for financial reporting, financial planning, cash management and tax management, among many other areas. She also has administrative responsibilities on the Northwell Board of Trustees' finance and audit committees.

Prior to her recent appointment, Ms. Cusack was Northwell Health's senior vice president of finance and deputy CFO.

Given her current duties and past experience, Ms. Cusack knows the financial challenges in today's healthcare environment. She recently answered questions from Becker's Hospital Review about these challenges and her goals for next year.

Note: Responses have been lightly edited for length and clarity. 

Question: What's your favorite part about being the CFO of a health system? 

Michele Cusack: The daily challenge. I would say that given the current healthcare environment, there isn't a day that goes by that does not present a new challenge or opportunity. The size of our organization and the depth and breadth of the services we provide positions us well for taking advantage of both.

Q: What is the biggest challenge you're facing as CFO?

MC: The dynamic changes with respect to our top line. There are the traditional pressures stemming from competitors and insurance company payment issues. In recent years, there are new pressures from consumer disruptors like Walmart, Google and Amazon that are now competing with hospitals, health systems and other providers. For example, we could soon have Amazon offering mail-order prescription drugs and other health services that we now provide to our patients directly. It's kind of a piecemeal assault of the services we provide.

Q: In August, Northwell Health announced plans to eventually shut down its health insurance business, CareConnect, due to financial losses. What kind of impact will this have on the health system?

MC: We incurred losses primarily as a result of the way the ACA rules played out relative to the risk corridors and risk adjustment. We are in the process of winding down the company over the next year as we continue to honor our customers' existing policies. We'll wrap up operations with some administrative costs of the wind-down in 2018 and 2019. It was the right strategy at the wrong time. We accomplished what we wanted in terms of getting into the health insurance business, coordinating high-quality care for our patients, and aligning our clinical performance and outcomes with financial incentives that historically have benefited insurance companies only — not providers who are on the front lines of delivering care and the patients they serve. It also provided us with additional insight on how to enhance our capabilities and competencies in population health management, and diversified our revenue stream. Unfortunately, government rules, regulations and constraints made it impossible for us to be successful in the current environment.

Q: What is one of your goals for 2018?

MC: Maintaining and delivering a higher operating margin as we continue to diversify our revenue stream, getting the most out of our revenue cycle, and staying as competitive and lean of an organization as we can — all while maintaining high-quality care to our patients.

Q: What advice do you have for other hospital and health system CFOs on going beyond the typical CFO duties and getting involved in other aspects of the business?

MC: It's important to be in step with your chief operating officer and other chief executives to understand more than just the numbers, but what's behind the numbers and their strategic vision from an operational standpoint. That's how to make sure you're a true partner.



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