Beyond all the numbers and details, it is important to understand that health care is deeply human and personal. We are all potential patients — many of us have already been. While we can discuss health care in theory, we can also do it on a personal level, based on our own experiences and those of our loved ones.

There is a constant temptation to make comparisons between healthcare organizations — especially provider organizations and other businesses or industries. Comparisons serve a purpose of course — you gain learning on how to adapt and improve. 

However, health care — especially nonprofit health care — is different. These differences and distinctions need to be understood. The following are a number of examples:

1. We serve everyone. We don't "choose" our customers. We do not just target specific demographics based on age, income level or lifestyle preferences as prospective customers — a common practice in other industries. We serve all irrespective of income status or circumstance.

2. Care is not contingent on payment. Care is provided to all. Unlike most industries where payment precedes services or payment is provided at the time of service, payment is often uncertain or non-existent. Payment is not guaranteed. This is a big distinction worth understanding.

3. Unlike most other businesses, we do not have the autonomy to set prices. Health systems and hospitals negotiate rates with insurance companies or adhere to government price-setting structures, such as Medicare and Medicaid. Medicaid, which makes up a large portion of revenue of most health systems, provides payment well below the cost of providing the service. Providers can often go for years without any increases, and when they do occur they are limited to a percentage or two — even though the demand for services increases and labor and other costs escalate.

4. Despite patients having insurance coverage, payment isn't guaranteed. Insurance denials and mechanisms to limit payment are increasing and often overlooked when we talk about health insurance coverage or agreed-upon reimbursement rates. Insurers' denial of payment was once reserved for a small portion of expensive treatments but is now a common occurrence for ordinary medical care. Denials are exacerbated by payers' use of artificial intelligence, resulting in faster and less reasoned decisions that often lack clear explanations. One analysis found about 1/3 of inpatient and outpatient claims submitted by providers to commercial payers went unpaid for more than 90 days throughout the first three months of 2023. In some cases, payment can take years. Like most health systems, Northwell employs thousands of people whose primary responsibility is to collect payment for a service after it is delivered.

8. Balancing business objectives with our community mission makes for an ongoing challenge. While managing an organization with a singular focus on profit is relatively straightforward, health system leaders face the complex task of reconciling conflicting goals: A healthy operating margin and a healthy community. Managing this is an essential test of leadership. Health systems like Northwell invest in services and programs to improve the overall health of the community — efforts to solve food insecurity, address substance use and mental health, broaden students' educational and professional opportunities, and more. Most of these activities are not fully reimbursed, yet the pressure to do more continually escalates. 

9. Health systems are more than hospitals. When most people comment on health systems, they primarily think of hospitals. That was true, but not anymore. Health systems are dynamic, evolving and innovative — and are, when a crisis occurs, the communities' safety net, as Covid-19 reminded us. While we at Northwell, for example, have 21 hospitals, we have over 900 outpatient ambulatory centers. Only 47% of our revenue is now tied to hospitals. We are also, like so many others, a major research, educational and academic institution — preparing future teachers, leaders and researchers. The depth and versatility of what we do needs to be better understood and appreciated. 

We all need to work cross industry, to learn from each other, to innovate and partner together so we can build a better community. We are all interdependent. We all have major responsibilities and obligations to build a better future. To do that, it helps to better understand each other.

This op-ed originally appeared in Becker's Hospital Review.