Latest / Becker’s Healthcare Podcast / Scaling Ambulatory Quality and Depression Screening at Northwell Health with Nancy Beran, MD

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Scaling Ambulatory Quality and Depression Screening at Northwell Health with Nancy Beran, MD · Becker’s Healthcare Podcast

• 0:01
  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  upper right.
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  Hi, everyone. You are listening to the Becker's
• 0:40
  Healthcare Podcast.
• 0:41
  I'm Erica Carbajal, an editor with Becker's Hospital
• 0:44
  Review. Thank you so much for tuning into
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  this episode.
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  Today, we're lucky to be joined by doctor
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  Nancy Baron, vice president and chief quality officer
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  of ambulatory
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  care at Northwell Health. Doctor Barron, pleasure to
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  have you on. Thank you for being here.
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  Thank you for having me.
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  Well, to start us off, do you mind
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  sharing a little bit about your background in
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  health care and the scope of your work
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  at Northwell?
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  Sure. I'd be delighted. So, I'm an internist
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  by training. I
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  have a women's health practice where we focus
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  on the internal medicine for women.
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  It's a practice that I started with a
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  colleague,
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  back in 2006.
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  From there, I helped start a multi specialty
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  medical group and was the,
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  chief medical officer of that medical group for
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  about fourteen years
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  and focused a lot on quality and ambulatory
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  quality.
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  We joined Northwell,
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  in 2017
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  with that group, and I started in my
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  current role as a chief quality officer for
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  ambulatory
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  in 2021.
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  I was the inaugural
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  person in that role.
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  Yeah. Doctor Barron, it's interesting to hear too
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  and and so relevant because I feel like
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  we've been hearing a lot more and doing
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  a lot more coverage about quality and safety
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  in in ambulatory
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  settings,
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  and how how, you know, that's just becoming
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  so much more important in an elevated priority
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  as more care moves to those settings.
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  Yeah. You know, what we're seeing, Erica, is
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  really just the trend of
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  everything being done at,
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  the appropriate
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  level of care. So we're seeing migration
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  of procedures that could be done in a
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  hospital, moving to ambulatory surgery centers, things that
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  are in ambulatory surgery centers that are going
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  into
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  office based procedures.
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  And we're seeing the complexity
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  of what's being done in the ambulatory environment,
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  increasing,
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  and Northwell's footprint continues to increase. So,
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  over the past several years, we've we've continued
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  through acquisitions and mergers
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  to grow in size,
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  and now we have over a thousand different
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  ambulatory
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  sites that my team,
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  really
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  is providing support for.
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  Yeah. It's a it's a big footprint to
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  oversee.
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  Doctor Buren, can you share one of the
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  most important initiatives that you've led in overseeing
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  ambulatory care over the past year? What was
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  it, and what were some of the results?
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  So I'm gonna share two big initiatives that
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  we led over the past year. One is
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  really,
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  on process improvement
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  and
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  population
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  health measure,
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  and the second was really in how we're
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  going to be redesigning and evaluating our own
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  scope and work.
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  So the first thing that we did was
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  we initiated
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  system wide
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  depression screening,
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  recognizing that one in five of our population
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  are suffering from depression,
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  trying to address the mental health crisis that
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  we're seeing in New York and throughout the
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  country.
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  We really felt strongly as a health system
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  that it was important to screen for depression.
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  So we built out workflows
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  that applied not just to primary care, but
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  to all of our doctors.
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  So if you saw a Northwell physician last
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  year, you were administered at a minimum at
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  PHQ two. That was the screening the two
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  screening questions for depression.
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  If they were positive, you were either referred
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  to a primary care physician
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  or to our behavioral health navigation team who
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  can hook you up with resources.
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  It's something that we began the work in
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  2024
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  with piloting with just one of our specialty
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  specialty service lines, our ENT service line, and
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  built out the process. And we worked through
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  the process with our primary care physicians and
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  grew what they were doing. And in 2025,
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  we made it a system wide goal.
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  We redesigned our electronic medical records
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  to support the initiative. We had digital interface
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  with questions wherever possible.
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  And last year, we screened over 700,000
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  unique patients for depression
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  and linked patients that were positive for depression
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  with care whenever possible.
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  So it was a huge initiative that we're
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  incredibly proud of the work. It was partnered
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  with our behavioral health service line who
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  correspondingly
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  built out collaborative care models embedded with our
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  primary care teams in pediatrics
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  and in,
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  internal medicine and in family medicine,
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  and additionally in some of our specialty offices
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  where we have licensed clinical social workers
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  working,
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  there to do counseling for our patients and
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  supporting our physicians and our advanced practice providers.
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  Additionally,
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  we have the behavioral health service line that
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  was stood up last year to really enable
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  trying to to match patients with resources. We
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  all know how challenging that is in the
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  mental health environment to get patients the appropriate
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  resources.
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  So there were lots of different, so they
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  would do the evaluation.
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  They had some access to urgent care in,
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  some of our markets,
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  like behavioral health, you know, same day care
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  or urgent evaluation.
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  We do have mental health,
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  resources in terms of hospitals and inpatient admissions,
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  and then we also partnered with several companies
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  for telehealth,
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  to provide services for our patient population. So
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  really exciting work there on depression screening. It's
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  one of the things we're really proud of
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  last year,
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  and that we've continued into 2026.
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  I'll pause there in case you have anything
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  you wanted to ask me about that before
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  I go into my next big initiative that
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  we did last year.
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  Yeah. Doctor Barron, thank you. Really interesting to
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  hear about scaling that depression screening system wide.
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  I imagine
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  such a big undertaking, but but a necessary
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  and valuable one. I mean, we talk about
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  so much about care coordination and connecting patients
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  to
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  appropriate levels of care and and really sounds
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  like it starts with being able to do
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  this,
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  at at scale and goes a long way
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  in avoiding unnecessary
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  or preventable ED visits. So I guess my
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  follow-up question around around that is, do you
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  have a sense, or is there any tracking
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  on that end of what
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  being able to do this screening system wide
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  and connect patients with
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  referrals as early as possible has had downstream
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  on ED strain?
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  Hard to tell on ED strain.
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  We're seeing about a four to five percent
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  positivity rate, which is lower than, you know,
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  historically, and I think largely because some of
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  the screening for depression's typically been done
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  in primary care offices. So,
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  I don't think that people always
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  respond the same when they go perhaps to
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  see their orthopedist. They're not anticipating that that's
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  something that they're going to discuss there.
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  So we've really been focusing on
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  getting the population
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  screened
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  and then subsequently
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  on making sure we're hooking them up with
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  care. So we've been tracking the volume at
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  our behavioral health navigation
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  center.
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  I do think it would be really fascinating
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  to look at ED admissions, but I often
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  think that, depression is a confounding variable.
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  So, you know, sometimes patients come in with
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  anxiety or chest pain or something else where
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  where the depression is a confounding variable, but
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  not always the main cause for the ER
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  visit. So,
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  it's an interesting thing to think about tracking,
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  one I'll have to take back to our
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  team to see what we could do.
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  Yeah. No. That makes sense. Interesting to hear.
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  Leah, do you wanna share a little bit
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  more too around the redesign
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  that you're that you're looking at in terms
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  of ambulatory?
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  Right. So, you know, we we joined a
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  you know, this my team has been managing,
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  you know, a large geography and footprint since
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  I've started,
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  but that geography and footprint
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  continues to expand.
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  Northwell recently,
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  merged with Nuvance Health, which now brings Northwell,
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  in the, you know, further north,
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  in New York and also into Western Connecticut,
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  our geography becomes less and less drivable.
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  And one of the things that we really
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  realized is
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  that we were often going into offices that
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  maybe we were filling a nursing gap or
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  an operational gap in quality. We were trying
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  there might have been a quality issue, but
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  the solution didn't really involve
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  our nursing team.
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  And we were looking at how do we
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  evaluate
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  the right amount of resources
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  to meet the needs
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  of an ever growing ambulatory footprint,
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  and also what are the educational
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  needs that we have
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  for our operations
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  colleagues
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  within
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  our market.
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  And really trying to say, how do we
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  do this in a way that's thoughtful
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  and resource, you know, conscious because none of
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  us can afford to just continue to expand
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  our resources.
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  So one of the things that we did
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  was we started to look at all different
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  clinical attributes of our practices.
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  And, you know, when you grow by acquisition,
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  you sometimes don't always have a great handle
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  on what's going on in every practice site.
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  So we spent about six months doing, you
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  know,
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  surveys of our practices and really getting a
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  very good handle on what was going on
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  in our practices.
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  So for example,
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  were they using
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  something that required high level disinfection or sterilization?
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  Do we have to think about infection prevention?
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  Were they distributing meds
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  or using controlled substances in their practice?
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  So do we need to have higher level
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  medication management in there?
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  Are they reporting or regulated by joint commission,
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  quad a? Are they an article 28? Those
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  type of things. How many practices do we
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  have that are doing that?
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  And then, you know, were they a dialysis
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  center? Are they a
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  doing procedures but no sedation? Are we doing
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  sedation in that office? So we looked at
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  all of these different clinical attributes and what
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  was going on in our practices,
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  and we came up with a rating and
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  tiering system
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  that allows us to evaluate
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  our practice sites off of tiers.
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  And then from that, we've been in the
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  process of saying, what is foundational?
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  What should our operations teams know in all
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  sites that is quality related.
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  And then we're looking at each site as
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  we increase risk for what's the appropriate clinical
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  oversight, what's the appropriate
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  quality oversight, and what's the appropriate racing matrix
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  with our operations teams to make sure that
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  our quality nurses are working to the top
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  of their license, that they're being used as
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  the resource that we need them to be,
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  and that similarly,
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  we are supporting all of our offices.
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  So we've been in that process, and we
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  are redesigning this year how we distribute our
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  staff and how we how we distribute
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  the offices
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  that they oversee
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  and that they carry with targeted
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  visits and
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  and,
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  checklist and oversight for each of those tiers.
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  So we're making tier one our highest risk,
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  then tier two, and then tier three is
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  our lowest risk practice site, and we're lining
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  that up and looking at how do we
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  do with that. It enables us that when
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  we bring on
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  new practices or a new market, we're able
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  to take a look at how are they
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  aligned,
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  what resources do they have, how can we
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  be supportive?
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  What do we need to, you know, perhaps
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  hire or fill? So it it's really been
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  a huge initiative for how we are redesigning
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  our thinking about ambulatory quality.
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  Yeah. Doctor Baron,
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  I've heard a lot to quality leaders talk
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  about the the exact sort of challenge that
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  you mentioned with
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  sometimes
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  systems as they've grown over the years. There's
• 13:21
  not just a clear understanding
• 13:23
  of what's happening where, and so how this
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  work really needs to start sometimes with literally
• 13:28
  just mapping it out and getting a clear
• 13:30
  understanding of what's happening where,
• 13:33
  to shore up quality
• 13:35
  in these settings. So really interesting to hear
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  what this
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  work looks like and how it's actually being
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  built out.
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  Yeah. It's trying to use data to drive
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  change, you know, and and really being thoughtful
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  and purposeful about it. You know, we are
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  all,
• 13:50
  you know, resource constricted
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  and
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  and really trying to do
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  more and more
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  with, you know, less. So how do we
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  how do we
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  adjust how we work and reform what we're
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  doing to be efficient
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  and effective and make sure we're keeping our
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  patients safe
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  in our offices?
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  Mhmm.
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  Yeah. Absolutely.
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  Well, throughout this year in 2026,
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  what is maybe one big priority that you're
• 14:22
  focused on and one challenge that you're anticipating
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  or navigating?
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  So one big challenge that I think we're
• 14:29
  focusing on is one that I think, you
• 14:31
  know, focused on in a lot of health
• 14:33
  systems, and that is really integrating,
• 14:37
  you know, new practice sites, new regions, new
• 14:40
  markets,
• 14:41
  new health systems
• 14:42
  into,
• 14:43
  you know, our health system or, you know,
• 14:45
  combining
• 14:46
  cultures
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  and really aligning
• 14:49
  priorities and goals.
• 14:51
  I think that's something that that takes a
• 14:53
  lot of time. It takes a lot of
• 14:55
  personal time,
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  to really understand where another
• 14:59
  health system is at in their journey
• 15:02
  and how do you both, you know, when
• 15:04
  you join together, grow faster together,
• 15:07
  and and how do you merge your resources
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  and align your structures.
• 15:11
  So I think that is one thing that
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  is really a priority for us,
• 15:15
  and I would say that we're doing that
• 15:17
  against a backdrop of a tremendous transformation at
• 15:21
  Northwell.
• 15:22
  We are making a tremendous digital transformation at
• 15:25
  Northwell as we are implementing
• 15:27
  EPIC
• 15:28
  throughout our health system
• 15:30
  and we are sunsetting
• 15:32
  multiple
• 15:33
  legacy EMRs,
• 15:35
  so it's not just the journey of implementing
• 15:38
  EPIC, you know, and a new EMR, but
• 15:41
  also building the culture around standardization of clinical
• 15:45
  workflows,
• 15:46
  everybody being on the same system,
• 15:49
  that system integrating with so many of the
• 15:52
  systems in our area. It's great for patient
• 15:54
  care,
• 15:55
  but and it also allows us to have
• 15:57
  way more of a more rapid digital transformation.
• 16:01
  So it's allowing us at Northwell to, you
• 16:03
  know, right, go right into online booking
• 16:07
  and patient,
• 16:09
  improving our patient access and patient experience. So
• 16:12
  trying to sustain our momentum
• 16:15
  on the work we're doing in depression, on
• 16:17
  aligning with new practices that are coming on
• 16:19
  in new regions and new health systems
• 16:22
  while being in this, you know, kind of
• 16:25
  major change,
• 16:26
  you know, major institutional
• 16:28
  digital change, I think, is is really what
• 16:30
  we're facing
• 16:32
  this year.
• 16:33
  Yeah. Definitely. I know that epic implementation is
• 16:36
  a huge project, so I imagine we'll lay
• 16:38
  the foundation for what will be just continued
• 16:41
  innovation and and patient care and workflows and
• 16:43
  being able to enable that. Doctor Baron, what
• 16:46
  do you see as the biggest opportunity for
• 16:50
  growth at Northwell in the year or several
• 16:52
  years ahead?
• 16:54
  I think that we have a tremendous footprint
• 16:58
  with,
• 16:59
  really
• 17:00
  talented,
• 17:01
  wonderful
• 17:03
  clinical teams.
• 17:04
  And I think that as we use our
• 17:08
  digital transformation
• 17:09
  to
• 17:11
  streamline the patient experience,
• 17:13
  improve our ambulatory
• 17:15
  efficiencies,
• 17:16
  standardize
• 17:17
  care,
• 17:18
  improve our referral system,
• 17:21
  and ultimately,
• 17:22
  you know, drive access.
• 17:25
  I think that is really where we will
• 17:28
  thrive and grow.
• 17:30
  I think it will will make it so
• 17:32
  that
• 17:33
  as we
• 17:35
  as people join us, they know the culture
• 17:38
  and the processes that they're joining.
• 17:40
  I think we've gone we've grown very rapidly
• 17:43
  as I think many health systems are, and
• 17:46
  I don't think we're slowing our,
• 17:49
  growth at any there's any intention to slow
• 17:52
  it, but I do think that there's
• 17:54
  intention to grow together more
• 17:57
  and to to utilize the opportunities
• 18:00
  to to build
• 18:02
  programs
• 18:03
  and
• 18:04
  centers of excellence and to make sure
• 18:08
  that people are aware of the amazing programs
• 18:10
  and centers of excellence that already exist within
• 18:13
  our health system.
• 18:14
  I think that's really where our where our
• 18:17
  opportunity
• 18:18
  really lies in streamlining all of our workflows
• 18:20
  and culture,
• 18:22
  really making that patient experience seamless and and
• 18:25
  high quality and
• 18:27
  and really improving access,
• 18:29
  which is what we hear about is really
• 18:31
  the struggle for our patients.
• 18:33
  Yeah. Certainly.
• 18:35
  Well, doctor Barron, thank you so much for
• 18:38
  joining me, for taking the time out of
• 18:40
  what I know is a busy schedule to
• 18:42
  share your insights with us. And,
• 18:45
  again, we're really looking forward to seeing you
• 18:47
  at the April annual meeting and and hearing
• 18:49
  from you live. So thank you so much,
• 18:52
  and I'm excited to catch up again soon.
• 18:55
  Thank you so much, Erica. Looking forward to
• 18:57
  seeing you too.