This is Alan Condon back with the Becker's
Healthcare Podcast, and I'm delighted to be joined
today by doctor Nancy Baron, vice president and
chief quality officer of ambulatory
at Northwell
Health.
Nancy, a real pleasure to have you make
your debut appearance with us on the Beckers
podcast today.
For those of our listeners who mightn't be
as familiar with Northwell Health or the work
it is that you do as vice president
and chief quality officer of ambulatory, do you
mind giving us a little bit of more
insight into your role and your background at
the health system?
Sure. So,
as many of you may know, Northwell is
a large integrated health system
located in,
the Southern Part Of New York.
We are the largest health care delivery system
in New York state,
and I oversee,
ambulatory quality,
which is, in about 900
ambulatory sites.
I ensure regulatory compliance for those sites,
patient safety.
I work on large system wide, quality initiatives.
I am an internist by training and still
see patients once a week in my practice.
And we really work
on those areas where there's the highest risk
in the ambulatory environment.
Fantastic. So sounds like certainly wearing many different
hats on any given day, an internist by
training,
still seeing patients, working on several initiatives across
the system as it relates to quality,
safety, compliance.
Nancy, I'd love to kinda get a
perspective from you. I guess, with all that
in mind, what are kind of the two
or three
key trends that you're paying close attention to
today in health care?
So we really focus in our department
on the migration of procedures
from our inpatient setting
to our outpatient setting, and sometimes even from
one you know, from the ambulatory surgery setting
into the ambulatory
office.
So we really are focusing on that,
making sure that when we do minor procedures,
in the ambulatory environment, that they're done safely,
that they're done efficiently,
that they're,
you know, using the appropriate
protections
for patients and for our providers.
So things like that are really my number
one focus. We are using more RN administered
sedation
for very minor procedures,
pro nox,
as an anxiolytic
agent for some of our urologic stem placements,
more and more GYN procedures being done in
the ambulatory environment.
That's probably the top trend we're looking at.
The second big thing we focus on, which
I think a lot of integrated health systems
and and,
accountable care organizations,
you know, live and die with is
data, especially in the ambulatory
environment.
We really are starting to look at data
aggregation across multiple different platforms.
So,
for those of you that might be aware,
in 2025,
all accountable care organizations
have to report their quality data
electronically. Prior to this, we would do it
via chart review and put it into a
web interface.
Now we have to pull in, electronic data
from the EMR.
We have an incredibly large accountable care organization
at Northwell that probably has over 30 m
EMRs. So we have about
six to eight large ones. And just trying
to get the the electronic data files
from all of those different electronic medical records,
marry those datasets through a data aggregation platform,
make sure we have good data integrity that
it really represents the work that our team
is doing,
and getting that ready for CMS is really
a big
trend and issue that we're following and focusing
on right now,
hoping to be able to use that data
as we continue to move forward
for really, you know, population health strategies. When
you have a dataset that's that large,
the, you know, the impact for population health
is tremendous.
So, really, the goal of getting an accurate
and workable dataset,
both for reporting and for patient management,
is a big priority for us.
Fantastic.
Doctor Verint, I actually recently
spoke with,
Northwell Health CFO,
Michelle Cusack,
and she just told me
how excited
she was, other leaders like yourselves are,
at Northwell in terms of this upcoming
go live implementation of the epic,
electronic health record.
I'm curious.
She Michelle kinda broke it down, really looking
at just for some some of these efficiencies,
financial initiatives that she might be able to
get a hold of once this comes into
play. From your perspective as a provider, vice
president of chief quality of ambulatory,
what are you kinda most excited about with
this upcoming transition, this huge initiative that's gonna
be system wide?
Kinda where do you see the biggest opportunities
in your current line?
So my current line that certainly is around,
you know, data aggregation.
Thinking about now, we are, you know, we
have about 5,000 different
physicians,
another 1,500
or more ambulatory advanced care providers,
thirty plus different electronic medical record systems.
So I think about, you know, the quality
of transitions of care,
just getting information from one system to the
other. Our hospitals are on one electronic medical
record. Our ambulatory environment is on a myriad
of systems.
I think one just the improvement in having
one large data set will be tremendous.
Additionally, I think about all of the
quality initiatives that we'll be able to drive
forward
When we think about diabetes control, when we
think about
mental health screening and depression screening,
we implemented that on a system wide level
this year, and we're still doing it across
multiple different electronic medical records.
The impact will be so much more significant
when we're all in the same medical record.
We'll be able to take that data. We'll
be able to look at cohorts and where
do we have opportunity for improvement,
Where do we have people who are leading
and where do we have the lagging?
What resources do we need to allocate differently
to really help improve our care across all
of our populations?
Got it. Certainly, a lot of excitement. Huge
challenge, but huge initiative, I imagine, that a
ton of,
fantastic exciting things coming your way. Once that
is up and done, we'll be paying close
attention to what's going on at Northwell over
the coming months.
Nancy, I did wanna have one other follow-up
question just specifically in relation to the first
trend that you'd mentioned. You talked about the
migration of procedures from inpatient settings to outpatient
settings,
offices being a core part of your focus
at the moment.
Is this something that Northwell is also working
on?
Integrating
behavioral
health or other specialties into primary slash ambulatory
care to help ease the load on emergency
departments. Is this something that Northwell is working
on given some of the capacity challenges that
we've seen at hospital emergency departments across the
country, or is this, something that not on
your on your agenda at the moment?
So no. I'm thrilled to say that, I
think Northwell has been, on the leading edge
of mental health,
resources
and programming for our patient population.
Several years ago, our behavioral health program
department
built out a collaborative care management program where
they embed a social worker in the vast
majority of our primary care practices.
Through that collaborative care,
model, the social workers are integrated and overseen
by psych a team of psychiatrists,
and we really reeducated
our primary care doctors to increase their comfort
level both with the diagnosis
and the management
of anxiety and depression
so that patients have increased
access, to
to the management of depression,
and anxiety
since we know resources are so limited.
Building on that, we committed. We doubled down.
And in 02/2024,
we committed to screen all of our patients
for depression,
and not just those patients that access to
care through primary care, but, we built out
electronic workflows and multiple EMRs
to allow for depression screening across,
any entry point into our ambulatory
network. So all of our specialists were trained
in how to screen for depression.
And then our behavioral health service line, launched
a behavioral health navigation program.
So if a patient is screened positive, we
have
about 18 different community,
resource guides
based on the different markets that we serve.
And then we have one behavioral health navigation
program
where it is also staffed again by social
workers and,
professionals that will assess the patient. They do
a deeper dive assessment,
and they will link that patient
populate that patient to either, you know, telehealth
resources,
in person resources,
whatever the, you know, they look at insurance,
they look at what's available,
and I'm really excited to say last year
we screened,
close to four hundred and fifty thousand individuals
for,
depression.
Our behavioral health service line navigation program received
about 500
referrals per month in the early months that
launched last September
and now it's getting about a thousand navigating
about a thousand patients per month
to behavioral health resources
within our community. So I think that we've
done tremendous work,
and really have made a commitment
across our whole health system and across all
of our specialties
to the mental health needs of our patients.
Wow. Fantastic. I mean, we're so clear how
how much of a leader Northwell Health is
in this space,
given given the critical need across so many
communities, not just in New York, but indeed
really across the country.
And, Nancy, that's, obviously one key area of
excitement for yourself. You did also touch a
little bit on how excited you are about
the upcoming the epic implementation,
the data initiatives, and the opportunities that come
along with that. But when you think about
the future of health care, the future of
Northwell Health, is there anything else that you're
particularly excited about?
So one of the things that I'm excited
about in the ambulatory environment
is, you know, there's definitely increasing complexity
in the ambulatory
environment.
And we are working on,
how do we redesign
our ambulatory quality
infrastructure
to meet the needs of a clinically integrated
health system that is in a huge expansion
phase as we have, recently signed and we'll
be going live
with our, merger with Nuance.
So, really, how do we use our talented
resources
but limited, you know, resources
across our entire network efficiently?
So we've done begun the process of assessing
the clinical attributes
and what's what's actually being done in our
different
ambulatory
sites and, evaluating them for clinical risk.
You know, the that risk being,
either the risk of the patient, the risk
of medications
being used,
the,
the risk to our staff
and saying, okay. Based off of, you know,
these clinical attributes, can we can we look
at our practice sites in a tiering matrix?
You know, tier one being our highest risk
sites,
tier two being our, you know, middle risk,
and maybe tier three being our ordinary
risk sites. What education,
training, resources, competencies
do we need to to really start to
build
for each level of that tier?
And how do we use our,
our quality team to the highest
skill levels?
And how do we build that? So that's
a big exciting,
project for us right now. And what we're
focusing on. Thinking about how do we
work smarter, how do we work efficiently, and
how do we work proactively
from a quality standpoint to drive down risk
to improve patient outcomes
as we move forward.
Fantastic. And I'm so lucky to be able
to talk with such fantastic leaders at Northwell.
I I did mention earlier in the conversation,
I spoke with your CFO,
also spoke to your CEO recently, Michael Dowding.
Now the pleasure of speaking with yourself, Nancy.
But one thing that Michael said that stuck
in my mind was that I believe it
was around about
45, 40 six percent of Northwell's
revenue comes from its inpatient side. So so
much of its revenue is driven
by the outpatient side of your health system,
and that's growing year over year over year.
That's obviously a key key part of growth
for your health systems, health systems across the
country.
I'm kinda just curious with that growth in
mind, what are kinda one, two, three areas
of outpatient specific growth, whether it be a
specific service line, anything that you're really focusing
on in terms of outpatient growth for the
next, one to two years or so?
So I'll start off with we're focusing on
primary care because we have a huge
access need for primary care throughout our country
and certainly in our market
and trying to think of new and, innovative
ways to design primary care that would meet
the needs of our patients and, our communities.
So certainly focused on primary care. And then
I think, you know, we're really looking at,
as I mentioned a little bit before, you
know, those procedures that can be done safely
in the ambulatory environment,
that can grow in the ambulatory environment, that
do not need to be done as in
such a high cost setting
as the hospital. So we're seeing more and
more vascular procedures being done in the ambulatory
environment, more cardiac procedures being done in an
ambulatory environment,
more urologic
procedures being done in an ambulatory environment. So
certainly working with our surgeons,
to strategically think about where is the appropriate
level of care
based off of treatment and diagnosis and condition
as we are really focusing. And then certainly,
lastly, like, the management of chronic diseases.
The the need to to really
engage with and manage our patients who have
multiple chronic conditions
and to make sure that they are plugged
into the appropriate specialty care, that their care
is coordinated
across our health system,
that we are allocating the necessary resources to
do them, that we leverage technologies and team
based care to engage patients
to really improve the care because it's certainly
those patients with lots of chronic conditions
that drive up cost in our health system
and and drive down outcomes. So we really
wanna make sure we are giving them the
resources they need to have the best care
and the best outcomes possible.
Fantastic. I mean, always a pleasure to to
kinda dive deeper into some of these great
initiatives that fantastic leaders, that fantastic health systems
like yourselves are working on.
Nancy, if you don't mind hearing me, I'd
one last question sprang to mind. I'd love
to end on a a safety or a
quality question,
that just sprung up based on a recent
Becker's,
report that we covered.
I believe this report said that inadequate
coordination during patient discharge is one of the
top threats to patient safety in 2025.
Is there anything
a specific strategy that Northwell is implementing or
maybe has implemented to improve
discharge coordination? And maybe how do you expect
it to reduce safety risks
or likely improve continuity of care?
So
Northwell has been focused for the last several
years
on transitions of care and especially
those that happen at the time of hospital
discharge.
Many different initiatives have gone on.
We have,
our health management and care coordination team manages
our health our highest risk patient population
at the time of discharge
with putting
with case management, seeing that patient in the
hospital
and additionally coordinating
them with outpatient
case management,
we've also seen, you know, the the critical
importance of engaging,
primary care
and a team based approach
that really gets those patients into visits,
within seven days ideally, but within fourteen days
of discharge.
The use of medication
reconciliation
early to make sure so we have engaged
more and more our pharmacists from our Vivo
Health
to help us reconcile medications at the time
of discharge with patients to make sure that
they know what medications
they need, making sure we get home health
services engaged early,
and that we have the appropriate
conversations, including goals of care conversations
with our patients while they are hospitalized
to make sure that what we the treatment
we are giving them matches with their personal
goals for their care are. And I'm really
excited to you know, I was actually on
a conference this morning
discussing, and the trend year over year has
been a steady
decrease
across all, you know, our over our 20
hospitals
in readmissions.
So I think it's very
I I think it's diligent work. It's multifactorial
work that takes a lot of
teamwork and a lot of different different levers
to really make a difference, but it's the
hyperfocus
and the commitment to doing that work that
really drives,
you know, the teams to to address all
of the different opportunities and and challenges.
Fantastic.
Doctor Nancy Barron, really, really so appreciate the
work that that you that your teams do.
So greatly respect the work that you and
your teams do.
Thank you so much for taking the time
out of your busy schedule to to join
us on the Becker's healthcare podcast today. Thank
you. Thank you. Thank you for having me.