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