1 00:00:00,080 --> 00:00:02,659 This is Alan Condon back with the Becker's 2 00:00:02,720 --> 00:00:05,679 Healthcare Podcast, and I'm delighted to be joined 3 00:00:05,679 --> 00:00:09,359 today by doctor Nancy Baron, vice president and 4 00:00:09,359 --> 00:00:11,699 chief quality officer of ambulatory 5 00:00:12,160 --> 00:00:12,900 at Northwell 6 00:00:13,199 --> 00:00:13,699 Health. 7 00:00:14,164 --> 00:00:15,765 Nancy, a real pleasure to have you make 8 00:00:15,765 --> 00:00:17,684 your debut appearance with us on the Beckers 9 00:00:17,684 --> 00:00:18,745 podcast today. 10 00:00:19,364 --> 00:00:21,684 For those of our listeners who mightn't be 11 00:00:21,684 --> 00:00:24,644 as familiar with Northwell Health or the work 12 00:00:24,644 --> 00:00:26,324 it is that you do as vice president 13 00:00:26,324 --> 00:00:28,710 and chief quality officer of ambulatory, do you 14 00:00:28,710 --> 00:00:29,910 mind giving us a little bit of more 15 00:00:29,910 --> 00:00:31,509 insight into your role and your background at 16 00:00:31,509 --> 00:00:32,250 the health system? 17 00:00:33,030 --> 00:00:33,670 Sure. So, 18 00:00:34,309 --> 00:00:36,469 as many of you may know, Northwell is 19 00:00:36,469 --> 00:00:38,649 a large integrated health system 20 00:00:39,109 --> 00:00:40,309 located in, 21 00:00:41,109 --> 00:00:43,449 the Southern Part Of New York. 22 00:00:43,935 --> 00:00:46,414 We are the largest health care delivery system 23 00:00:46,414 --> 00:00:47,715 in New York state, 24 00:00:48,335 --> 00:00:49,475 and I oversee, 25 00:00:50,094 --> 00:00:51,234 ambulatory quality, 26 00:00:51,695 --> 00:00:54,035 which is, in about 900 27 00:00:54,175 --> 00:00:55,475 ambulatory sites. 28 00:00:56,060 --> 00:00:59,520 I ensure regulatory compliance for those sites, 29 00:01:00,060 --> 00:01:01,120 patient safety. 30 00:01:01,740 --> 00:01:05,359 I work on large system wide, quality initiatives. 31 00:01:06,299 --> 00:01:09,274 I am an internist by training and still 32 00:01:09,274 --> 00:01:11,295 see patients once a week in my practice. 33 00:01:11,914 --> 00:01:13,215 And we really work 34 00:01:13,914 --> 00:01:17,034 on those areas where there's the highest risk 35 00:01:17,034 --> 00:01:18,575 in the ambulatory environment. 36 00:01:19,594 --> 00:01:22,795 Fantastic. So sounds like certainly wearing many different 37 00:01:22,795 --> 00:01:25,129 hats on any given day, an internist by 38 00:01:25,129 --> 00:01:25,629 training, 39 00:01:26,009 --> 00:01:29,450 still seeing patients, working on several initiatives across 40 00:01:29,450 --> 00:01:31,390 the system as it relates to quality, 41 00:01:32,009 --> 00:01:33,149 safety, compliance. 42 00:01:34,170 --> 00:01:36,189 Nancy, I'd love to kinda get a 43 00:01:36,614 --> 00:01:38,614 perspective from you. I guess, with all that 44 00:01:38,614 --> 00:01:40,055 in mind, what are kind of the two 45 00:01:40,055 --> 00:01:40,795 or three 46 00:01:41,174 --> 00:01:43,575 key trends that you're paying close attention to 47 00:01:43,575 --> 00:01:44,715 today in health care? 48 00:01:45,334 --> 00:01:47,995 So we really focus in our department 49 00:01:48,390 --> 00:01:50,489 on the migration of procedures 50 00:01:50,870 --> 00:01:52,569 from our inpatient setting 51 00:01:52,950 --> 00:01:56,390 to our outpatient setting, and sometimes even from 52 00:01:56,390 --> 00:01:59,049 one you know, from the ambulatory surgery setting 53 00:01:59,430 --> 00:02:00,409 into the ambulatory 54 00:02:00,790 --> 00:02:01,290 office. 55 00:02:02,234 --> 00:02:04,414 So we really are focusing on that, 56 00:02:04,715 --> 00:02:07,134 making sure that when we do minor procedures, 57 00:02:08,074 --> 00:02:10,894 in the ambulatory environment, that they're done safely, 58 00:02:11,034 --> 00:02:12,495 that they're done efficiently, 59 00:02:12,794 --> 00:02:13,534 that they're, 60 00:02:13,879 --> 00:02:15,580 you know, using the appropriate 61 00:02:16,280 --> 00:02:16,780 protections 62 00:02:17,159 --> 00:02:19,340 for patients and for our providers. 63 00:02:20,280 --> 00:02:22,360 So things like that are really my number 64 00:02:22,360 --> 00:02:25,500 one focus. We are using more RN administered 65 00:02:25,719 --> 00:02:26,219 sedation 66 00:02:26,905 --> 00:02:28,444 for very minor procedures, 67 00:02:28,905 --> 00:02:29,644 pro nox, 68 00:02:30,424 --> 00:02:31,405 as an anxiolytic 69 00:02:31,784 --> 00:02:34,764 agent for some of our urologic stem placements, 70 00:02:36,025 --> 00:02:38,584 more and more GYN procedures being done in 71 00:02:38,584 --> 00:02:39,884 the ambulatory environment. 72 00:02:40,264 --> 00:02:43,270 That's probably the top trend we're looking at. 73 00:02:44,050 --> 00:02:47,009 The second big thing we focus on, which 74 00:02:47,009 --> 00:02:49,490 I think a lot of integrated health systems 75 00:02:49,490 --> 00:02:50,689 and and, 76 00:02:51,090 --> 00:02:52,550 accountable care organizations, 77 00:02:52,930 --> 00:02:54,789 you know, live and die with is 78 00:02:55,175 --> 00:02:57,034 data, especially in the ambulatory 79 00:02:57,334 --> 00:02:57,834 environment. 80 00:02:58,534 --> 00:03:00,775 We really are starting to look at data 81 00:03:00,775 --> 00:03:03,754 aggregation across multiple different platforms. 82 00:03:04,534 --> 00:03:04,854 So, 83 00:03:05,334 --> 00:03:07,014 for those of you that might be aware, 84 00:03:07,014 --> 00:03:08,375 in 2025, 85 00:03:08,375 --> 00:03:09,995 all accountable care organizations 86 00:03:10,830 --> 00:03:13,250 have to report their quality data 87 00:03:14,030 --> 00:03:16,590 electronically. Prior to this, we would do it 88 00:03:16,590 --> 00:03:18,909 via chart review and put it into a 89 00:03:18,909 --> 00:03:19,810 web interface. 90 00:03:20,509 --> 00:03:23,469 Now we have to pull in, electronic data 91 00:03:23,469 --> 00:03:24,370 from the EMR. 92 00:03:24,824 --> 00:03:27,645 We have an incredibly large accountable care organization 93 00:03:28,185 --> 00:03:31,465 at Northwell that probably has over 30 m 94 00:03:31,705 --> 00:03:33,324 EMRs. So we have about 95 00:03:33,705 --> 00:03:36,185 six to eight large ones. And just trying 96 00:03:36,185 --> 00:03:38,699 to get the the electronic data files 97 00:03:39,159 --> 00:03:41,819 from all of those different electronic medical records, 98 00:03:42,519 --> 00:03:45,580 marry those datasets through a data aggregation platform, 99 00:03:46,439 --> 00:03:48,759 make sure we have good data integrity that 100 00:03:48,759 --> 00:03:50,919 it really represents the work that our team 101 00:03:50,919 --> 00:03:51,580 is doing, 102 00:03:52,354 --> 00:03:54,775 and getting that ready for CMS is really 103 00:03:54,914 --> 00:03:55,495 a big 104 00:03:56,114 --> 00:03:58,935 trend and issue that we're following and focusing 105 00:03:58,995 --> 00:03:59,974 on right now, 106 00:04:00,275 --> 00:04:02,134 hoping to be able to use that data 107 00:04:02,194 --> 00:04:03,974 as we continue to move forward 108 00:04:04,560 --> 00:04:07,680 for really, you know, population health strategies. When 109 00:04:07,680 --> 00:04:09,700 you have a dataset that's that large, 110 00:04:10,080 --> 00:04:12,640 the, you know, the impact for population health 111 00:04:12,640 --> 00:04:13,379 is tremendous. 112 00:04:13,760 --> 00:04:16,259 So, really, the goal of getting an accurate 113 00:04:16,399 --> 00:04:17,699 and workable dataset, 114 00:04:18,735 --> 00:04:22,035 both for reporting and for patient management, 115 00:04:22,655 --> 00:04:24,355 is a big priority for us. 116 00:04:25,694 --> 00:04:26,194 Fantastic. 117 00:04:26,495 --> 00:04:28,595 Doctor Verint, I actually recently 118 00:04:28,895 --> 00:04:30,029 spoke with, 119 00:04:30,670 --> 00:04:32,290 Northwell Health CFO, 120 00:04:32,670 --> 00:04:33,889 Michelle Cusack, 121 00:04:34,430 --> 00:04:35,889 and she just told me 122 00:04:36,189 --> 00:04:37,009 how excited 123 00:04:37,470 --> 00:04:40,209 she was, other leaders like yourselves are, 124 00:04:40,750 --> 00:04:42,985 at Northwell in terms of this upcoming 125 00:04:43,365 --> 00:04:45,764 go live implementation of the epic, 126 00:04:46,324 --> 00:04:47,704 electronic health record. 127 00:04:48,165 --> 00:04:48,805 I'm curious. 128 00:04:49,444 --> 00:04:52,324 She Michelle kinda broke it down, really looking 129 00:04:52,324 --> 00:04:54,665 at just for some some of these efficiencies, 130 00:04:55,699 --> 00:04:57,540 financial initiatives that she might be able to 131 00:04:57,540 --> 00:04:58,980 get a hold of once this comes into 132 00:04:58,980 --> 00:05:01,540 play. From your perspective as a provider, vice 133 00:05:01,540 --> 00:05:03,319 president of chief quality of ambulatory, 134 00:05:03,699 --> 00:05:05,780 what are you kinda most excited about with 135 00:05:05,780 --> 00:05:09,220 this upcoming transition, this huge initiative that's gonna 136 00:05:09,220 --> 00:05:10,274 be system wide? 137 00:05:10,675 --> 00:05:12,454 Kinda where do you see the biggest opportunities 138 00:05:12,675 --> 00:05:13,894 in your current line? 139 00:05:14,675 --> 00:05:17,154 So my current line that certainly is around, 140 00:05:17,154 --> 00:05:18,454 you know, data aggregation. 141 00:05:20,035 --> 00:05:23,074 Thinking about now, we are, you know, we 142 00:05:23,074 --> 00:05:25,220 have about 5,000 different 143 00:05:25,759 --> 00:05:26,259 physicians, 144 00:05:27,120 --> 00:05:28,480 another 1,500 145 00:05:28,480 --> 00:05:31,139 or more ambulatory advanced care providers, 146 00:05:31,920 --> 00:05:35,300 thirty plus different electronic medical record systems. 147 00:05:36,074 --> 00:05:38,495 So I think about, you know, the quality 148 00:05:38,875 --> 00:05:40,574 of transitions of care, 149 00:05:40,954 --> 00:05:43,435 just getting information from one system to the 150 00:05:43,435 --> 00:05:46,235 other. Our hospitals are on one electronic medical 151 00:05:46,235 --> 00:05:49,274 record. Our ambulatory environment is on a myriad 152 00:05:49,274 --> 00:05:49,935 of systems. 153 00:05:50,910 --> 00:05:53,550 I think one just the improvement in having 154 00:05:53,550 --> 00:05:56,129 one large data set will be tremendous. 155 00:05:57,389 --> 00:05:59,649 Additionally, I think about all of the 156 00:06:00,830 --> 00:06:03,569 quality initiatives that we'll be able to drive 157 00:06:03,629 --> 00:06:04,129 forward 158 00:06:04,514 --> 00:06:07,475 When we think about diabetes control, when we 159 00:06:07,475 --> 00:06:08,214 think about 160 00:06:08,595 --> 00:06:10,935 mental health screening and depression screening, 161 00:06:11,314 --> 00:06:13,794 we implemented that on a system wide level 162 00:06:13,794 --> 00:06:15,954 this year, and we're still doing it across 163 00:06:15,954 --> 00:06:18,375 multiple different electronic medical records. 164 00:06:18,720 --> 00:06:21,139 The impact will be so much more significant 165 00:06:21,520 --> 00:06:24,100 when we're all in the same medical record. 166 00:06:24,400 --> 00:06:26,240 We'll be able to take that data. We'll 167 00:06:26,240 --> 00:06:28,480 be able to look at cohorts and where 168 00:06:28,480 --> 00:06:30,740 do we have opportunity for improvement, 169 00:06:31,204 --> 00:06:33,365 Where do we have people who are leading 170 00:06:33,365 --> 00:06:34,904 and where do we have the lagging? 171 00:06:35,285 --> 00:06:38,504 What resources do we need to allocate differently 172 00:06:38,964 --> 00:06:41,685 to really help improve our care across all 173 00:06:41,685 --> 00:06:42,584 of our populations? 174 00:06:44,079 --> 00:06:46,079 Got it. Certainly, a lot of excitement. Huge 175 00:06:46,079 --> 00:06:48,240 challenge, but huge initiative, I imagine, that a 176 00:06:48,240 --> 00:06:48,639 ton of, 177 00:06:49,360 --> 00:06:51,600 fantastic exciting things coming your way. Once that 178 00:06:51,600 --> 00:06:53,279 is up and done, we'll be paying close 179 00:06:53,279 --> 00:06:55,519 attention to what's going on at Northwell over 180 00:06:55,519 --> 00:06:56,500 the coming months. 181 00:06:56,964 --> 00:06:58,725 Nancy, I did wanna have one other follow-up 182 00:06:58,725 --> 00:07:01,365 question just specifically in relation to the first 183 00:07:01,365 --> 00:07:04,264 trend that you'd mentioned. You talked about the 184 00:07:04,805 --> 00:07:07,944 migration of procedures from inpatient settings to outpatient 185 00:07:08,004 --> 00:07:08,504 settings, 186 00:07:08,830 --> 00:07:10,830 offices being a core part of your focus 187 00:07:10,830 --> 00:07:11,650 at the moment. 188 00:07:12,670 --> 00:07:14,990 Is this something that Northwell is also working 189 00:07:14,990 --> 00:07:15,490 on? 190 00:07:16,029 --> 00:07:16,529 Integrating 191 00:07:16,990 --> 00:07:17,490 behavioral 192 00:07:17,870 --> 00:07:22,035 health or other specialties into primary slash ambulatory 193 00:07:22,095 --> 00:07:24,514 care to help ease the load on emergency 194 00:07:24,574 --> 00:07:27,055 departments. Is this something that Northwell is working 195 00:07:27,055 --> 00:07:29,454 on given some of the capacity challenges that 196 00:07:29,454 --> 00:07:32,334 we've seen at hospital emergency departments across the 197 00:07:32,334 --> 00:07:34,654 country, or is this, something that not on 198 00:07:34,654 --> 00:07:36,444 your on your agenda at the moment? 199 00:07:36,939 --> 00:07:39,420 So no. I'm thrilled to say that, I 200 00:07:39,420 --> 00:07:42,060 think Northwell has been, on the leading edge 201 00:07:42,060 --> 00:07:43,199 of mental health, 202 00:07:43,899 --> 00:07:44,399 resources 203 00:07:44,779 --> 00:07:47,439 and programming for our patient population. 204 00:07:48,620 --> 00:07:51,759 Several years ago, our behavioral health program 205 00:07:52,314 --> 00:07:52,814 department 206 00:07:53,355 --> 00:07:56,954 built out a collaborative care management program where 207 00:07:56,954 --> 00:07:59,274 they embed a social worker in the vast 208 00:07:59,274 --> 00:08:01,454 majority of our primary care practices. 209 00:08:02,634 --> 00:08:04,095 Through that collaborative care, 210 00:08:04,555 --> 00:08:08,000 model, the social workers are integrated and overseen 211 00:08:08,000 --> 00:08:09,620 by psych a team of psychiatrists, 212 00:08:10,560 --> 00:08:11,939 and we really reeducated 213 00:08:12,560 --> 00:08:15,120 our primary care doctors to increase their comfort 214 00:08:15,120 --> 00:08:16,500 level both with the diagnosis 215 00:08:17,120 --> 00:08:17,939 and the management 216 00:08:18,240 --> 00:08:19,699 of anxiety and depression 217 00:08:20,240 --> 00:08:21,860 so that patients have increased 218 00:08:22,235 --> 00:08:23,454 access, to 219 00:08:23,754 --> 00:08:25,535 to the management of depression, 220 00:08:26,314 --> 00:08:27,055 and anxiety 221 00:08:27,915 --> 00:08:30,254 since we know resources are so limited. 222 00:08:30,954 --> 00:08:33,754 Building on that, we committed. We doubled down. 223 00:08:33,754 --> 00:08:35,995 And in 02/2024, 224 00:08:35,995 --> 00:08:38,470 we committed to screen all of our patients 225 00:08:39,089 --> 00:08:39,909 for depression, 226 00:08:40,289 --> 00:08:42,450 and not just those patients that access to 227 00:08:42,450 --> 00:08:45,330 care through primary care, but, we built out 228 00:08:45,330 --> 00:08:48,230 electronic workflows and multiple EMRs 229 00:08:48,769 --> 00:08:51,190 to allow for depression screening across, 230 00:08:51,570 --> 00:08:53,884 any entry point into our ambulatory 231 00:08:54,185 --> 00:08:56,605 network. So all of our specialists were trained 232 00:08:56,904 --> 00:08:58,524 in how to screen for depression. 233 00:08:59,065 --> 00:09:01,945 And then our behavioral health service line, launched 234 00:09:01,945 --> 00:09:04,205 a behavioral health navigation program. 235 00:09:04,585 --> 00:09:07,144 So if a patient is screened positive, we 236 00:09:07,144 --> 00:09:07,644 have 237 00:09:07,950 --> 00:09:10,129 about 18 different community, 238 00:09:10,750 --> 00:09:11,889 resource guides 239 00:09:12,269 --> 00:09:14,509 based on the different markets that we serve. 240 00:09:14,509 --> 00:09:17,170 And then we have one behavioral health navigation 241 00:09:17,309 --> 00:09:17,809 program 242 00:09:18,190 --> 00:09:20,830 where it is also staffed again by social 243 00:09:20,830 --> 00:09:21,550 workers and, 244 00:09:22,394 --> 00:09:25,195 professionals that will assess the patient. They do 245 00:09:25,195 --> 00:09:26,735 a deeper dive assessment, 246 00:09:27,274 --> 00:09:28,975 and they will link that patient 247 00:09:29,514 --> 00:09:32,175 populate that patient to either, you know, telehealth 248 00:09:32,315 --> 00:09:32,815 resources, 249 00:09:33,115 --> 00:09:34,415 in person resources, 250 00:09:35,309 --> 00:09:37,730 whatever the, you know, they look at insurance, 251 00:09:37,789 --> 00:09:39,090 they look at what's available, 252 00:09:39,629 --> 00:09:42,350 and I'm really excited to say last year 253 00:09:42,350 --> 00:09:43,149 we screened, 254 00:09:43,950 --> 00:09:46,850 close to four hundred and fifty thousand individuals 255 00:09:47,789 --> 00:09:48,110 for, 256 00:09:48,669 --> 00:09:49,169 depression. 257 00:09:50,315 --> 00:09:54,475 Our behavioral health service line navigation program received 258 00:09:54,475 --> 00:09:55,774 about 500 259 00:09:55,914 --> 00:09:58,554 referrals per month in the early months that 260 00:09:58,554 --> 00:09:59,774 launched last September 261 00:10:00,235 --> 00:10:03,134 and now it's getting about a thousand navigating 262 00:10:03,195 --> 00:10:05,455 about a thousand patients per month 263 00:10:06,049 --> 00:10:07,669 to behavioral health resources 264 00:10:08,209 --> 00:10:10,370 within our community. So I think that we've 265 00:10:10,370 --> 00:10:11,909 done tremendous work, 266 00:10:12,370 --> 00:10:14,149 and really have made a commitment 267 00:10:14,610 --> 00:10:17,009 across our whole health system and across all 268 00:10:17,009 --> 00:10:17,829 of our specialties 269 00:10:18,529 --> 00:10:20,789 to the mental health needs of our patients. 270 00:10:21,774 --> 00:10:24,575 Wow. Fantastic. I mean, we're so clear how 271 00:10:24,575 --> 00:10:27,134 how much of a leader Northwell Health is 272 00:10:27,134 --> 00:10:28,014 in this space, 273 00:10:28,575 --> 00:10:30,815 given given the critical need across so many 274 00:10:30,815 --> 00:10:33,134 communities, not just in New York, but indeed 275 00:10:33,134 --> 00:10:34,434 really across the country. 276 00:10:35,149 --> 00:10:38,110 And, Nancy, that's, obviously one key area of 277 00:10:38,110 --> 00:10:40,350 excitement for yourself. You did also touch a 278 00:10:40,350 --> 00:10:42,350 little bit on how excited you are about 279 00:10:42,350 --> 00:10:44,370 the upcoming the epic implementation, 280 00:10:44,750 --> 00:10:46,830 the data initiatives, and the opportunities that come 281 00:10:46,830 --> 00:10:48,995 along with that. But when you think about 282 00:10:48,995 --> 00:10:51,235 the future of health care, the future of 283 00:10:51,235 --> 00:10:53,634 Northwell Health, is there anything else that you're 284 00:10:53,634 --> 00:10:55,014 particularly excited about? 285 00:10:55,715 --> 00:10:57,715 So one of the things that I'm excited 286 00:10:57,715 --> 00:10:59,495 about in the ambulatory environment 287 00:11:00,149 --> 00:11:03,129 is, you know, there's definitely increasing complexity 288 00:11:04,069 --> 00:11:04,889 in the ambulatory 289 00:11:05,190 --> 00:11:05,690 environment. 290 00:11:06,230 --> 00:11:07,850 And we are working on, 291 00:11:08,870 --> 00:11:10,089 how do we redesign 292 00:11:10,789 --> 00:11:12,569 our ambulatory quality 293 00:11:12,870 --> 00:11:13,370 infrastructure 294 00:11:14,264 --> 00:11:16,445 to meet the needs of a clinically integrated 295 00:11:16,504 --> 00:11:18,925 health system that is in a huge expansion 296 00:11:18,985 --> 00:11:22,184 phase as we have, recently signed and we'll 297 00:11:22,184 --> 00:11:23,165 be going live 298 00:11:23,545 --> 00:11:25,565 with our, merger with Nuance. 299 00:11:26,610 --> 00:11:29,830 So, really, how do we use our talented 300 00:11:30,049 --> 00:11:30,549 resources 301 00:11:31,250 --> 00:11:33,029 but limited, you know, resources 302 00:11:33,410 --> 00:11:35,910 across our entire network efficiently? 303 00:11:36,450 --> 00:11:39,830 So we've done begun the process of assessing 304 00:11:40,370 --> 00:11:41,830 the clinical attributes 305 00:11:42,154 --> 00:11:44,715 and what's what's actually being done in our 306 00:11:44,715 --> 00:11:45,215 different 307 00:11:45,674 --> 00:11:46,174 ambulatory 308 00:11:46,475 --> 00:11:49,855 sites and, evaluating them for clinical risk. 309 00:11:50,235 --> 00:11:51,835 You know, the that risk being, 310 00:11:52,394 --> 00:11:54,554 either the risk of the patient, the risk 311 00:11:54,554 --> 00:11:55,294 of medications 312 00:11:55,595 --> 00:11:56,415 being used, 313 00:11:56,875 --> 00:11:57,035 the, 314 00:11:58,019 --> 00:12:00,200 the risk to our staff 315 00:12:00,740 --> 00:12:03,059 and saying, okay. Based off of, you know, 316 00:12:03,059 --> 00:12:05,779 these clinical attributes, can we can we look 317 00:12:05,779 --> 00:12:08,259 at our practice sites in a tiering matrix? 318 00:12:08,259 --> 00:12:10,420 You know, tier one being our highest risk 319 00:12:10,420 --> 00:12:10,920 sites, 320 00:12:11,335 --> 00:12:13,575 tier two being our, you know, middle risk, 321 00:12:13,575 --> 00:12:16,154 and maybe tier three being our ordinary 322 00:12:16,455 --> 00:12:18,154 risk sites. What education, 323 00:12:18,534 --> 00:12:20,394 training, resources, competencies 324 00:12:21,095 --> 00:12:23,414 do we need to to really start to 325 00:12:23,414 --> 00:12:23,914 build 326 00:12:24,860 --> 00:12:27,360 for each level of that tier? 327 00:12:27,980 --> 00:12:29,740 And how do we use our, 328 00:12:30,379 --> 00:12:32,480 our quality team to the highest 329 00:12:32,860 --> 00:12:33,679 skill levels? 330 00:12:34,059 --> 00:12:35,579 And how do we build that? So that's 331 00:12:35,579 --> 00:12:36,720 a big exciting, 332 00:12:37,179 --> 00:12:39,595 project for us right now. And what we're 333 00:12:39,595 --> 00:12:42,014 focusing on. Thinking about how do we 334 00:12:42,634 --> 00:12:45,674 work smarter, how do we work efficiently, and 335 00:12:45,674 --> 00:12:47,134 how do we work proactively 336 00:12:48,075 --> 00:12:50,875 from a quality standpoint to drive down risk 337 00:12:50,875 --> 00:12:52,975 to improve patient outcomes 338 00:12:53,595 --> 00:12:54,654 as we move forward. 339 00:12:55,850 --> 00:12:58,490 Fantastic. And I'm so lucky to be able 340 00:12:58,490 --> 00:13:01,049 to talk with such fantastic leaders at Northwell. 341 00:13:01,049 --> 00:13:02,809 I I did mention earlier in the conversation, 342 00:13:02,809 --> 00:13:04,110 I spoke with your CFO, 343 00:13:04,490 --> 00:13:07,209 also spoke to your CEO recently, Michael Dowding. 344 00:13:07,209 --> 00:13:09,289 Now the pleasure of speaking with yourself, Nancy. 345 00:13:09,289 --> 00:13:11,325 But one thing that Michael said that stuck 346 00:13:11,325 --> 00:13:13,804 in my mind was that I believe it 347 00:13:13,804 --> 00:13:15,184 was around about 348 00:13:15,965 --> 00:13:18,705 45, 40 six percent of Northwell's 349 00:13:19,565 --> 00:13:23,004 revenue comes from its inpatient side. So so 350 00:13:23,004 --> 00:13:25,024 much of its revenue is driven 351 00:13:25,340 --> 00:13:27,980 by the outpatient side of your health system, 352 00:13:27,980 --> 00:13:30,399 and that's growing year over year over year. 353 00:13:31,019 --> 00:13:33,259 That's obviously a key key part of growth 354 00:13:33,259 --> 00:13:35,899 for your health systems, health systems across the 355 00:13:35,899 --> 00:13:36,399 country. 356 00:13:36,940 --> 00:13:38,940 I'm kinda just curious with that growth in 357 00:13:38,940 --> 00:13:41,225 mind, what are kinda one, two, three areas 358 00:13:41,605 --> 00:13:44,004 of outpatient specific growth, whether it be a 359 00:13:44,004 --> 00:13:46,884 specific service line, anything that you're really focusing 360 00:13:46,884 --> 00:13:48,644 on in terms of outpatient growth for the 361 00:13:48,644 --> 00:13:50,825 next, one to two years or so? 362 00:13:51,445 --> 00:13:53,205 So I'll start off with we're focusing on 363 00:13:53,205 --> 00:13:55,865 primary care because we have a huge 364 00:13:56,629 --> 00:13:59,990 access need for primary care throughout our country 365 00:13:59,990 --> 00:14:01,450 and certainly in our market 366 00:14:01,910 --> 00:14:04,649 and trying to think of new and, innovative 367 00:14:04,710 --> 00:14:07,750 ways to design primary care that would meet 368 00:14:07,750 --> 00:14:10,649 the needs of our patients and, our communities. 369 00:14:11,375 --> 00:14:14,575 So certainly focused on primary care. And then 370 00:14:14,575 --> 00:14:16,835 I think, you know, we're really looking at, 371 00:14:17,054 --> 00:14:19,214 as I mentioned a little bit before, you 372 00:14:19,214 --> 00:14:22,254 know, those procedures that can be done safely 373 00:14:22,254 --> 00:14:23,875 in the ambulatory environment, 374 00:14:24,480 --> 00:14:27,039 that can grow in the ambulatory environment, that 375 00:14:27,039 --> 00:14:28,799 do not need to be done as in 376 00:14:28,799 --> 00:14:30,339 such a high cost setting 377 00:14:30,639 --> 00:14:32,720 as the hospital. So we're seeing more and 378 00:14:32,720 --> 00:14:36,100 more vascular procedures being done in the ambulatory 379 00:14:36,399 --> 00:14:39,415 environment, more cardiac procedures being done in an 380 00:14:39,415 --> 00:14:40,554 ambulatory environment, 381 00:14:40,934 --> 00:14:41,675 more urologic 382 00:14:42,054 --> 00:14:45,014 procedures being done in an ambulatory environment. So 383 00:14:45,014 --> 00:14:46,875 certainly working with our surgeons, 384 00:14:47,654 --> 00:14:50,634 to strategically think about where is the appropriate 385 00:14:50,855 --> 00:14:51,995 level of care 386 00:14:52,340 --> 00:14:55,720 based off of treatment and diagnosis and condition 387 00:14:56,179 --> 00:14:58,679 as we are really focusing. And then certainly, 388 00:14:59,139 --> 00:15:01,960 lastly, like, the management of chronic diseases. 389 00:15:03,220 --> 00:15:05,879 The the need to to really 390 00:15:06,424 --> 00:15:09,144 engage with and manage our patients who have 391 00:15:09,144 --> 00:15:10,524 multiple chronic conditions 392 00:15:11,144 --> 00:15:12,904 and to make sure that they are plugged 393 00:15:12,904 --> 00:15:15,865 into the appropriate specialty care, that their care 394 00:15:15,865 --> 00:15:16,684 is coordinated 395 00:15:17,065 --> 00:15:18,524 across our health system, 396 00:15:19,350 --> 00:15:22,629 that we are allocating the necessary resources to 397 00:15:22,629 --> 00:15:25,909 do them, that we leverage technologies and team 398 00:15:25,909 --> 00:15:27,850 based care to engage patients 399 00:15:28,470 --> 00:15:31,769 to really improve the care because it's certainly 400 00:15:31,990 --> 00:15:34,169 those patients with lots of chronic conditions 401 00:15:34,554 --> 00:15:36,715 that drive up cost in our health system 402 00:15:36,715 --> 00:15:39,274 and and drive down outcomes. So we really 403 00:15:39,274 --> 00:15:40,875 wanna make sure we are giving them the 404 00:15:40,875 --> 00:15:43,595 resources they need to have the best care 405 00:15:43,595 --> 00:15:45,134 and the best outcomes possible. 406 00:15:46,315 --> 00:15:49,019 Fantastic. I mean, always a pleasure to to 407 00:15:49,019 --> 00:15:51,019 kinda dive deeper into some of these great 408 00:15:51,019 --> 00:15:54,220 initiatives that fantastic leaders, that fantastic health systems 409 00:15:54,220 --> 00:15:56,079 like yourselves are working on. 410 00:15:56,860 --> 00:15:58,940 Nancy, if you don't mind hearing me, I'd 411 00:15:59,100 --> 00:16:01,259 one last question sprang to mind. I'd love 412 00:16:01,259 --> 00:16:02,860 to end on a a safety or a 413 00:16:02,860 --> 00:16:03,919 quality question, 414 00:16:04,664 --> 00:16:06,845 that just sprung up based on a recent 415 00:16:06,904 --> 00:16:07,404 Becker's, 416 00:16:08,024 --> 00:16:09,164 report that we covered. 417 00:16:10,184 --> 00:16:12,605 I believe this report said that inadequate 418 00:16:13,144 --> 00:16:16,264 coordination during patient discharge is one of the 419 00:16:16,264 --> 00:16:19,485 top threats to patient safety in 2025. 420 00:16:19,799 --> 00:16:20,639 Is there anything 421 00:16:21,080 --> 00:16:24,360 a specific strategy that Northwell is implementing or 422 00:16:24,360 --> 00:16:26,539 maybe has implemented to improve 423 00:16:27,000 --> 00:16:29,480 discharge coordination? And maybe how do you expect 424 00:16:29,480 --> 00:16:31,179 it to reduce safety risks 425 00:16:31,559 --> 00:16:34,620 or likely improve continuity of care? 426 00:16:35,774 --> 00:16:36,274 So 427 00:16:36,654 --> 00:16:39,294 Northwell has been focused for the last several 428 00:16:39,294 --> 00:16:39,794 years 429 00:16:40,334 --> 00:16:42,514 on transitions of care and especially 430 00:16:43,054 --> 00:16:45,054 those that happen at the time of hospital 431 00:16:45,054 --> 00:16:45,554 discharge. 432 00:16:46,894 --> 00:16:49,794 Many different initiatives have gone on. 433 00:16:50,309 --> 00:16:50,950 We have, 434 00:16:51,429 --> 00:16:55,210 our health management and care coordination team manages 435 00:16:55,429 --> 00:16:59,049 our health our highest risk patient population 436 00:16:59,590 --> 00:17:00,889 at the time of discharge 437 00:17:01,350 --> 00:17:02,170 with putting 438 00:17:02,595 --> 00:17:05,315 with case management, seeing that patient in the 439 00:17:05,315 --> 00:17:05,815 hospital 440 00:17:06,194 --> 00:17:07,575 and additionally coordinating 441 00:17:07,875 --> 00:17:09,335 them with outpatient 442 00:17:09,634 --> 00:17:10,454 case management, 443 00:17:11,154 --> 00:17:13,575 we've also seen, you know, the the critical 444 00:17:13,714 --> 00:17:15,255 importance of engaging, 445 00:17:15,875 --> 00:17:16,775 primary care 446 00:17:17,170 --> 00:17:18,710 and a team based approach 447 00:17:19,329 --> 00:17:22,150 that really gets those patients into visits, 448 00:17:23,089 --> 00:17:25,890 within seven days ideally, but within fourteen days 449 00:17:25,890 --> 00:17:26,630 of discharge. 450 00:17:27,170 --> 00:17:28,390 The use of medication 451 00:17:28,690 --> 00:17:29,190 reconciliation 452 00:17:30,164 --> 00:17:32,725 early to make sure so we have engaged 453 00:17:32,725 --> 00:17:35,525 more and more our pharmacists from our Vivo 454 00:17:35,525 --> 00:17:36,025 Health 455 00:17:36,325 --> 00:17:39,045 to help us reconcile medications at the time 456 00:17:39,045 --> 00:17:41,285 of discharge with patients to make sure that 457 00:17:41,285 --> 00:17:42,505 they know what medications 458 00:17:42,965 --> 00:17:45,529 they need, making sure we get home health 459 00:17:45,529 --> 00:17:47,309 services engaged early, 460 00:17:48,009 --> 00:17:49,789 and that we have the appropriate 461 00:17:50,170 --> 00:17:52,750 conversations, including goals of care conversations 462 00:17:53,369 --> 00:17:55,470 with our patients while they are hospitalized 463 00:17:56,105 --> 00:17:57,945 to make sure that what we the treatment 464 00:17:57,945 --> 00:18:00,445 we are giving them matches with their personal 465 00:18:00,744 --> 00:18:03,305 goals for their care are. And I'm really 466 00:18:03,305 --> 00:18:04,984 excited to you know, I was actually on 467 00:18:04,984 --> 00:18:06,445 a conference this morning 468 00:18:06,984 --> 00:18:09,705 discussing, and the trend year over year has 469 00:18:09,705 --> 00:18:11,484 been a steady decrease 470 00:18:12,079 --> 00:18:14,480 across all, you know, our over our 20 471 00:18:14,480 --> 00:18:14,980 hospitals 472 00:18:15,599 --> 00:18:16,420 in readmissions. 473 00:18:17,839 --> 00:18:19,460 So I think it's very 474 00:18:19,920 --> 00:18:22,660 I I think it's diligent work. It's multifactorial 475 00:18:23,200 --> 00:18:24,980 work that takes a lot of 476 00:18:25,335 --> 00:18:28,315 teamwork and a lot of different different levers 477 00:18:28,934 --> 00:18:30,934 to really make a difference, but it's the 478 00:18:30,934 --> 00:18:31,434 hyperfocus 479 00:18:32,615 --> 00:18:35,015 and the commitment to doing that work that 480 00:18:35,015 --> 00:18:35,994 really drives, 481 00:18:37,174 --> 00:18:39,480 you know, the teams to to address all 482 00:18:39,480 --> 00:18:42,460 of the different opportunities and and challenges. 483 00:18:43,559 --> 00:18:44,059 Fantastic. 484 00:18:44,680 --> 00:18:47,960 Doctor Nancy Barron, really, really so appreciate the 485 00:18:47,960 --> 00:18:50,119 work that that you that your teams do. 486 00:18:50,279 --> 00:18:52,039 So greatly respect the work that you and 487 00:18:52,039 --> 00:18:52,904 your teams do. 488 00:18:53,384 --> 00:18:54,904 Thank you so much for taking the time 489 00:18:54,904 --> 00:18:56,744 out of your busy schedule to to join 490 00:18:56,744 --> 00:18:58,744 us on the Becker's healthcare podcast today. Thank 491 00:18:58,744 --> 00:19:01,244 you. Thank you. Thank you for having me.