Scaling Ambulatory Quality and Depression Screening at Northwell Health with Nancy Beran, MD

Summary

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Podcast Summary: Scaling Ambulatory Quality and Depression Screening at Northwell Health with Nancy Beran, MD

Podcast: Becker’s Healthcare Podcast
Host: Erica Carbajal
Guest: Dr. Nancy Beran, Vice President and Chief Quality Officer of Ambulatory Care, Northwell Health
Date: February 24, 2026

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Episode Overview

In this episode, Dr. Nancy Beran discusses Northwell Health’s innovative efforts to scale quality initiatives across ambulatory settings, focusing particularly on the implementation of system-wide depression screening and redesigning quality oversight for a rapidly growing network of over 1,000 ambulatory care sites. Dr. Beran gives insight into the strategies used to track, improve, and standardize care, addresses the challenges of integrating new practices and digital systems, and shares her vision for future growth and patient experience improvements at Northwell Health.

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Key Discussion Points & Insights

Dr. Beran’s Background and Northwell’s Ambulatory Expansion

• Background & Role ([01:09]):

  • Dr. Beran is an internist specializing in women’s health and began her quality leadership journey by co-founding a multi-specialty group, eventually joining Northwell Health in 2017.
  • Became the inaugural Chief Quality Officer for ambulatory care in 2021, now overseeing over 1,000 ambulatory sites.
  • Quote: “I'm an internist by training… I started in my current role as chief quality officer for ambulatory in 2021. I was the inaugural person in that role.” ([01:09])

• Ambulatory Care Trends ([02:14]):

  • Increasing migration of complex procedures from hospitals to ambulatory settings and subsequently to office-based care.
  • Northwell’s rapid growth necessitates robust quality oversight.

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Major Quality Initiatives from 2024–2026

1. System-wide Depression Screening

• Description & Impact ([03:20]–[06:35]):

  • Recognizing the mental health crisis, Northwell launched routine depression screening for all patients—across all specialties, not just primary care.
  • Built EMR workflows and digital interfaces for universal deployment.
  • 700,000+ unique patients screened in one year.
  • Positive screens led to referrals to primary care or the behavioral health team, deploying collaborative care, LCSWs, and telehealth partnerships.
  • Quote: “If you saw a Northwell physician last year, you were administered at a minimum...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 could hook you up with resources.” ([03:36])

• Behavioral Health Integration ([05:10]):

  • Built collaborative care models in primary care, pediatrics, internal and family medicine, and select specialties.
  • Stood up a behavioral health navigation center and partnered for urgent behavioral health appointments (including telehealth).
  • Quote: “We partnered with several companies for telehealth to provide services for our patient population. So really exciting work there on depression screening.” ([06:25])

• Screening Outcomes & Challenges ([07:33]):

  • 4–5% positivity rate observed, possibly impacted by screening nontraditional settings (e.g., orthopedics).
  • Challenges in directly correlating depression screening/referral with reduced ED usage due to confounding variables.
  • Quote: “I often think that depression is a confounding variable…not always the main cause for the ER visit.” ([07:55])

2. Redesign and Tiering of Ambulatory Practices

• Restructuring Approach ([08:53]–[13:10]):

  • Mergers and rapid growth (e.g., with Nuvance Health) made oversight across a vast geography challenging.
  • Initiated comprehensive surveys to assess every site’s operations, clinical complexity, regulatory status, and risk-level.
  • Developed a tiered rating system to allocate resources efficiently and tailor oversight based on risk profiles.
  • Quote: “We looked at all of these different clinical attributes...came up with a rating and tiering system that allows us to evaluate our practice sites off of tiers.” ([11:20])

• Resource Allocation & Targeted Support ([12:45]):

  • Staff distribution, quality nurse oversight, and operational support now aligned with tier/risk level.
  • Facilitates appropriate onboarding for new practices and ensures foundational quality across all sites.
  • Quote: “How do we distribute the offices that [our team] oversee...with targeted visits and checklists and oversight for each of those tiers?” ([12:55])

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Data-driven Quality Improvement

• Mapping & Standardization ([13:10]):
  • Emphasized using data to drive quality interventions and resource decisions.
  • Lean, efficient models are necessary amidst ongoing expansion.
  • Quote: “We're all resource-constricted…trying to do more and more with less. So 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?” ([13:42])

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2026 Priorities and Challenges

Integration and Digital Transformation

• Cultural and Structural Integration ([14:27]):

  • Ongoing challenge of integrating new practice sites, cultures, and systems after mergers and acquisitions.
  • Need for alignment of goals and shared best practices when combining health systems.
  • Quote: “It takes a lot of personal time to understand where another health system is at in their journey…how do you both grow faster together, and how do you merge your resources and align your structures?” ([14:35])

• Epic Implementation ([15:30]):

  • Northwell is implementing Epic EMR, sunsetting multiple legacy systems.
  • Standardization across the system will enhance interoperability, referral management, access, and patient experience improvements.
  • Quote: “It's not just the journey of implementing Epic and a new EMR, but also building the culture around standardization of clinical workflows.” ([15:47])

Opportunities for Growth

• Enhancing Patient Experience & Access ([16:54]–[17:56]):
  • Leveraging digital transformation to streamline access, ambulatory efficiencies, and care standardization.
  • Building programs and centers of excellence, raising awareness for services already within Northwell.
  • Quote: “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 drive access, I think that is really where we will thrive and grow.” ([16:56])

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Memorable Quotes & Moments

• On Scaling Depression Screening:
  “If you saw a Northwell physician last year, you were administered at a minimum...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 could hook you up with resources.” —Dr. Nancy Beran ([03:36])

• On Resource Allocation:
  “How do we distribute the offices that [our team] oversee...with targeted visits and checklists and oversight for each of those tiers?” —Dr. Nancy Beran ([12:55])

• On Growth and Integration:
  “How do you both grow faster together, and how do you merge your resources and align your structures?” —Dr. Nancy Beran ([14:37])

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Important Timestamps

• 01:09 – Dr. Beran’s background and Northwell’s ambulatory footprint
• 03:20 – Launch of system-wide depression screening initiative
• 06:48 – Effects of screening on ED strain and ongoing tracking
• 08:53 – Practice site mapping, survey, and tiering process
• 13:10 – Data-driven resource allocation and standardization efforts
• 14:27 – Main 2026 priority: integrating new sites and systems
• 15:30 – Epic EMR implementation and impact on patient experience and workflows
• 16:54 – Opportunities for growth in digital transformation, patient access, centers of excellence

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Summary

This episode provides a comprehensive look at the complexity of scaling quality initiatives and mental health screening across a massive, rapidly growing ambulatory network. Dr. Nancy Beran illustrates how Northwell Health is utilizing data-driven approaches, innovative digital tools, and structured integration strategies to maintain and elevate quality, improve patient outcomes, and achieve operational efficiency. She candidly addresses both the challenges and opportunities inherent in their transformation journey, offering valuable insights for any health system facing similar growth and integration demands.

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Transcript

[A]

Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.

[B]

Hi everyone. You are listening to the Becker's Healthcare Podcast. I'm Erica Carbajal, an editor with Becker's Hospital Review, and thank you so much for tuning into this episode. Today we're lucky to be joined by Dr. Nancy Barron, Vice president and Chief Quality Officer of ambulatory care at Northwell Health. Dr. Dr. Barron, pleasure to have you on. Thank you for being here.

[C]

Thank you for having me.

[B]

Well, to start us off, do you mind sharing a little bit about your background in healthcare and the scope of your work at Northwell?

[C]

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 14 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 neat inaugural person in that role.

[B]

Yeah. Dr. Barron, it's interesting to hear too, 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, you know, that's just becoming so much more important in an elevated priority as more care moves to those settings.

[C]

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 continued through acquisitions and mergers to grow in size and now we have over 1000 different ambulatory sites that my team really is providing support for.

[B]

Yeah, it's a big footprint to oversee. Dr. Barron, can you share one of the most important initiatives that you've led in overseeing ambulatory care over the past year? We what was it and what were some of the results?

[C]

So I'm going to 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 1 in 5 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 Northville physician last year, you were administered at a minim 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 could hook you up with resources. It's something that we began the work in 2024 with piloting with just one of our specialty service lines, our ent service line, and built out the process. And we worked through the process with our primary care physicians and GRE 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 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 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 daycare 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.

[B]

Yeah. Dr. Baron, thank you. Really interesting to hear about scaling that depression screening system wide. I imagine such a big undertaking, 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 really sounds like it starts with being able to do this at scale and goes a long way in avoiding unnecessary or preventable ED visits. So I guess my follow up question 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?

[C]

Hard to tell. On ED strain, we're seeing about a 4 to 5% 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 are 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 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.

[B]

Yeah, no, that makes sense. Interesting to hear. Leah, do you want to share a little bit more too around the redesign that you are, that you're looking at in terms of ambulatory?

[C]

Right. So, you know, we, we joined, you know, this. My team has been managing, you know, a large geography and footprint since I've started, but that geography and footprint print 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 involved 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, and 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? Did 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 in 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 procedure suite? Are they 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 checklists and oversight for each of those tiers. So we're making tier one our highest risk, then tier two, 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 supported, supportive, what do we need to, you know, perhaps hire or fill? So it's really been a huge initiative for how we are redesigning our thinking about ambulatory quality.

[B]

Yeah. Dr. Baron, I've heard a lot to quality leaders talk about 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 the 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.

[C]

Yeah, it's trying to use data to drive change 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 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?

[B]

Mm, 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 navig. Navigating.

[C]

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 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 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, and it also allows us to have way more of a more rapid digital transformation. So it's allowing us at Northwell to go right into online booking and 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 kind of major change, major institutional digital change, I think is really what we're facing this year.

[B]

Yeah, definitely. I know that EPIC implementation is a huge project and I imagine will lay the foundation for what will be just continued innovation in patient care and workflows and being able to enable that. Dr. Baron, what do you see as the biggest opportunity for growth at Northwell in the year or several years ahead?

[C]

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 utilize the opportunities 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 high quality and really improving access, which is what we hear about is really the struggle for our patients.

[B]

Yeah, certainly. Well, Dr. 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 hearing from you live. So thank you so much, and I'm excited to catch up again soon.

[C]

Thank you so much, Erica. Looking forward to seeing you, too.