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

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.

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.

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])

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])

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])

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])

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

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.