Editors’ Note

Dr. Zenobia Brown oversees Northwell Health Solutions’ clinical programs, where she designs, implements and manages value-based care management programs. She also collaborates with site, clinical and managed care leaders to develop Northwell’s value-based clinical strategy. As Medical Director for Northwell Health Solutions, a role she has worked in since 2014, Dr. Brown established episodic care models for orthopedics, stroke, COPD and cardiothoracic surgery patients. She oversaw Northwell’s Health Home Program and collaborated on its system-wide effort to reduce Medicare readmissions. Board-certified in family medicine, and hospice and palliative care, Dr. Brown also maintains a clinical practice within Northwell’s House Calls program. She received her medical degree from Columbia University College of Physicians and Surgeons and completed a family medicine residency and chief residency at New York-Presbyterian/Columbia University Medical Center. Dr. Brown spent more than a decade in Florida, where she helped implement state Department of Health community-based services, received a master’s degree in public health from the University of South Florida and served as Associate Medical Director at Tidewell Hospice and Palliative Care.

Institution Brief

Northwell Health (northwell.edu) is New York State’s largest healthcare provider and private employer, with 21 hospitals, 850 outpatient facilities and more than 12,000 affiliated physicians. Northwell Health cares for more than two million people annually in the New York metro area and beyond, thanks to philanthropic support from its communities. Its 79,000 employees – 18,900 nurses and 4,900 employed doctors, including members of Northwell Health Physician Partners – are working to change healthcare for the better. They are making breakthroughs in medicine at the Feinstein Institutes for Medical Research. Northwell Health is training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Nursing and Physician Assistant Studies.

Will you highlight Northwell Health Solutions and how you define its purpose?

Health Solutions is a division which was established to assure that Northwell is successful in value-based models of care. Value-based care is a mechanism by which providers of healthcare get paid based on the clinical outcomes and quality of patient care as opposed to the traditional model around quantity of care. To succeed in this space, there is a need to leverage new healthcare technologies and be very innovative on how the care is delivered. Oftentimes, this means delivering care in alternative ways (for example, through digital platforms) and locations (for example, in the patients home). The key factor in these innovations is that the approach is customized to the patient, always considering what technology or clinical care is most convenient to them, and what type of care is most likely to achieve an optimal outcome.

Northwell Health launched the Center for Maternal Health. Will you provide an overview of the Center and its effort to reduce the country’s maternal mortality rate?

As a nation we are struggling with the fact that on a per-capita basis we spend more on healthcare than any other nation with similar economies. Despite this level of healthcare investment, we lag in terms of our clinical outcomes, including maternal mortality where women in the U.S. are three to four times more likely to have a poor outcome. What is equally alarming is that Black women in the U.S. are three to four times more likely than their white counterparts to have these disparate outcomes. Of every infant in the nation, 1 percent is born at a Northwell facility and while we have been successful in assuring that our outcomes are superior to the national averages, we recognize that there is more work to do. It is precisely because of our depth of expertise and programming that Northwell looks to be a national leader in promoting and deploying best practices which improve outcomes for all women and eliminate the disparities in outcomes that we see by race and ethnicity. The Center for Maternal Health convenes stakeholders and content matter experts throughout our organization and in the community, such that we promote scientific and evidentiary discovery, while simultaneously deploying and effectuating care models in real-time which impact patient outcomes. In other words, coming together to establish and innovate on best practice and deploying and disseminating that design, keeping our mothers and infants healthy.

How will the Center work to address health risks facing Black women in America who you mentioned are three times more likely to die from pregnancy-related causes than white women?

Based on the terrible disparities in outcomes, we will be focusing in particular on care of Black women. One of the first risks to Black women that is in our power to control is the risk that they will not be listened to when they identify an issue. We can save many lives in the U.S. simply by listening to women when they tell us something is wrong. For this reason, we will have a focus on workforce training around biases specific to pregnancy. Throughout the pregnancy and post-partum, we will be active partners with women in assessing and ameliorating their risks. This means using low tech solutions like asking women to measure their blood pressures, or if they are at risk, taking an Aspirin, to high-tech solutions like automatic chat bots that assess symptoms and connect mothers in real time virtually with healthcare providers. It means deploying patient-centered care navigation to wrap additional services around our highest risks mothers. Across all of the work is the recognition that there are social vulnerabilities that have to be addressed in addition to the medical risks. All of our pregnant women will also be assessed for these vulnerabilities and connected with services, assuring that we are taking a 360-degree approach to wellness.

Will you discuss the value and benefit for the Center to be part of the Katz Institute for Women’s Health?

Katz is a critical component in this work. We understand that many pregnancy risks predate the pregnancy and exist well after delivery. Having an organization like Katz, which is establishing and convening expertise on healthcare specific to women, provides real opportunity to connect women with life-saving treatment at all phases of their reproductive cycle. This approach is about optimizing health through prevention, expert management, and treatment of disease and risk which is critical to have a lasting impact on the total health of women.

What is your hope for the impact that the Center for Maternal Health will make in reducing the country’s maternal mortality rate?

My hope is that Northwell will set a new standard in terms of the kind of care that we can deliver for women by providing the care that women need and deserve regardless of background. My hope is that this model will be reproducible and replicated nationwide. I believe we can do it and we owe women and families the care they need and deserve.