{"id":4919,"date":"2016-02-03T00:00:00","date_gmt":"2016-02-03T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/02\/03\/at-this-clinic-the-doctor-is-out\/"},"modified":"2019-02-05T09:17:39","modified_gmt":"2019-02-05T16:17:39","slug":"at-this-clinic-the-doctor-is-out","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/at-this-clinic-the-doctor-is-out\/","title":{"rendered":"At this clinic, the doctor is out"},"content":{"rendered":"
<\/div>
<\/h5>\n

At the new CU Healthcare Partners @ Belleview Point clinic, the doctor is not in \u2013 and that\u2019s the idea.<\/p>\n

The University of Colorado College of Nursing (CON) clinic opened Jan. 19 in a bright second-floor space in a modern strip mall at Parker Road and Belleview Avenue in Aurora. It takes the proven notion that advanced practice nurses (APNs) can provide first-rate primary care at affordable prices to its logical conclusion.<\/p>\n

HCP Belleview\u2019s<\/a> full-time staff includes a family nurse practitioner, a licensed clinical social worker to consult with patients on the behavioral aspects of whole-person care, a medical assistant\/receptionist, and an office manager. It\u2019s a lean operation, this gleaming clinic above the Chubby\u2019s Fresh Mexican Grille, but it\u2019s also innovative on the financial end. The clinic offers both low-cost fee-for-service<\/a> as well as subscription-based direct primary care options. The latter involves a flat monthly fee ranging from<\/a> $19 (for those ages 2-18) to $79 (50 and older) \u2013 with no co-pay.<\/p>\n

The CON invested about $300,000 in launching the clinic, says Adrienne Wolf, MPH, the clinic\u2019s operations manager; if it\u2019s a clinical and financial success \u2013 it may take a year to 18 months to determine that \u2013 the plan is to open more clinics where the doctor is out.<\/p>\n

From left, Adrienne Wolf, Kristen Petrelli and Carolyn Hughes at the CU Health Partners at Belleview Point clinic.<\/figcaption><\/figure>\n

The new clinic was Amy Barton\u2019s<\/a> idea. Barton, RN, PhD, is chair of Rural Health Nursing at the CON and a longtime proponent of addressing the shortage of primary care physicians by having APNs work at the top of their games.<\/p>\n

In Colorado, nurse practitioners (NPs) are allowed to diagnose, treat and prescribe medication without physician oversight. It\u2019s hard to find a primary care clinic that doesn\u2019t harness their talents to some degree. They are a mainstay of care for the underserved, and they\u2019re the focus at CON\u2019s Sheridan Health Services<\/a>, whose establishment Barton also led. But it was a second APN-focused practice, the Center for Midwifery<\/a>, that hinted at the potential for combining NP-based care with a direct primary care subscription approach, Barton said.<\/p>\n

\u201cThe Center for Midwifery showed that there is a demand for advanced practice nursing services, and people are willing to pay for it,\u201d Barton said.<\/p>\n

Symbiosis<\/strong><\/p>\n

Not that the NP can do everything, said Kristen Petrelli, FNP, the board-certified family nurse practitioner who spearheads patient care at HCP Belleview. Petrelli took the job after a decade working as an oncology nurse, most recently with the multidisciplinary Lung Cancer Clinic at the University of Colorado Cancer Center at University of Colorado Hospital (UCH). She made the switch in part because she saw how improved access to primary care could have helped catch cancers sooner, she said.<\/p>\n

\u201cI thought it would be great to manage chronic needs and get to things earlier,\u201d she said.<\/p>\n

She says the clinic is establishing close relationships with UCHealth providers at the Anschutz Medical Campus, where she refers patients with complex, chronic or serious conditions. The referrals go both ways, adds Wolf: The UCH Emergency Department has referred patients to HCP Belleview for primary care follow-up. She views the relationship with UCHealth as symbiotic. They chose the clinic\u2019s location because it was far from other UCHealth\u2019s primary care clinics; going forward, she hopes to be referring patients to (and receiving referrals from) the nearby UCHealth ERs at Mississippi Ave. and Chambers Road and at E. Smoky Hill Road and E. Arapahoe Road.<\/p>\n

That\u2019s not happened just yet, Wolf said, because she\u2019s been busy being what amounts to a health care startup entrepreneur. She took the job in March, just as Barton signed the lease, and spent the ensuing months helping to establish everything from d\u00e9cor to service delivery. The latter involved building a list of services \u2013\u00a0 relating to strep, blood sugar (there\u2019s onsite HbA1c testing), sprains, skin conditions, stitches, smoking cessation and a raft of others \u2013 and then coming up with prices. She benchmarked to come up with the clinic\u2019s retail prices (now posted<\/a> on the website in a deliberate effort to be transparent, Wolf said) and then worked with Barton to come up with the monthly\/annual direct primary care pricing.<\/p>\n

\u201cI had this big spreadsheet matrix, and from that, we narrowed it down to what was competitive,\u201d Wolf said.<\/p>\n

She also contracted with the Denver Health NurseLine for 24\/7 phone consults for patients and with electronic health record provider Aprima<\/a>, which interfaces well with UCHealth mainstay Epic but is less of an information behemoth.<\/p>\n

\u201cEpic would be like killing a flea with a sledgehammer,\u201d Wolf said.<\/p>\n

Start it up<\/strong><\/p>\n

She was also on the hook for publicizing the clinic\u2019s opening. It attracted a deluge of attention: TV crews from FOX31<\/a>, 9News, CBS4<\/a>, and Channel 7<\/a> were all on hand when the doors opened on Jan. 19. A shower of email inquiries followed and continue to come in, Wolf said. About half the patients so far have been Medicare\/Medicaid, she said, and while HCP Belleview accepts a growing list of insurance plans, many of the rest have been uninsured. For those with high-deductible insurance, she\u2019s positioning the clinic \u2013 in particular the direct primary care option \u2013 as a way to address preventive and non-catastrophic care on a budget.<\/p>\n

Colorado is among the top-10 states with people with high-deductible insurance plans, Barton said.<\/p>\n

\u201cThe direct primary care approach allows them to pay for that membership fee and get primary care \u2013 we didn\u2019t really think we were meeting an access need, but we are,\u201d she said.<\/p>\n

The goal is to see 4,000 patients the first year, and to introduce each of them to Carolyn Hughes, LCSW, on their first visit. The clinic has four consultation rooms \u2013 three outfitted as classic exam spaces and a fourth with a small couch and easy chair. This is Hughes\u2019 domain, the physical expression of a belief in the inseparability of physical and mental health care.<\/p>\n

\u201cIt is really our philosophy of care,\u201d Barton said. And considering that two of the top five primary care diagnoses are anxiety and depression, she added, \u201cHow can you see that patient population and not provide behavioral health services?\u201d<\/p>\n

Patients in need of behavioral-health counseling (the initial, hour-long introductory session with Petrelli includes a short test for depression) will then work with Hughes, either as a warm hand-off or via a scheduled appointment. The counseling might involve tobacco cessation; it might revolve around grief and loss. Hughes takes all comers. She refers serious psychiatric cases to specialists.<\/p>\n

\u201cRight now, we\u2019re just trying to engage,\u201d said Hughes. \u201cMy job is to do brief, focused change interventions and engagement. I\u2019m not going to have a caseload of 100 patients and see them for an hour laid out on the couch every week.\u201d<\/p>\n

For Hughes, the absence of a physician may be new, but it\u2019s no surprise.<\/p>\n

\u201cNurse practitioners are everywhere. Doing a stand-alone clinic like this was the next thing. It\u2019s a fabulous model,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":"

At the new CU Healthcare Partners @ Belleview Point clinic, the doctor is not in \u2013 and that\u2019s the idea. The University of Colorado College of Nursing (CON) clinic opened Jan. 19 in a bright second-floor space in a modern strip mall at Parker Road and Belleview Avenue in Aurora. It takes the proven notion […]<\/p>\n","protected":false},"author":23,"featured_media":2189,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,48,351],"class_list":["post-4919","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-cancer-center","tag-primary-care"],"acf":[],"yoast_head":"\nAt this clinic, the doctor is out - UCHealth Today<\/title>\n<meta name=\"description\" content=\"At the new CU Healthcare Partners @ Belleview Point clinic, the doctor is not in \u2013 and that\u2019s the idea. 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