Editor's Note: Back in August 2012, CHI published its safety net clinic database for the first time in acknowledgment of National Health Center Week and Safety Net Clinic Week. CHI has now released an update to those resources: a database of Colorado safety net clinics, and two maps showing where they are located throughout the state. They are available here.
Nurse practitioner Deanna Tolman’s approach to health care is based on common-sense principles. Among them: Keep quality high, prices low and use technology to handle a lot of the paperwork.
Her Aurora family practice clinic, Head2Toe Healthcare, is one of the newer organizations that make up Colorado’s health care safety net - providers and clinics offering medical, dental or mental health care to low-income uninsured and underinsured residents and people with public health insurance.
“Anybody who walks through the door gets to be seen within a reasonable period of time,” Tolman says.
The safety net landscape in Colorado changes frequently as some providers drop out and others, like Head2Toe, open for business. In response, the Colorado Health Institute maintains a database of Colorado providers that is updated twice a year as part of its catalog of information about this essential piece of the health care system. The database includes a list of clinics with information such as type of services, addresses, websites and more.
The Colorado Health Institute and its Safety Net Advisory Committee (SNAC) also host the SNAC Labs project, which brings together policy makers, advocates, providers and philanthropic organizations to discuss challenges and successes in securing access to health care for vulnerable Coloradans.
As for Tolman, she launched her clinic in September 2010. About 30 percent of her patients are uninsured, 30 percent are covered by Medicaid and 40 percent are commercially insured. Her clinic is based on the “ideal medical practice” model, which aims to keep overhead low, provide personalized service and employ technology for appointments and record-keeping, among other things.
“I’m a nurse practitioner with very, very specific ideas on how health care ought to be done,” she says. “And when I was working as an employee for physicians, I wasn’t allowed to do it that way.”
Tolman, who earned a doctorate degree from Columbia University, runs her clinic using minimal staff and without physicians, whose care is typically more expensive than that provided by a nurse practitioner. She offers longer appointments - 90 minutes or so for new patients -- to provide time for more complete care and to educate patients and learn about their lives.
“You have to take the time to hear the whole story, put all the clues together, to find what the problem is,” she says. “And then you have to teach the patient why they’re taking whatever treatment you’re going to prescribe for them.”
Tolman keeps her overhead in check – the office is outfitted by Ikea and she painted it herself – and typically clocks 60 or more hours a week. Patients can set their own appointments online.
“I use software to help me manage instead of hiring more people,” she says. “We try to keep our prices low by keeping our overhead low.”
One of her guiding principles, she says, is that “everybody should be able to have health care.”
Tolman has plenty of ideas on how to improve the system, but her focus is much more on people than policy.
“I’m not trying to save the world here,” she says. “I’m trying to help the patient sitting in front of me."