Nurse practitioner-led clinics triple patient visits since 2019
Wellness 360, a growing patient-care practice of the UT Health San Antonio School of Nursing, quickly has established itself providing primary and acute care to the public at the school’s main campus, at a variety of community partner sites and on campuses of The University of Texas at San Antonio and Alamo Colleges.
What began exclusively as an employee and student health clinic, the practice started expanding in 2018 to include pediatric care, essentially opening to the public, and progressing to a general practice for adults as well, with care provided by nurse practitioners and nurses. By the end of the last fiscal year, total annual patient visits had more than tripled to 35,600, from 2019.
Along the way, Wellness 360 was recognized for excellence in health care for foster families, leading to a $4 million federal grant to expand foster health care services to a 28-county region of Central Texas and the Hill Country. And its orange, 40-foot-long mobile nursing unit has become a common sight in local communities and rural areas.
“I think we are a significant part of clinical practice at UT Health San Antonio,” said Cindy Sickora, DNP, RN, FAAN, clinical professor and vice dean of practice and engagement at the UT Health San Antonio School of Nursing. “It really evolved from accepting a few pediatric patients to a full-blown pediatric practice and the adult services we provide, which also include behavioral health.”
Sickora estimates that about one-third of the overall practice is available to the public, still led by pediatrics, which is fully open to the public. But she sees that expanding to 50% in the near term, with continuing growth expected in pediatrics, adult primary care and behavioral health.
Why not see everyone?
She traces the beginning to 2018, when Karen Schwab, PhD, APRN, CPNP-PC, PMHS, an associate professor/clinical at the UT Health San Antonio School of Nursing, told her she had a few pediatric patients she’d like to see at the clinic.
“When Karen started seeing patients from the outside,” Sickora said, “that’s when we started saying, ‘Why can’t we just see everyone?’ And that’s what we started doing.”
Schwab started with just a waiting area and an exam room in the student health clinic on the main campus in January of that year. By the summer, the student and employee clinics combined into a single space, and Schwab and her tiny staff were full onboard seeing pediatric patients in the former student health clinic.
The pediatric business continued to grow, last year reaching 3,778 patient visits, more than double from 1,734 in 2019. Adult primary care followed, and Wellness 360’s behavioral health wellness services moved into a renovated space upstairs. More providers joined, and now the overall clinic operation numbers 23 nurse practitioners plus nurses.
“We have services a lot of places don’t – pediatrics, adult and behavioral health – and we wanted to bring as many services under one roof as possible to make it more convenient,” Schwab said. “Also, we have a lot of Medicaid patients who sometimes felt like they weren’t treated right. We have the philosophy that everyone deserves concierge-level service.”
Foster health care leader
On the strength of its pediatric and behavioral health services growth, Wellness 360 in 2019 received a Foster Care Center of Excellence designation from Superior HealthPlan, becoming the state’s only nurse practitioner-led and -managed health care clinic earning the honor.
And it followed that in 2022 with the four-year federal grant from the Health Resources and Services Administration to fund access to community-based health care for foster care children and their families, across the state’s Public Health Region 8. The first community hub under the grant program opened earlier this year at the New Braunfels campus of SJRC, one of Wellness 360’s foster care partners.
Schwab said those were major milestones. In the process, Wellness 360 connected with a lot of community partners, particularly those providing child welfare services. And it was through those connections that it received its first contracts for RN (registered nurse) services away from the main campus.
Having RNs at those locations allowed Schwab and others as nurse practitioners to go there and provide full primary care, and behavioral health care providers followed as well. Wellness 360 has partnered with community agencies including SJRC, The Children’s Shelter, Healy Murphy Center and others.
More partnerships, going mobile
Meanwhile, in 2020, Wellness 360 partnered with the Alamo Colleges District to provide telehealth services to students during the pandemic. It later expanded to provide a broad range of in-person, low-cost primary and preventive care on-site at Palo Alto College and San Antonio College, in addition to telehealth, and to both students and employees.
Sickora said the effort provides much-needed services to many first-generation college students who might not have had access to health care previously. And extending care to employees ultimately can boost the number of non-employee family members interested in services from Wellness 360, she said.
Wellness 360 entered into a similar partnership to provide clinical services on campus at UTSA for students there, including primary care, women’s health and behavioral health services.
Additionally, the mobile nursing unit has been used to reach communities with various needs, including after Hurricane Harvey in 2017 and with COVID-19 vaccines in 2021. Beginning early last year, the fully equipped medical bus visited more than 30 sites in Bexar County, Uvalde and Castroville, providing wellness checks, immunizations and a range of other exams and services to more than 300 patients who might have lacked access to care.
“The delivery of care may take different forms, so that’s why the mobile unit has been important,” Schwab said. “If they can’t come to us, we’ll go to them.”
Everyone is invested
And everywhere it goes, Wellness 360 is able to involve nursing students who need clinical experience in order to graduate.
“Now we have clinical sites for undergraduate students and doctoral students doing their DNP (doctor of nursing practice) projects or PhD students, or even nurse practitioners to do their clinicals,” Schwab said. “That’s another benefit of us growing the enterprise.”
Sickora’s goal is to grow overall patient visits by at least 10% over the next year, and to see increases in both private-insurance and Medicare patients. Already, Wellness 360 is a preferred provider for one local network that provides services to older adults.
Other practices are larger and more established, where there might be one person each working phones or the front desk, registration, scheduling, the back end or as medical assistants.
“Our staff is all of that,” Schwab said. “You’ll find me answering the phones, too. And cleaning rooms. We all pitch in. It’s a small team, but everyone is invested in this dream of being a good practice.”