In our first ever "Meet The Nice Clinicians" event, Nice’s Elizabeth Chidothe, FNP, and Tilly Beaudette (No longer with the company) discuss how their professional experience and how Nice enables them to deliver better primary care to their patients. Watch the recording with the complete transcript below:

Read The Complete Transcript:

Elizabeth Chidothe: Alright, we will go ahead and get started. Hello everybody, I'm Elizabeth Chidothe. I'm a family nurse practitioner and clinical manager at Nice Healthcare. I'm excited that you have joined us today for our first webinar where you will learn a little bit about Nice Healthcare and meet one of our new clinicians. Before we start, I'm going to share a little bit about myself and how I ended up here. So, I am based in Minneapolis, Minnesota. I went to nurse practitioner school at the University of Pennsylvania almost 10 years ago and I have been with Nice Healthcare since its inception. For those of you who don't know what Nice Healthcare is, we are a direct primary care clinic that brings medical services to you through virtual visits and home visits. We make it possible to have a clinician in your community to meet your healthcare needs. One of the many things that differentiates us is that we are a nurse practitioner owned and led company. Nurse practitioners provide high quality care by diagnosing and prescribing like our physician colleagues. We chose to utilize nurse practitioners because nurse practitioners learn how to relate to patients before we learn how to diagnose and treat. The difference is often felt and the relationship that you build with your provider. And speaking of excellent nurse practitioners, I have one of my esteemed colleagues with me today, Tilly Beaudette. Hi, welcome! Thanks for joining me today... So, tell us a little bit about yourself.

Tilly Beaudette: I'm going to forget my name, hahaha. I’m Tilly as she said. I live in Omaha, Nebraska with my husband and three sons. I have been a nurse for close to 15 years and have worked in hospital settings, clinic settings, and long term care.

Elizabeth Chidothe: That's awesome.

Tilly Beaudette: I love Omaha.

Elizabeth Chidothe: Yeah, what's awesome is clearly we are in different cities and from each other. So, you talked a lot about that you have 15 years of diverse experience as a nurse... What led you to become a nurse practitioner?

Tilly Beaudette: You know, to some degree, I think it's just kind of that evolution of nursing you want to learn more all the time, but also there's this aspect of that relationship that you build with patients at the bedside and knowing that you know as a nurse practitioner I probably would have even more opportunity for spending time one on one building relationships and there's this ability to reach people on a primary care level where, hopefully, you know you can reach these people before they're sick and in the hospital being able to spend that time. Yeah, like you said, the nursing role, coming into it learning how to take care of patients and relate to patients before you learn to diagnose.

Elizabeth Chidothe: And I feel like that's kind of a common theme with a lot of nurse practitioners in terms of may have had some experience in a hospital setting, where we saw the outcome of healthcare as it exists today, and so we wanted to be a part of that solution and go more to the primary care, similar to me. That's awesome! Where did you go to school before joining the Nice Healthcare team?

Tilly Beaudette: I got my BSN at Methodist College in Omaha and my nurse practitioner degree in Graceland out of Iowa.

Elizabeth Chidothe: Fabulous! And describe how you found Nice Healthcare and what made you decide to make the move? And then, how did we stand out to you during that application process?

Tilly Beaudette: I graduated right at the beginning of COVID shutdowns, and so it was kind of an interesting job market. A lot of people weren't hiring or were even on job freeze, you know, during that time and furloughing nurses... I don't know if that happened in Minneapolis, but it did in Omaha. Nice was still hiring and I remember getting told during the interviewing process that you know Nice didn't have to do that, you know they continue to grow and flourish during this time. They didn't have to lay off anyone or furlough anyone, and obviously that's pretty appealing today. But also, it just offered something different, you know I had done the internal medicine and pediatric urgent care rule clinics and you know your patients are in and out. I really wanted to be able to establish that relationship and I thought this aspect of virtual and home visit care would give me something different.

Elizabeth Chidothe: Absolutely! And is there anything about your experience with Nice Healthcare in terms of, as a team, you know we're a virtual team that's it in different cities... has there been anything that's kind of stood out to you in terms of how your experience with Nice Healthcare as a clinician?

Tilly Beaudette: You know, I had nothing to base my experience off of because it's all new to me - doing virtual care and being part of this virtual team - but I've been really surprised at how supportive the environment is. I mean, I can put out a question related to patient care or anything else and get a response in 30 seconds. Last night, after hours, one of the care coordinators put out a question like “Hey, can somebody look at this that just came back for a refill that needs to be done?” and literally, there were like five clinicians fighting over who got to do it. I was like “Does this happen anywhere else that we're fighting over who gets to send someone else's refills?” It's just people really want to be here, and you can tell yeah.

Elizabeth Chidothe: And there's a lot of it's a team effort for sure. We're glad you're part of the team! So, I'd like us to talk a little bit about how the Nice Healthcare experience differentiates itself from a regular clinic, like you said, you had time and urgent care internal medicine other places like that. So, in your opinion, how does Nice Healthcare provide greater access to care?

Tilly Beaudette: The accessibility of Nice Healthcare care is really where it stands apart, in my opinion. That patients can just jump onto this App on their phone or computer, make an appointment or ask a question... And I think our response time is something like four minutes on average. But patients are able to do all of this so easily. It's not this ‘call and wait on hold for 15 minutes to leave a message for the medical assistant, who will then call you back, who will leave a message for your doctor who will call you back’. You know, it's not this two day process of getting your needs met. Really, patients are able to access us pretty seamlessly. And I've used it myself, it really is easy. You really can reach a clinician and I think that's huge. Not even just scheduling appointments, but even just questions after the appointment or that follow up is a lot easier.

Elizabeth Chidothe: And you said that you have used it yourself... So you kind of talked about how you're a busy mother of three. What that experience would look like if you had to go into a clinic?

Tilly Beaudette: Certainly COVID complicates things even further, because they don't let you bring your kids to appointments, so you know that. You know the parent person, or even the busy working person, I mean how many of us are able to schedule that appointment two weeks in advance? To figure out childcare work schedules... there's just so many things to work around. Even just the students, I mean working around their class schedule and virtual schedules, it's definitely not easy but dragging three kids to the doctor and then being able to talk about your needs that's not real. I'm like “no don't touch that. Don't! Oh, I'm sorry, I'm sorry! They did that? I'm fine, can I go?”

Elizabeth Chidothe: And so, how does that look different with Nice Healthcare?

Tilly Beaudette: Well, just having that flexibility of, being able to reach someone in my own home,being able to not have to rearrange my entire life, I can have a visit over my lunch break. Or, I mean, it doesn't have to be such a big production to be seen, so that you can have your needs met. And then, as far as you know, having somebody come out to your house, they can work around your schedule or meet you at your workplace.

Elizabeth Chidothe: Yeah it's...

Tilly Beaudette: It really is, I mean it's really different. 

Elizabeth Chidothe: Yeah, I agree so… Also, a part of having access to health care is the cost of care. We've all had that experience, where we receive a bill from a healthcare provider months after we have received the service. And it's confusing... It often includes hidden costs, which can lead to a lot of anxiety and I don't know about anybody else who's looking or watching this, but it actually turns me from wanting to go back for care so well. With the cost of Nice Healthcare being covered by employers, how does it benefit our patients to have that cost be covered, I mean that they come to us and they get a zero-dollar bill...

Tilly Beaudette: I know we've talked about this before, but just even learning, you know as part of my education in school, that patient limitations include costs and that's something as a clinician you should always be considering. So, you know ordering that extra lab that may or may not be beneficial but would give everyone peace of mind and be able to check that off the list is not always something that's possible for us as clinicians because we want to keep in mind our patients cost limitations, and that is very real in healthcare. Not being able to take that medication, because you can't afford it… not following up with those blood pressure checks, because that extra $200 office visit just to have your blood pressure checked doesn't seem worth it. Though I feel like as a clinician, I'm able to take care of patients the way that they need to be, and deserve to be taken care of, without having to always consider that cost limitation. And also, it puts a patient's at ease. I feel like I get much better follow up from people I probably wouldn't.

Elizabeth Chidothe: Yes! What about so speaking of the cost and what you can actually offer as services. Can you kind of tell everyone who's listening, who may not know what services are actually included in that fee? It's not a fee to the patient. It's up to the employer what's included.

Tilly Beaudette: I mean it's a base cost, right... it doesn't cost more if you're seen more often. It doesn't cost more if you have hypertension, but unlimited visits, so that includes chat, virtual like video visits and also in-home visits most common labs that I would need for any acute or chronic condition often X rays, so when we're looking at bones and physical therapy now. And medications and there's something like 500 medications on our formulary so most medications that I would need to be able to treat you are included in our formulary and I know meds are huge for people

Elizabeth Chidothe: Right? And kind of pulling it back to cost and relationships, I feel like something that is tied to both of those concepts is actually ‘time’ and I know that when I was working in a clinic I would have 15 minutes from the patient being roomed, to needing to get that prescription out, to be with my patient and that's that so probably maximum of five {minutes} actually in the room, with the individual. Tell me how that, again, because of how we're structured… What does time look like with Nice Healthcare?

Tilly Beaudette: So, for virtual visits, we have 40 minutes and really often we technically have more than that, but then, when the home visit provider comes out, you know they have an hour. So, if we're looking at a physical, like an annual, and I'm seeing you first virtually, then I'm sending a home provider out to get labs and to assess what you were talking about, an hour and 40 minutes time to spend with a patient. Even just with chat appointments and phone appointments, I'm able to spend 20-30 minutes with every patient and that makes all the difference in the world and being able to actually talk to your patients and listen to their responses versus asking them, the question that you need to be able to give them the script so that they can get out of your office right.

Elizabeth Chidothe: Right, it makes all the difference. I'm excited that that really talks about the relationship that you were able to build with the patient. And speaking of that, there's going to be some people... you had talked earlier about people chatting or asking a question or needing a refill and oftentimes people worry about being able to establish that one relationship with one individual. Can you talk to how people are able to build and maintain a relationship with a provider at night?

Tilly Beaudette: So, all patients, at any time, are able to select the clinician they want to see or select whoever is available. I would say, often in my experience, my patients do tend to follow up with me, especially when we're talking about chronic conditions and when we're talking about acute you know they got sick and I might not be there. On that day, you know, often they'll see whoever is available, but because of the way Nice works, I mean we're all able to work as a team, so if a refill request comes in, on a day I'm off someone definitely addresses it and doesn't leave it for five days, while I'm on my vacation of the you know it gets done that day by someone else. But I would say, for you know, chronic conditions and follow ups, I tend to see my own patients.

Elizabeth Chidothe: And another... it sounds like you're really building a lot of great relationships with your patients as they're clearly kind of coming back to you for. I feel like COVID has changed things and obviously we're having this discussion via video, but has anyone ever raised concerns about being able to build or really have a relationship with you, virtually? Or what does that look like to you as a clinician?

Tilly Beaudette: I think that, until you experience it as a patient there is kind of and even as a new clinician coming in there's kind of this misconception that these relationships are not attainable when we're talking about virtual care. But being able to sit with someone like this and talk to them for 40 minutes... You develop those relationships. I feel like potentially it's even easier than it was before, just because of the amount of time I get to spend and it's not so distracting. They're not like rushed when they get to me and have three kids that are touching everything when they're not supposed to, and that relationship comes with time. But we get that.

Elizabeth Chidothe: Absolutely, and, if I may add, I've done quite a few home visits with my time with my healthcare and the unique opportunity with, that is when we do go into the home. We get to see your location; we get to see any barriers to access to care in terms of the environment surrounding the home and you really get to welcome us into your most intimate space and I feel like there is sometimes hesitancy there. But I can 100% say that we there was never any judgment and then it oftentimes feels really comfortable and for the working mom, the children get to be playing and taking naps or whatever else. For the busy person, you know we do get to come in and sit up at your dinner table and be able to administer or be able to collect any assessments needed at that time at that moment. I know for myself, I've had diabetic patients where I've been able to sit and we've been able to have long discussions. We have an hour where we can talk about and look in their cupboards and the refrigerator and we can have, honest and open conversations about what that looks like... in terms of managing their diet, their diabetes and that, at that moment.

Tilly Beaudette: The whole concept of meeting people where they are is real yeah with Nice Healthcare.

Elizabeth Chidothe:  Absolutely, I love it! So, speaking of patient stories, are there any patient stories that are particularly memorable or that have impacted you in a meaningful way?

Tilly Beaudette: Yeah, I mean, I have a lot, because I really enjoy my work, but I do have a specific patient in mind. He's just a young gentleman. He came to me for a skin condition, but he scheduled a video visit, so we had a lot of time after sorting through that, and so I was just able to kind of talk to him about “hey how was work, going through code and how has that changed, and what does that look like, for you” - socially working at home as a single young person who lives alone… Through talking through this, I just kind of got that maybe you know, he was struggling, and I think there's this perception that a lot of us have right now that everyone's struggling, so we just keep going through it, you know. With Covid and so many other changes that are happening right now, but in talking to him I realized, he was actually having a lot of anxiety and he was probably depressed, and so I just kind of brought it up like ‘Hey, you know it sounds like you're kind of struggling. I love to be able to help you with that.  We don't have to talk about it today, but if you want to come back, make an appointment and talk to me about it.’ That anxiety that you're experiencing leaving the House and having to go back into the workplace soon with this pandemic going on. I would love to talk to you, and he did actually make an appointment, a few days later, and we were able to talk and get him started on meds and he restarted in counseling and we followed up regularly, for the first two months, probably every two weeks made some adjustments and now we obviously don't have to follow up that frequently but he's doing so much better and he's so grateful that we were able to have those conversations. I can say that you know those types of questions and that type of relationship where you actually get to listen to what people have to say in between the questions that you need to ask, as a clinician, that is where you really get the gold, right?

Elizabeth Chidothe: Yes! Kind of to connect it to other pieces, you know I recently had a discussion with another provider of ours, where we saw elevated triglycerides in an individual and we realized that it was likely related to not diet, not exercise, but to anxiety. So, this person literally had high cholesterol, likely related to the stressful state that they were in and to be able to correlate labs with the stories that come with them, because we had the time to ask, and really care about our patients in a whole holistic fashion, it is pretty amazing.

Tilly Beaudette: Yeah! If you're any kind of practitioner in primary care, I mean you're in it for the relationships and Nice is a dream job. Yeah, it's incredible.

Elizabeth Chidothe: Well, I thank you so much, Tilly, for your approach to the patients, you know anyone makes appointments with you they're going to be lucky to have you, as without any right clinicians. And we happen to have the time to answer one question that came through, and they are asking ‘do people often use the same nurse practitioner regularly and develop a relationship with them or do people just see whoever is soonest available?’

Tilly Beaudette: When you know we kind of answered that, but I would say, you know it depends on both the patient and the reason for being seen, I would say, often, though, and this does not just apply to me for chronic conditions and follow ups patients tend to see their own clinicians if they're available like they're the person they've been seen they're available and often, then you know for a cute, so I would say, patients see whoever. You know, new patients tend to pick whoever’s available. And then, they often come to us for an acute reason but, just like the story I just told them often follows with you.

Elizabeth Chidothe: I agree! I've definitely had people follow me for years. So similar! Awesome! Well for those who are watching, you will be receiving an email with a survey for feedback and ideas for future topics, but this concludes our first kind of coffee chat webinar and follow us on social media and stay tuned for those future events and content. Thank you so much for joining us today and have a Nice afternoon everybody!