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FESTUS, Mo. — Pat Niemeyer, 76, had been seeing Dr. Joanne Waltman for 14 years for primary care. Recently, at her first visit with Waltman at Mercy's new 65 Prime+ clinic here in the exurbs of St. Louis, Niemeyer noticed things were different.

Waltman had more time to review Niemeyer's medications. She had more time to talk to Niemeyer about her social life, her support system, her exercise routine.

"OK, so you're not a drinker," said Waltman. "Now what are you doing for exercise these days?"

"Sitting in my chair," Niemeyer said wryly.

"Thinking about it?" Waltman asked, encouragingly.

"I do a lot of that," Niemeyer replied.

The Mercy 65 Prime+ clinic opened in September, Mercy's first in the St. Louis region. It's modeled after the success of a Mercy 65 Prime+ clinic that opened a year ago in Joplin, Missouri, in the southwest part of the state.

The clinics, geared toward Medicare patients who are 65 and older, offer longer and more frequent appointments so providers can better cover patients' concerns and needs. The clinics' services include flu shots and other immunizations; Medicare annual wellness visits; general medical evaluations and wellness exams; treatment of minor illnesses and injuries; cholesterol checks; and a special focus on diabetes, hypertension, incontinence, Alzheimer's disease, dementia and early memory loss, osteoporosis, and Parkinson's disease and other movement disorders.

"The ministry-level population health administrators wanted to create this kind of new model for senior-focused health care, and so they put together a framework for what they wanted and sent it to us and we pulled it off," said Dustin Parker, the practice manager for the clinic in Joplin. "I think it's going very well for being so new. We get very, very positive reviews from patients. I think it's a great model."

A personal connection
Waltman joined Mercy 14 years ago, taking over the practice of a retiring geriatrician. When she learned Mercy was going to open a second clinic geared toward seniors, she jumped at the chance to spend more time with a population she loves.

"They just appreciate everything you do," she said. "They want to be very involved in their care."

Waltman, a mother of four, attends church with many of her patients. She enjoys the personal relationship she's established with them. "They come in, and I ask, 'Is there anything else that you want to talk about?' And they're like, 'Yes, I'm going to need to see pictures of your children.'"

In addition to Waltman, the clinic has a nurse practitioner and two medical assistants. There's also a registered nurse, a front desk receptionist, an office manager and two office coordinators. The Joplin clinic has a doctor, a primary case nurse, a nurse practitioner, two medical assistants, a practice manager and a receptionist. A medical assistant at each clinic acts as a care navigator.

Parker explained that in a typical primary care visit, a patient might get about 20 minutes with a care provider. With the senior care model, the first visit is an hour, giving the provider and patient time to create a plan of care for the rest of the year.

"It sometimes gets scary for our senior patients when you've got five or six different doctors and people telling you, 'You need to be here at this time or here at this time.' With that care navigator, if a patient needs help, she can walk them through from the moment they come through our door the very first day all the way through the entire process of their health care journey."

— Dustin Parker

Patients are placed in one of three tiers, depending on how healthy they are. The tiers determine how often they return for visits. Someone who is healthier might come back in six months, but someone who needs more care might get appointments every month.

Navigating care and getting help
The care navigator follows up with phone calls about appointments and schedules patients with social services if they need them.

"It sometimes gets scary for our senior patients when you've got five or six different doctors and people telling you, 'You need to be here at this time or here at this time,'" said Parker. "With that care navigator, if a patient needs help, she can walk them through from the moment they come through our door the very first day all the way through the entire process of their health care journey."

The clinics' patient pools are smaller as well. The one in Festus is set up to see about 1,000 patients, which allows for longer and same-day visits. Waltman's previous clinic cared for about 2,200 patients. Now, she typically sees eight to 12 patients a day.

Often, family members or caregivers accompany patients to the clinics, and their exam rooms are large enough to accommodate them.

"A patient came in here and we spent that full hour going over everything," said Waltman. "And then her daughter who had brought her said, 'Can I get a new patient packet?' Since the patient was 90, her daughter was old enough."

The area the Festus clinic serves has limited public transportation, so its staff works with a local disability resource group to arrange rides. The clinic also helps patients with financial challenges get lower-cost or even free medications. In addition, clinic staff can coordinate home health care and help patients write advance directives.

In the future, Waltman hopes to establish an intensive behavioral therapy group for people with obesity. The clinic's staff also hopes to trial a program to help those with early valvular heart disease as well as a program to assess gait and balance, which would be like one in Joplin. That clinic uses a camera to take photos and video of a patient walking, standing and sitting. A computer program then uses that information to assess fall risk.

'Someone who cares'
One benefit of longer visits is to give the clinics' staff time for follow-up services that might otherwise need a separate appointment.

During Niemeyer's visit, she showed Waltman her Apple watch and noted that it had detected abnormal heart rhythms. Waltman asked to look at Niemeyer's phone, where she noted a pattern of similar alerts on a health app. Waltman asked for an EKG, which was performed in the exam room. It showed a pattern of atrial fibrillation. Waltman prescribed Niemeyer a blood thinner and referred her to a cardiologist.

After the appointment, Niemeyer praised Waltman as an attentive and respectful doctor. She appreciated the extra time with Waltman at the clinic. "Oh, I was amazed over that," she said. "Usually, it's in and out."

She said she planned to tell her friends about Mercy 65 Prime+.

"I think it's a good idea because I'm old now," Niemeyer said matter-of-factly. "And it does make a difference when you have someone who cares. And I believe in her heart, she really does care, and she really tries to help."