‘THE GOOD CLINIC’ IS THE FIRST PRIMARY CARE GROUP STAFFED SOLELY BY NURSE PRACTITIONERS
The start-up healthcare chain is designed to emphasize wellness and continuity of care through a unique NP-driven model.
The Good Clinic’s NP model evolved from the shrinking volume of primary care practices in the United States.
Patients need more than urgent care clinics; rising chronic diseases require that healthcare do more continuity of care.
By next year 50 The Good Clinics are expected to be in operation.
A primary care clinic start-up is differentiating itself by being the first primary care group staffed only by nurse practitioners (NPs).
Minneapolis-based The Good Clinic chain is designed to emphasize patient engagement, continuity of care, and an emphasis on wellness and convenience through a unique nurse practitioner-driven model, says Larry Diamond, CEO of Mitesco Inc., which operates The Good Clinic brand.
More than half of U.S. states—26 states, Washington, D.C., and two U.S. territories—have granted patients full and direct access to care by NPs in adopting Full Practice Authority (FPA), according to the American Association of Nurse Practitioners (AANP).
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing. This regulatory framework eliminates requirements for NPs to hold a state-mandated contract with a physician as a condition of state licensure and to provide patient care.
SHORTAGE OF PHYSICIANS
The Good Clinic’s NP model evolved from the shrinking volume of primary care practices in the United States, which in turn, occurred because of low reimbursement rates to primary care physicians, Diamond says.
“What’s happened over time is because reimbursements are low, physicians graduating from medical school with these huge student loan bills can’t afford, even if they wanted to, to go into primary care, and so the number of new docs coming out of medical school who want to go into primary care has been waning,” he says.
“The AMA (American Medical Association) says there’s a shortage of about 25,000 to 35,000 primary care providers, which is one of the reasons why all of these urgent care centers have popped up, because in America today, it’s typically two to five weeks’ waitlist to get in to see your primary care provider for just a normal visit, a physical, or just a follow-up,” Diamond says. “So, America learned, ‘Oh, if I have an earache, a sore throat, or a cut, let me run over to the urgent care clinic,’ and the challenge there is that we stopped providing care and just started fixing problems.”
But the prevalence of chronic diseases requires that healthcare do more than simply fix problems, he says.
“Diabetes is at an all-time high, and pulmonary issues, well, they all start somewhere and it’s typically because they’re not addressed earlier in their disease process,” he says. “And the government finally has recognized that if you focus on prevention, you can avoid a lot of the costs associated with people developing chronic illnesses, and then deteriorating with them, where it always costs more to address a problem later in its cycle.”
Nursing is better aligned to primary care from a philosophy perspective than medicine, Diamond says. “Nursing is about working with a patient over time, to help them overcome some of the challenges that they’re experiencing, where medicine has evolved to be much more about ‘one and done. Let me do something and solve the problem,’” Diamond says. “And with chronic illness in America, it’s not typically a ‘one and done’ type of solution.”
Good Clinics began when the physicians that started MinuteClinic, which has since been sold to CVS, added Diamond to their team to create a primary care model that was whole-person focused—one that considered physical health, behavioral health, stressors, and how they use the healthcare system.
“The concept is about, ‘How do I take care of a person soup to nuts?’ [by] considering complementary and alternative medicine or whatever the person is interested in—yoga, meditation, supplements, vitamins, standard medicine—and to have a relationship where we co-develop a wellness plan with that person.”
For example, the adolescent population has been struggling with depression and anxiety after COVID and are frequently prescribed antidepressants by behavioral health services.
“No. 1, they’re not looking at their physical health to understand “How is their nutrition?” because nutrition in adolescents really is the start point of how you feel mentally, behaviorally. We were finding thyroids that are not operating at the levels they should be, and we’re finding that their vitamin D and vitamin B levels are not the adequate level,” Diamond says. “Nutrition is the first starting place when you’re trying to address behavioral health issues, and unfortunately, so many of the behavioral health services operate in isolation of primary care.”
STARTING IN FPA-FRIENDLY STATES
The company’s first clinic opened in February 2021, and by the end of the year it had six clinics operating around Minneapolis. This year, it expects to open an additional 12 clinics in Minnesota, Colorado, and Arizona and by next year 50 clinics are expected to be in operation in states where NPs can freely practice at the top of their license.
And though NPs have FPA in slightly more than half of U.S. states, that doesn’t preclude The Good Clinic from expanding into states where NPs don’t have FPA, Diamond says.
“Nurse practitioners pretty much in every state have the ability to practice; what changes as you go state to state is they often have to practice under the tutelage, from a quality control perspective, of a physician,” he says. “There are different levels—a physician [may have to] review chart review or they may have to sit in on a certain number of patient visits with a particular nurse practitioner. So, you can operate our model in all 50 states; it just becomes a little bit more expensive.”
Georgia and Texas, for example, have the highest level of quality assurance, and Florida requires a physician to sit in on all medical exams. But that won’t prohibit The Good Clinic from expanding into those states.
“It just lowers it on the list,” Diamond says, “as to where we’re going to want to start.”