Rachael Cabral Guevara believes in personal and affordable healthcare, delivered the way it used to be—at home or in a comfortable clinic, for a reasonable fee. Working as a Nurse Practitioner for a traditional healthcare company left her dissatisfied and dreaming of a solution to the problems confronting her patients. “Transportation was difficult for people, for various reasons,” she said. “And it was hard to see so many patients struggle with the costs.” Rachael committed to starting her own business to deliver high-quality healthcare directly to patients, in their homes or at her clinic, for an affordable fee. She named it Nurse Practitioner Health Services, LLC.
Jumping in, with help from the SBDC
Rachael had no entrepreneurial experience but didn’t let that stop her. In 2013, she began to develop a direct-service model to compete with large healthcare providers. In 2014, Rachael sought help from the UW-Oshkosh Small Business Development Center, where she met center director Colleen Merrill. That year, she began offering her nursing services via house calls, and later, opened a clinic. In 2015, she added support staff. By 2018, she was able to bring on additional medical service providers.
As a single mom of four, juggling contract work and a teaching position at UW-Oshkosh as well as launching a new business wasn’t easy. “She has a vision and she’s very determined,” Colleen said. “She turns up opportunities, makes mistakes, and like a true entrepreneur, uses those lessons to progress in her business.”
Rachael’s biggest challenge has been, she said, “helping people understand how we work because they’re not exposed to this model anymore. I’m not practicing healthcare any differently than the large systems; I’m just challenging the costs associated with it.” Once prospective customers understand how Nurse Practitioner Health Services can help avoid high co-pays and deductibles, “they want to come,” Rachael explained.
Learning business basics
“Colleen helped me understand the fundamentals of my business,” Rachael said. “She taught me how to network—I had no idea. I’m quite introverted.” Colleen connected Rachael with marketing resources. Students at UW-Oshkosh helped with social media and graphic design.
Colleen advised Rachael on tax and liability issues and helped her establish her pricing structure. Colleen recalled, “There were many times I scolded her for not charging enough. She wanted to care for people, but she learned that she needed to charge enough to sustain her business or she wouldn’t be here to help her clients.” Colleen taught Rachael how to forecast her finances, set goals, and identify trigger points at which she could hire more help. “When she exceeded goals, she’d come in so excited! She dug in and learned the financial components,” Colleen said.
Accomplishments with the SBDC at UW-Oshkosh:
- Pricing for sustainable profits
- Networking introductions
- Marketing training and resources
Spreading the business model
It surprised Rachael when other nurse practitioners across Wisconsin approached her about setting up similar businesses. While franchising isn’t an option, given the legal and insurance ramifications, Rachael has developed a service helping other nurses set up their businesses. They own their businesses, paying for back-office operations such as scheduling provided by Rachael’s Appleton office. “With my help, they can keep their overhead down and work solo,” Rachael explained.
Rachael has found a niche for Nurse Practitioner Health Services in businesses that need employer health services. She can provide physicals, drug testing, and monitoring for companies working with hazardous materials. She is continuing to counsel more people interested in start-up nurse services and is planning to purchase her own clinic. Colleen observed, “With all the issues in healthcare, and a lack of physicians and providers, this is a great way for people to get exceptional care.”