CFO Tells of ‘3-Bucket’ Balancing Act at Healthcare Startup

For the chief financial officer (CFO) of a small, early-stage startup, every day is different.

Broadly speaking, though, the duties fall into three categories, Greater Good Health CFO Michael Grover told PYMNTS.

There is the core financial process that helps teams understand the financials of the business and optimize performance; the financial decisions around strategies for growth, and the investor relations and fund raising necessary at a venture-backed company.

“I don’t always know exactly what to expect on any given day, but it’s always fun and interesting,” Grover said.

Grover joined Greater Good Health in July, bringing more than a decade of finance experience to the firm that provides a primary care model centered around nurse practitioners (NPs).

In his new role, Grover was tasked with supporting the company’s continued growth by designing and implementing innovative and value-based payment mechanisms and contracts.

Weighing in On Strategy

Interviewed for the PYMNTS series “A Day in the Life of a Digital-First CFO,” Grover said that the opportunity to weigh in on strategy is a new addition to the role of CFOs, as that role was historically more narrowly defined.

Today, especially at smaller companies, CFOs are more likely to participate in conversations around things like the types of customers the company is going to pursue.

“For me, being able to plug into roles like that is what really attracted me to come work in a startup — that you get to play in all those different areas of the business,” Grover said.

One question that he and the rest of the leadership at Greater Good Health have dealt with is the one that faces any startup: Should they grow the top line as fast as they can for the sake of growth, or focus on higher-quality clients and create growth that is thoughtful, profitable and sustainable?

“We’re still growing exceptionally fast as a startup, but we’ve made the decision to be a bit more thoughtful about growth and be selective about our client base,” Grover said.

Meeting a Growing Need

As it is looking to add more clients and expand its product mix, the company expects to go back to the market with a Series A funding round early next year.

As the leadership team considers its fundraising strategy — how much to raise, who to raise it from, when to raise it — they seek guidance from their existing investors and some external advisors, Grover said.

The demand for the services provided by Greater Good Health is driven by the primary care shortage in the United States, which has been caused by the population getting older and sicker even as many doctors are retiring, and new doctors are choosing to go into specialty care rather than primary care.

One solution to this challenge is provided by nurse practitioners, who are the nurses with the highest level of training and experience. In 26 states, nurse practitioners have “full practice authority” that allows them to practice primary care without the supervision of a medical doctor (MD).

“Our business model is becoming the employer of choice for nurse practitioners and then figuring out high-value ways to deploy them,” Grover said.

Tapping a New Resource

To date, that has meant recruiting nurse practitioners, training them and deploying them to insurance companies or existing primary care groups.

Soon, it will also include placing nurse practitioners in new Greater Good Health-branded primary care centers. The first four such clinics are to be launched by September of next year.

The company fully employs the nurse practitioners as well as a clinical staff and the management team.

This is a needed service at a time when there are parts of the country in which it takes senior citizens six or seven months to get a primary care appointment.

“A huge component of how we provide value to the healthcare ecosystem and to these patients is through access,” Grover said. “By tapping a new resource to deliver primary care, we’ll be able to provide materially better access than anyone in those markets is currently doing.”