Episode #618: Med Spa Expansion, Regulation, and Niches-Insights from Amanda Guarniere of GuardianMD

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This is Pete Moore on Halo Talks NYC. I have the pleasure of

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bringing Amanda Guarneri to

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the podcast for her first Halo Talks. We're going to talk about

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Guardian MD, which relates to

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med spas, IV hydration, weight loss,

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telehealth, and, and all things medical related that I

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think our industry needs to know more and more out and try to

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infuse either partnerships or direct, um, uh,

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you know, practitioners into our field to help people get the

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results they want. Um, and we're going to learn all about that today in our

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podcast. So Amanda, welcome to the show. Hey, thanks for having me.

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Awesome. So you, um, run a clinical practice,

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um, up in Fairfield and also are the VP of Sales and Marketing

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for GuardianMD. Talk about your background, and then how

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Guardian pulled you in to also represent them in

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addition to what you're— what you have built on your own. Sure, sure.

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So I'm a nurse practitioner by training. I've been an NP now for 15

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years. Most of my experience has been pretty traditional in

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terms of the clinical environments I worked in. I worked in emergency rooms

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and primary care centers and, and had, you know, very

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traditional healthcare experience. And about

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5 years or so ago, I ended up moving into

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the world of leadership, and specifically in

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the world of medical oversight and compliance, which is,

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you know, what we will be talking a bit about today. That being said, I

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have not abandoned my clinical roots. Along the way, I did

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start my own kind of boutique private practice on the side

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part-time. So, I'm able to wear a few hats

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and speak from a few lenses of being the clinician operator,

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and also being kind of on the leadership side. of things in, you know, a

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compliance software service company. Gotcha. So,

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you know, most of our audience here are, you know, health club operators,

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boutique fitness operators. Some of them, you know, touched the

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med spa or workout recovery categories

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within the subsectors of our Halo umbrella.

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Obviously, there's been a huge proliferation of GLP.

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There's been a huge proliferation of workout recovery.

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I was actually looking at a real estate ad the other day and

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someone had referenced that like, this would be a great place

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for contrast therapy. And I'm just like, I've never

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seen someone pitch that as a

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modality that was now a retail

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lead category. So talk about what you've

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seen over the last couple of years. What inning, quote unquote,

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are we in if we're using like a baseball analogy? And

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what do you see as some of the opportunities and maybe some of the pitfalls

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of people that are getting into the category? Yeah, I mean, it's super

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interesting. People are accessing medical services

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in so many different places than they used to, right? It used to be you

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went to a doctor's office or a hospital or an urgent care,

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but now, you know, you can go online, you can go to a

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gym, you can go to a spa, right? So I think that the

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access different medical services has really proliferated.

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And especially in, you know, the past 4

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years with GLPs, we've seen an explosion of that. Right.

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Because, you know, it's a service that has really hit the mainstream

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media and everyone sees the benefits. And, you know, with

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that power comes great responsibility, right? So, at the end of the day, we're

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still talking about medical services. So, I think there are a lot of

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different industries who want to access this health vertical,

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provide it to their clients or customers in some way,

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but they still have to keep in mind that there's still a whole host of

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compliance things related to providing medical services. And that's really,

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you know, at least where GuardianMD comes in to be able to help

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some of those problems. Yeah, an appropriately named

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company from what I read up on it, right? Guardian of the, of the MD,

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or if you want to be an MD, you know, make sure like you do

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this correctly or you're going to get in a lot of trouble.

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Having said that, one of the clients that we have in the med spa

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space, you know, when we started researching it and we saw like Hims

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and Hers and some of these other online groups, you know, kind of

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making up their own compounds and maybe getting a little bit of trouble

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related to some of their products and services.

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And we refer to it as kind of like the Wild West of healthcare. Are

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we still in the Wild West? Are we kind of getting to a point where

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maybe there's a normalized level of

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ethics and compliance and regulation

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in like a capitalist environment, I guess

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is the question, if there is one in there? Yeah, no, I think it's a

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great question. And I think we're almost there,

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right? And you kind of have to walk before you run

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in that regard, I think. the last

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piece, or at least the more timely piece in terms of that, would

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be the conversation around peptides and kind of the

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FDA consideration of certain peptides. We're still

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seeing things be a little bit of the Wild West in terms of a

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lot of consumption of research-use-only

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peptides, which we can talk or we can leave that on

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the shelf because there are some pretty strong opinions on both sides

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there. But, I think once that hurdle is crossed. Sure, there'll always

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be something new. But in

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terms of what I've seen from the wild, wild west, I think

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we're moving in the right direction so that things can be delivered safely. Because that

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ultimately is what I want as a healthcare provider,

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right? I want access to things that are helpful. And I

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want what people are actually consuming to be safe.

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Right. And, you know, heard some heard some horror stories. There are some

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even, you know, studies of safety concerns

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with certain substances. So, that's my hope for the next—

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And, just to kind of, you know,

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in a shortened version of like the peptide,

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you know, negotiation between all the different

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stakeholders here, is there a

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Is this related to like an overuse or misdiagnosis of

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people taking peptides that would have an adverse effect on their

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health, or is it also related to like the

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efficacy of what's in the peptide, or both?

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Yeah, I think it's more so the former, right? There— I think

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there's a lot of anecdotal evidence and information that the

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majority of these substances are safe and hopefully sometimes helpful, right?

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It just hasn't been studied enough for those deductions to be made.

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My concern, and I think, you know, more of the concern, is that, you

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know, the majority of these things, you're injecting a substance into your body. There's

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certain math that needs to be done on how to reconstitute

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doses to administer properly. So, you know, the

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concern is more of the safety of improper use or

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misuse or unintended overuse

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than the safety of the peptides themselves. Right. But ultimately, you know,

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in fairness, just like with any other medical treatment, it really should be studied so

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that we know what works and what is safe in the long term.

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This is Pete Moore. I want to let you in on a little secret. There's

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this company called Promotion Vault, and what they do is they give out rewards

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from retailers that allow you to incentivize your members

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without having to do zero down and one month free. or

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giving away shakes or giving away t-shirts. What you want to do is

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build a rewards program that lasts, that people value,

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and that doesn't discount your own products and services. So here's the deal.

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There's something called Rewards Vault. The Rewards Vault is going to

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allow a member to set up their own profile. They are going to

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answer questions. You are going to get those answers. You're going to be able to

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target those members and you're going to reward them inside your club,

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inside your spa and outside of the club and outside of the spa

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to get them to become loyal, to get them to pay their monthly dues,

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and to be rewarded properly for the actions. A lot of companies

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are cutting back on rewards. You shouldn't be. Promotion Vault's your answer.

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Trust me, this is real.

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So on the med spa side, we've seen

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several franchisors that have launched over the last, you know, call

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it 5 to 7 years, that basically allow

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an entrepreneur who wants to be in the

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anti-aging longevity space to go in and not make the

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mistakes that, you know, would incur if you're just kind of trying

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to ramp up your own location and have a business

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model and a product and service set

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and, you know, blood work and here's the type of people you need and here's

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like the state-by-state compliance and so on and so forth. What does

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GuardianMD do that would either

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potentially partner with a franchisor to say, hey, I could

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help you do this so you don't have to have that overhead, or to say

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to an independent operator who could be a clinician

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on their own and wants to expand their service set to include this

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without necessarily, you know, trying to do it on their own? Sure.

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I would say that the primary thing that Guardian offers is the physician

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itself, which is a huge piece of value. So

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we work with multiple franchisor brands and have

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services for their franchisees where we are providing the physician

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medical director and also, you know, oversight of the

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protocols, clearance exams through our nurse

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practitioner telemed providers, right? So really providing

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all the compliance around that as well. But we

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can also do that on an individual scale for someone who wants to be a

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single location operator. They can come to us, we can share, you know,

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the knowledge of the Compliance in their state, whether or not they're

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allowed to own the clinical entity outright, or do they need to have a

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friendly PC model, for example. You know, that's all information that

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we hold, and then we know, okay, you're in South

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Carolina. Here's the requirements of the physician that you need. We'll give

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you the physician and make sure that it's a compliant one, right?

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So, you know, core value is is giving you a human who's going to work

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remotely, but also we have the technology and the infrastructure

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to support kind of all those compliance bits around around. that service.

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Right. So the one thing I do know about the med spa anti-aging

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longevity space is that there needs to be a doctor of

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record for that actual physical location as

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well as for the client base or members or

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people that are getting bloodwork done or testosterone shots or what have

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you. Is the doctor that you're referencing, let's say, in the

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state of South Carolina, Is that

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doctor an employee of GuardianMD? Are they an

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affiliate of GuardianMD? Great question. So we have a

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network of hundreds of physicians who work for Guardian, some in

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employment capacity, some in contractor capacity, and many of

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them have their own clinical practices,

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or they, you know, work for a hospital network or whatever, and they

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also provide medical direction through Guardian as, as part of

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their work. So they're experienced in being a medical director, being that physician

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of record. So, so rather than that med spa having to

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go out and hire or, you know, we're not even a staffing

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company, right? They're utilizing Guardian as the vendor. And as the vendor,

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we provide the physician and kind of streamline all the

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work around that. Got it. So when you take a look at

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bricks-and-mortar locations that, that could be ramped

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up and Guardian, let's say, is facilitating them to get ramped

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up. And there's also a health club, let's say, in that

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same strip center. We kind of view the health clubs, you

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know, whether that's because we come from the health club industry. So we're like, hey,

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someone's going into your shopping center plaza because you have

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1,000 people that work out there a day. And that's a great spot for

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them to basically like hang out and try and get your members inside

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versus maybe a health club putting this inside of their

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operation to try and run it. Are you seeing more

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established businesses like a health club or a spa that's

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turning into a med spa generate more traffic

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than somebody starting up their own? Or is it still kind of like

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50/50 and like it's just kind of a lot is out there and we're gonna

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see kind of survival of the fittest or the best? Yeah.

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Yeah, I would say the hardest, the hardest

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thing in the majority of healthcare businesses is patient

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acquisition. And I think an established

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business that is kind of having a new segment,

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or a new offering to their established business is already going to be

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several steps ahead, right? You have a lead list of, of all your

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members of your health club. then the marketing is

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maybe going to be the easy part. And maybe the bigger hurdle is going to

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be learning what it means to incorporate a healthcare business

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or contract with a healthcare business, whatever that looks like, you know, the

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integration piece. But I definitely think, you know, you're

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steps ahead if you are looking to add medical into

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an established business in another vertical, for sure. And do you think,

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and this is the debate that a client of mine and ours

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have had, which is ongoing, is

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what do people expect the

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actual location to be? And my

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question related to that is, you know, it could look like a doctor's office

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where people are walking around with, you know, lab coats, and it could be,

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you know, pharmaceutical-grade, you know, cleanliness, or

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it could be the equivalent of like walking into your old like

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orthodontist, you know, office where they got some of the old highlight magazines

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and they're basically administering these things and it doesn't need to be fancy,

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or they have like a marble

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$25,000 desk in the

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front. Do you feel like people are expecting

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something that is high-end because that

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allows the operator to basically charge more, or do you think like,

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hey, this could actually be disseminated at a

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level of— I love using analogies and I stay in hotels a

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lot. Could this be like administered in like the equivalent of

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like the Hampton Inn versus like the, you know, the Ritz-Carlton? Sure.

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How's that? No, I love that. I think it really—

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I think it depends on the type of client experience you want

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to provide. Right. I think that absolutely the person who's

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offering, you know, an hour and a half long consultation and a

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visit with a marble desk is going to be able to command a

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higher-priced program than

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the Hampton Inn, who might be able to

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charge for, you know, a sub-$300 a month membership, which

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doesn't have a lot of touchpoints. So, I think that's part of the decision-making is

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what type of experience do you want to provide and then build your

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programs around that. And also keep in mind, who do you already have in your

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pipeline of clientele, especially if you're integrating

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into another business. I will say, you know, depending on the

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services you're providing, you do want to pay attention to things like

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health department rules and laws. If you're drawing blood, for example, you

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need to follow, you know, what your health department says in terms of

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having a sink in the room and, and, and kind of

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inspection-level cleanliness. If you're not administering anything

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on-site or you're not drawing labs or doing anything invasive, then you can definitely

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get away with, you know, a glorified office

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space, for example, without needing You know, the

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typical medical exam chair. It really all depends on what

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services you are incorporating.

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This is Pete Moore. Here's the last tip for you of the podcast.

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We are partnered up with a company called HigherDOSE,

264
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268
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271
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saturating your market, having your members walk outta the club and going into

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one of their locations for $200 per month where they're paying

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to meet the demands of your members. And hey, let's get people

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happy, healthy, and sweaty, and the recovery should be

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just as good as the workout.

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From a standpoint of when someone's

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launching and saying, look, okay, Guardian's my partner, whether that's through a

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franchisor relationship or you're affiliated with that

283
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franchisor or an independent, one of

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the things that we've seen is, one, it's a very

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long road to break-even profitability at

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a standalone location. And the second thing is we've seen is that

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there's a relatively high fixed cost because a

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lot of these franchisees or operators say, hey, I

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basically have to have this staff that is not, you know, like,

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you know, running a fast food restaurant, you know, 3

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or 4x that amount, obviously, on staff at all times because I

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don't know what the traffic flow is gonna be. Sure. So I guess

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the question there is, Have you come up with a formula

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or a methodology that says, look, you only have to draw

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blood 1 or 2 days a week between these times, or you

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only have to have this nurse practitioner here, you know, X number of

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hours a day, or else like you just basically,

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you're never gonna get to a point where you can ramp up quick enough for

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you to like be excited about waking up every day knowing that like, hey, when

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am I gonna get to the other side as a business owner? Yeah, for sure.

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For sure. It's definitely, it's definitely a tricky road. And I would

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say on the GuardianMD side, we don't really micromanage

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this, right? We can, we can advise and kind of counsel,

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but we, we charge a flat fee so that we're not taking

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royalties. We're not, you know, taking a percentage of income. So we make it nice

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and predictable for the business owner. Speaking from

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my, like, clinician operator hat, please. It's a tough road,

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right? You need to have some sort of idea of what you

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want your lead flow to be, what you want your conversion rates

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to look like. And maybe that means, okay, we're

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going to be open part-time hours, or only this day

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and this day because— or a nurse practitioner is only going to do

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visits one day a week, or we're going to use a third-party service where we're

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paying for an on-demand nurse practitioner evaluation

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to save costs in the interim until we get to X point where we can

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justify bringing in that, you know,

317
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more full-time hire. So I think that's definitely a

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challenge because no one has a crystal ball. Right. See what that will look

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like. But, but just having the awareness that there's a ramp-up period and, and a

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time that it takes to break even and become profitable, and,

321
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and making sure that you're, you're funding that runway in whatever way

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you need to is important. Because if, you know, what I've,

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what I've seen with specifically NPs who

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start practices who may not understand that you know, they're going to

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start up and then they're going to close down within 3 or 4 months because

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they haven't, they haven't understood that they need to give themselves that

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runway. So it's, it's definitely, I'd say, one of

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the, one of the biggest challenges. Yeah. So sticking with

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the— and thanks for all these candid and very

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00:20:44,300 --> 00:20:48,000
solid answers to all these questions. I appreciate it. From

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a standpoint of taking a look at some of the concepts that are out there,

332
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and if you have any conflicts, just, you know, don't even respond or say, I

333
00:20:56,067 --> 00:20:59,775
can't answer that. But one of the groups we work with that we like a

334
00:20:59,775 --> 00:21:02,985
lot is a team out of Orlando called Serotonin.

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And Serotonin has a pretty wide

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span of products and services including supplements and

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they do on-demand supplements now and they do recurring

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subscriptions. Then you have like VIO, which

339
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got bought by VIO, which is more on the facial side and kind of now

340
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is pushing into med spa. And then you see like a group that's called Game

341
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Day, which basically does testosterone shots and, you know, very

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small office. And, you know, it could be— no offense to them— you know, it

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looks like you're walking into like Supercuts, you know, like the way it's set up,

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which is fine. And then like that kind of brought me to the point of

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like, hey, you don't have to like overbuild something if you're doing,

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you know, one thing. So do you see that there's a

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market? I think my question is this. Is

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it— is providing everything too much

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and is providing only a couple of things too little? Or

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obviously it's up to the operator to find out what their local market is. But

351
00:22:01,249 --> 00:22:04,907
do you see people kind of spreading themselves too thin or too narrow?

352
00:22:05,100 --> 00:22:08,855
Or could somebody like say, hey, I do this now, I could have the

353
00:22:08,855 --> 00:22:10,652
right to do this, now I have the right to do this, now I have

354
00:22:10,652 --> 00:22:14,488
the right to do this? Yeah, I think, you know, there are a few

355
00:22:14,552 --> 00:22:18,099
phrases that come to mind, like the riches are in the niches. I'm of the

356
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mindset that It is good to specialize in something.

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It is good to be known as the specialist in something so that

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when consumers have choices, like, when you

359
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look and think about consumer behavior, and a good thing is to think about yourself,

360
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right? If I'm— I have curly hair. It's very, very curly

361
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hair. There are 100 hairdressers within

362
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a few square miles of me. I could go to the cheapest one, or I

363
00:22:45,849 --> 00:22:49,362
could go to the one that specializes in curly hair, because what's important to me

364
00:22:49,442 --> 00:22:52,425
is the outcome that I have is the best for curly hair, right? Just to

365
00:22:52,425 --> 00:22:55,807
use kind of a silly analogy. And I'm going to pay

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double or triple what I would pay the cheapest hairdresser

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00:23:00,424 --> 00:23:04,271
who cuts all sorts of hair because that's what's important to

368
00:23:04,271 --> 00:23:07,701
me. So, I think thinking first, okay, what type of—

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what am I going for? Am I going for more of a

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higher-touch, specialized, higher-cost service where I'm really

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attracting the person who's looking for the specialist? Or do

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I have a business that is more of a commoditized transaction?

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Thing, in which case what's important is volume. And I think

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having that mindset is really smart. And the sooner you think about

375
00:23:31,057 --> 00:23:34,824
that, the better. And that's not to say you can't first become the master

376
00:23:34,824 --> 00:23:37,886
of curly hair and then, you know, add in another

377
00:23:38,335 --> 00:23:41,878
vertical where you're mastering mohawks or something, right? I

378
00:23:41,878 --> 00:23:45,532
think chipping away at it and becoming really good at one thing

379
00:23:46,110 --> 00:23:49,700
is so valuable, and it'll teach you a lot about how to then apply that

380
00:23:49,796 --> 00:23:52,393
to be really good at the next thing. And I think you can apply this

381
00:23:52,393 --> 00:23:56,116
to medical services as well. Because, you know, even on,

382
00:23:56,453 --> 00:24:00,261
on the medical side, you know, I know I'm going to choose someone who's more

383
00:24:00,261 --> 00:24:04,084
specialized as opposed to a place where I could get every single

384
00:24:04,084 --> 00:24:07,860
thing under the sun. With, with some caveats, right? If I'm

385
00:24:07,860 --> 00:24:10,800
going to a med spa and I want multiple modalities for

386
00:24:11,089 --> 00:24:14,623
aesthetics, then I'm not necessarily going to go to someone who just does Botox, right?

387
00:24:14,672 --> 00:24:17,965
That's true. I'm going to go to someone who does Botox, fillers, and lasers and

388
00:24:18,142 --> 00:24:21,932
all the things that I may want. So, I think having that in

389
00:24:21,932 --> 00:24:25,028
the forefront when you're designing your, your menu and your services,

390
00:24:25,621 --> 00:24:29,277
um, is important. Okay, so let's say hypothetically

391
00:24:29,389 --> 00:24:32,885
HALO, which we use as our acronym, which stands for Health,

392
00:24:33,142 --> 00:24:36,910
Active Lifestyle, and Outdoors, stood for Hair, Active Lifestyle,

393
00:24:37,007 --> 00:24:40,374
and Outdoors. Who is the best curly hair specialist in Fairfield County?

394
00:24:40,454 --> 00:24:43,389
Well, I love my girl Lauren.

395
00:24:43,646 --> 00:24:47,013
Lauren, shout out to Lauren. Give her a shout out.

396
00:24:48,072 --> 00:24:51,251
We'll put her in the show notes. She will generate a significant amount of leads

397
00:24:51,283 --> 00:24:55,056
and we will take Halo MD affiliate

398
00:24:55,056 --> 00:24:58,155
lead gen on that. No, it's great. No, it's a great analogy

399
00:24:58,733 --> 00:25:02,249
because I do think a lot of these brands that are being established,

400
00:25:02,683 --> 00:25:06,103
if they could be known as like, we're the best at X, then you have

401
00:25:06,199 --> 00:25:09,651
the authority to do more things later on versus trying to be

402
00:25:09,667 --> 00:25:13,264
everything to all people and then try and figure out like, how is that

403
00:25:13,264 --> 00:25:16,059
defined? Yeah. In the eyes of the consumer.

404
00:25:17,055 --> 00:25:19,963
So in closing here with GuardianMD,

405
00:25:20,750 --> 00:25:24,590
do you turn people down because they don't meet certain

406
00:25:24,590 --> 00:25:28,221
criteria? Do you basically look at their business

407
00:25:28,221 --> 00:25:31,579
plan or any kind of like quality control

408
00:25:31,659 --> 00:25:35,226
checks? Not just like background checks on who's people. I mean, just maybe

409
00:25:35,226 --> 00:25:38,873
furtherance of like what a franchisor would do. And then

410
00:25:38,970 --> 00:25:42,515
we'll close out the podcast here. some great learning about this from you.

411
00:25:43,461 --> 00:25:47,292
Sure. So I would say the, the one pretty strict criteria that we have

412
00:25:47,741 --> 00:25:51,108
is that a business needs to have a healthcare

413
00:25:51,316 --> 00:25:55,083
professional, a licensed healthcare professional involved somehow. They don't

414
00:25:55,083 --> 00:25:58,658
have to be the owner of the business, but care must be delivered by,

415
00:25:59,347 --> 00:26:03,098
you know, at least an LPN or an RN or above. Because when we're

416
00:26:03,098 --> 00:26:06,448
establishing that kind of compliant chain of

417
00:26:06,465 --> 00:26:10,087
oversight, it comes down from the physician and, and acts of medicine

418
00:26:10,087 --> 00:26:13,696
can only be delegated within medically licensed So,

419
00:26:14,001 --> 00:26:16,890
you know, if someone comes to us and they have no medical credentials and they

420
00:26:16,890 --> 00:26:20,566
have a gym and they're saying, hey, I want to offer these services,

421
00:26:20,903 --> 00:26:24,499
we'll say, that is fantastic. In order to work with us, your first step is

422
00:26:24,595 --> 00:26:27,950
to acknowledge that you will need to hire at least an RN

423
00:26:28,384 --> 00:26:32,204
to be kind of the face of the medical service so that we can then

424
00:26:32,397 --> 00:26:35,736
delegate those medical acts down to that person.

425
00:26:36,651 --> 00:26:40,391
But other than that, we make working with us very easy. really,

426
00:26:40,889 --> 00:26:44,517
really easy. We want to improve access to care. We want, you know, healthcare

427
00:26:44,517 --> 00:26:48,307
entrepreneurs to, um, be able to, you know, spread their,

428
00:26:48,516 --> 00:26:52,257
spread their services far and wide. Awesome. All right, well, thanks

429
00:26:52,369 --> 00:26:55,629
to your people for allowing you to come on with us today. I

430
00:26:55,853 --> 00:26:59,466
appreciate that. And learning all about the med spa and

431
00:26:59,852 --> 00:27:03,593
compliance, quality control, and proliferation of what we all want is

432
00:27:03,769 --> 00:27:07,155
to make sure people live a happier healthier, less lonely,

433
00:27:07,818 --> 00:27:11,553
uh, you know, fit life. So thanks for your efforts, and,

434
00:27:11,618 --> 00:27:15,240
um, we will get this out there and hopefully bring some

435
00:27:15,240 --> 00:27:18,035
business to you guys. So appreciate your time. Thank you.

436
00:27:18,730 --> 00:27:19,150
Awesome.

437
00:27:31,499 --> 00:27:35,242
This is Pete Moore on Halo Talks, your captain speaking. I am the

438
00:27:35,242 --> 00:27:39,017
founder and managing partner at Integrity Square. We've been around now

439
00:27:39,017 --> 00:27:42,534
for 15 and a half years. We have been helping

440
00:27:42,647 --> 00:27:46,004
people like yourselves get capital, do mergers and

441
00:27:46,004 --> 00:27:49,682
acquisitions, consulting, strategic advice in the health,

442
00:27:49,859 --> 00:27:53,666
active lifestyle, and outdoor halo sector, trying to help as

443
00:27:53,810 --> 00:27:57,575
many entrepreneurs as possible get to the next level. To take

444
00:27:57,575 --> 00:28:00,712
that inflection point and be the force behind your growth.

445
00:28:01,472 --> 00:28:04,884
We are helping companies that have at least $3 million of

446
00:28:04,948 --> 00:28:08,749
EBITDA, around $10 million of revenue, and we

447
00:28:08,878 --> 00:28:11,852
are positioned to help you get institutional growth capital

448
00:28:12,655 --> 00:28:16,504
or to negotiate deals with strategic partners. If you go to

449
00:28:16,504 --> 00:28:20,305
integritysq.com/ISQ, you can

450
00:28:20,305 --> 00:28:23,854
see our capabilities deck. Happy to set up a consultation at any time.

451
00:28:24,417 --> 00:28:27,612
That is free of charge, and we look forward to helping

452
00:28:27,901 --> 00:28:31,369
solve obesity, loneliness, and diabetes. Go

453
00:28:31,402 --> 00:28:31,883
Halo!