Prepared for Joyce Kinyua, PMHNP, APRN · Doc ID IHA-2026-JK-002 · Confidential
Start hereThis is already filled in from our August 26 call. You are not starting from a blank page. Three things need you: four numbers in Section 2, four answers in Section 3, and a quick look at the plan in Section 4. About forty-five minutes. It saves as you type, so you can stop and come back.
1. What actually changed
Something shifted on our last call that is bigger than the individual items on your list, and it is worth naming before you plan anything.
You are not building a practice anymore. You are building the first of four. Tennessee is a pilot for the new partnership network. Georgia, Michigan, and Florida come next, and you said it plainly: you will duplicate the same program in the other states.
That changes what "good enough" means. Every process you build loosely in Tennessee, you rebuild three more times. Every process you build once and write down, you copy. The next four months are not about surviving a busy season. They are about building the unit that gets replicated.
The constraint everything runs into. You told me 25 clinical hours a week is your ceiling once admin is counted. Between now and December you are adding a partnership, three students, a nurse practitioner, and a virtual assistant, while leaving Rula. Every one of those costs hours before it returns them. That is the whole planning problem.
2. Your four numbers
This has not been done yet, and it is the reason the next few months feel heavier than they should. Best estimate is fine. Nobody is auditing this.
The new partnership clinical hoursCurrent, not projected. This week is a fair sample.
Nuru direct clinical hoursGenomic intakes at 90 min, results reviews at 60.
Rula clinical hoursToday's number. Declining through December.
Admin and business hoursHiring, contracts, content, partnership coordination, accounting.
Total hours per week—
3. Delegation matrix
These are the recurring tasks you described on our call. The matrix has already routed every one of them. The logic is simple: anything needing a licence cannot go to an assistant, anything needing clinical judgement stays with you, and everything else leaves your plate. Change any row you disagree with — the totals and the recommendation update as you go.
Patient texts asking to reschedulecurrently: You
Booking and rebooking appointmentscurrently: You
Following up on missed appointmentscurrently: You
Chasing incomplete intake paperworkcurrently: You
Website and email inquiry triagecurrently: You
Pre-qualifying discovery callscurrently: You
Coordinating the new partnership, Nuru and personal calendarscurrently: You
Appointment reminderscurrently: You
Non-controlled medication refillscurrently: You · needs a licence
Between-visit check-ins and nutrition follow-upcurrently: You · needs a licence
Patient education on supplements and planscurrently: You · needs a licence
Controlled substance refillscurrently: You · needs a licence · needs clinical judgement
Clinical questions about medicationcurrently: You · needs a licence · needs clinical judgement
Crisis responsecurrently: You · needs a licence · needs clinical judgement
Intellects results reviewcurrently: You · needs a licence · needs clinical judgement
Social posting and engagementcurrently: Charles
Insurance claims and billingcurrently: Biller
11 of your 17 recurring tasks can leave your plate. 7 go to an assistant, 3 need a licence, 1 can be automated, and 4 stay with you because they need clinical judgement.
What the matrix says to do
Hire the clinical assistant first
7 tasks route there, more than any other category, and none of them need a licence. This is the fastest route to a quieter phone.
post by Sept 12
The LPN is a second hire, not an alternative
3 tasks need a licence — refills, education, and between-visit follow-up. That is a real role, and it is the follow-up care tier you described: patients who cannot afford full sessions stay engaged and only need you once or twice a year. That is a service line with its own revenue, not an assistant. Scope it once the assistant is running.
scope in Nov
Automate reminders
Already available inside PracticeQ. No new tool needed.
Sept
Two decisions the matrix does not make
Support role first
The matrix routes most of your plate to an assistant. Confirm which role you post first.
NP engagement model
Set to 1099 contractor, based on what you described on the call: the candidate is moonlighting while building her own practice, and you are not dictating her days. That is the test you named yourself. Your attorney confirms this, not me. It is on the agenda for that appointment.
Rula patients transitioning
Your best estimate of how many of your Rula patients follow you to Nuru against your four credentialed payers.
Platform direction
One question decides this, and it is not a preference question.
No PHI, no BAA, no HIPAA hosting. Faster and cheaper to build, and it can be upgraded later if the grant funds individual tracking.
4. The plan
Four phases. Open one at a time. Tick what is already done, and tell me in Section 5 what I got wrong. Items marked ▲ are the ones that protect revenue you already have.
5. The year ahead
On the call I said you needed to sit down with the next twelve months rather than the next few weeks, because capacity decisions made now determine what you can accept later. Rather than ask you to plan it, this works it out. Give it one number.
Patients per week you want to be seeing by this time next yearYour April intake said 20 to 25. Change it if that has moved.
Average clinical hours per patientGenomic intakes run 90 minutes, follow-ups and med management shorter. 1.25 is a fair blend.
The four quarters
Milestones only. Detail belongs in the 120-day plan above.
Q4 2026 — stabiliseAssistant running. First clinician onboarded. Out of the legacy contract. Tennessee model written down.
Q1 2027 — prove the unitTennessee running without you in every loop. Margin per clinician known. Follow-up care tier scoped and priced.
Q2 2027 — replicate onceState two opened using the documented model. If it takes as long as Tennessee did, the model was not written well enough.
Q3 2027 — replicate againStates three and four. By now this should be a checklist, not a project.
6. What did I get wrong?
Corrections are more useful to me than agreement. If a date is unrealistic or I have misread something, say so here.
7. Where you were in April, and where you are now
We ran the S.E.C.U.R.E.™ diagnostic on you in April. Overall readiness came back at 68 out of 100. Four months on, some of those numbers have moved on their own and one has quietly become the thing that matters most.
Acquirewas 42
Solved, and you may not have noticed. In April this was your weakest growth score: fewer than five inquiries a week, referral system only somewhat in place, lifetime value never calculated. The new partnership is now a referral engine sending you patients ahead of schedule. This was the problem in April. It is not the problem now.
Buildwas 44 · now the constraint
This is the one. In April it read as a soft gap: no formal systems for scaling past solo practice. That was fine when you were solo. You are now adding a VA, an NP, three students, and a partner channel, with three more states behind it. Build was theoretical in April and is the binding limit today.
Systems Alignmentwas 80 · unchanged
Calendar integration was named as your friction point in April. It is still open, and Microsoft Bookings has been added to it. This is the oldest unresolved item on your list and the only one currently touching live partner revenue.
Compliance & Claritywas 89 · your strongest
Still your best score, and worth protecting. Note where the new exposure sits: the VA's BAA, the consent set for the new partnership patients, updated malpractice, contractor agreements. Four new compliance obligations inside ninety days, all landing on the dimension you score highest on. Strong scores are easiest to lose when things move fast.
Explainabilitywas 53 · lowest
Your lowest score in April and largely unchanged: how AI use is explained to patients and staff. Lower urgency than the rest, but it becomes real the moment a VA and an NP are answering patients on your behalf.
Which of these feels most limiting to you right now?
Thirty seconds. Your read matters more than my read, and it tells me where to spend our time on the 18th.
8. What is not in this plan
Four things came up that are real and worth doing, and that sit outside our current arrangement. I am listing them rather than quietly folding them in, so we can scope each one properly when the timing is right.
The operations agent
A Monday brief so five workstreams stop living in your head.
Rebuilding your Nuru portal
To match the practice you have now rather than the one you had in April.
The patient platform
Once Path A or Path B is settled.
The replication pack
The documented Tennessee model that makes states two, three, and four a copy rather than a rebuild.
Worth saying once: none of these are urgent this month. September is the Bookings integration, the consent set, the attorney, and the VA. Those four protect what you already have. We can talk about the rest on the 18th once your four numbers are in front of us.
9. What happens on the 18th
Thirty minutes, not an hour. We confirm the four decisions above, look at your capacity number together, and agree what I take off your plate versus what stays with you. You do not need to prepare anything beyond this page.
Capacity number and what it means for sequencing10 min
Confirm or change the four recommendations10 min
What I pick up next, and what that costs10 min
10. Download your completed plan
This saves on whichever device you are using. If you switch from phone to laptop, download it before you switch.
Download your completed plan, then email it back to Jennifer before our next meeting.
Your September action list
Generated from your answers on 10/31/2026. Print this or save it as a PDF and keep it somewhere you will see it.
Your week is currently — hours. That is within the ceiling you described, which gives us room to sequence the assistant and the nurse practitioner in whichever order suits you.
Integrate Microsoft Bookings with PracticeQ and your calendar
The new partnership is booking patients today across systems that do not talk. Test it by booking one live appointment and confirming it blocks your Nuru availability.
by Sept 12
Build the consent and intake set for patients referred through the new partnership
You flagged this yourself. Patients are already arriving, so this is live rather than upcoming.
by Sept 19
Post the Clinical VA role
Use the hiring pack, Doc ID IHA-2026-JK-005. The job description is ready to send as written. Pick one sourcing channel and stop comparing.
by Sept 12
Book the attorney appointment
Take all of this to one meeting: Contractor and NP agreements; Confirm 1099 contractor is defensible for this arrangement; Malpractice update for a multi-clinician practice; Partnership protection for the new partnership arrangement.
by Sept 19
Close Rula to new patients
End of September, as planned.
by Sept 30
Review your Nuru pricing
You raised this on the call. It sets the floor for the NP revenue share, so it comes before that conversation rather than after.
by Sept 26
What I am doing before the 18th
Reviewing your capacity number and sequencing
So we start the call with a recommendation rather than a discussion.
Charles has September content already
Nothing needed from you on that this month.
Doc ID IHA-2026-JK-002 · Imara Health AI Consulting LLC