After working as a nurse practitioner for the last few years, Sandy Lauer saw disparity with how she was trained versus what she could do.

She said it seemed as if there were constraints in everything, especially time spent with her patients. Lauer, who lives in Alexandria, said the business of health care wasn’t what she wanted for her patients. Lauer worked as a registered nurse at Alomere Health in Alexandria for five years and then she worked as a nurse practitioner in Melrose at the CentraCare family practice clinic.

“This is not how family medicine is supposed to be,” said Lauer, a mom of two young sons who received her doctorate in nursing practice in 2016 from North Dakota State University. “Health care is a big mess. But this is in no way a reflection on the health care providers in this area, it's the health care system in general.”

Lauer didn’t want to spend her entire medical career working in a system that wasn’t working for what she believed in so she took matters into her own hands. Just this past week, Lauer opened up her own clinic in Alexandria, Well & Company. The clinic is the third of its kind in Minnesota and the first of its kind in this area, she said.

Well & Company operates under a direct primary care model, which offers a monthly membership for individuals, couples, children, families and college students. Health insurance is not needed.

Lauer said direct primary care cuts the middleman out so health care providers can directly provide patients with services.

When talking about traditional health care, Lauer said cost is a big factor for many people. She gave an example of a mom with three children who were each diagnosed with strep throat. The bill could be upward of $1,200 plus the cost of the medicine when billed appropriately.

“With costs that high, the next time you think and wonder, ‘Will that mom even bring the kids in?’” she said. “Plus, for one provider, it can take up to 13 support staff. That’s why it gets expensive. I didn’t feel I was practicing what I was trained for and was on a constant wheel of trying to provide good care. It was a conflict of consciousness and what catapulted me into the decision to open a direct primary care clinic.”

Lauer said life is short and she wanted to spend her medical career practicing medicine how she was trained. She said when it comes to the health care system, her philosophy is, “It’s not about you versus me, it is about us versus the process.”

To open Well & Company, she said it took nearly a year of planning and a few setbacks.

“The moment I decided to do it, in my gut, I knew it was right,” said Lauer. “I prayed to my mom and God and they helped put everything into perspective.”

When she decided to open the clinic, she did first think about using insurance, but wanted a more affordable option. She started Googling “affordable care” and came across information about direct primary care. For four months, she researched everything she could on this option and spoke with other physicians who use this method.

Lauer will work with wholesalers for lab services and medicines. If a patient needs labs, they can be drawn right at the clinic and typically within 24 hours, she will have the results. For prescriptions, she works with a wholesale company that offers meds at a reasonable cost.

When it comes to costs, Lauer said she is all about price transparency. She said there won’t be any surprise bills.

“There is no reason our health care system can’t be price transparent, especially in family care,” she said. She noted there are regulations being developed to help promote more price transparency within the health care system.

According to Julie Sabo, advanced practice nursing specialist with the Minnesota Board of Nursing, advanced practice registered nurses are registered nurses who have graduate level education, knowledge and skills.

In Minnesota, a newly graduated clinical nurse specialist or certified nurse practitioner must practice for 2,080 (about one year of full-time practice) in a hospital or clinical setting where advanced practice nursing specialists and physicians work together.

A direct primary care clinic can only provide primary care. The provider, such as Lauer in this case, charges each patient a monthly fee in return for convenient access and a buffet-like menu of mostly basic primary care services. Since they do not accept insurance, they do not accept Medicare or Medicaid patients.

Sabo said these types of clinics are not licensed by the Minnesota Department of Health.

Lauer said the direct primary care model is a newer concept in Minnesota and said it may not be for everyone. She also said that people can still have health care insurance but up their deductibles and use for catastrophic events.

“I just want to be able to provide affordable, accessible and quality care for our community,” she said, noting that she can take up to 500 patients, which will allow her to provide more individualized, personal care.

Among many other services, a nurse practitioner can prescribe medications, treat patients for ailments, diagnose conditions, provide yearly physicals and other preventative care services, as well as stitch up wounds, take X-rays and when needed, refer patients to specialists.

While she is not a doctor, her main focus is family practice and she specializes in women’s care, especially those who are between the ages of 30 and 65. Within her clinic, there is a medical spa that offers skin care services as well as gynecological health services.

One of the pieces of equipment is called the MonaLisa Touch, which offers a laser procedure that provides women a fast, painless way to feel more comfortable and confident with their gynecologic health, said Lauer, who was emotional talking about the machine and how women’s health is so important. She said because women’s bodies are constantly evolving, especially in those middle-aged years and that they can struggle so much through the menopause years, she is passionate about providing them with the care they need to feel empowered and better about themselves.

Although there are plans to expand, Lauer said as of right now, her staff includes Cassandra Johnson, licensed practical nurse; Briana Craig, registered nurse; and Emily Bienias, advanced practice esthetician, who happens to be her sister.

For more information about Well & Company, visit its website at