Vignettes
Real Work. Real Situations. Real Breakthroughs.
Most behavioral health owners and operators know they need support, but aren’t always sure where or why.
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Growth stalls. Complexity creeps in. What used to feel clear starts to feel heavy. The business is working, just not at its full potential.
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The vignettes below reflect real situations I’ve navigated as an operator and advisor in behavioral health. Names are confidential, but the challenges are common.
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You may recognize your own organization in these stories. If you do, that’s not a problem, it’s a signal. These examples are meant to help you identify where you’re stuck, where leverage exists, and what kind of breakthrough could unlock your next phase of success.
Acting as the Operator Voice in Transaction Rooms
Challenge: Deal processes often lacked practical understanding of how behavioral health businesses actually operate.
Work: Served as an operator-informed advisor during diligence and negotiations, grounding discussions in real-world clinical and operational realities.
Outcome: More realistic deal structures, fewer post-close surprises, and smoother integrations.
Helping Founders Decide Whether to Sell
Challenge: A founder felt pressure to transact but was unsure whether selling aligned with long-term goals and values.
Work: Modeled multiple paths, including remaining independent, partial liquidity, and full exit, integrating financial and lifestyle considerations.
Outcome: The founder made a confident, informed decision rather than a reactive one.
Cleaning Up “Messy EBITDA” Before It Became a Problem
Challenge: Strong cash flow was obscured by founder compensation, one-time expenses, and inconsistent accounting practices.
Work: Normalized EBITDA, clarified add-backs, and separated operational performance from financial optics.
Outcome: Improved internal decision-making and increased credibility with lenders, investors, and future buyers.
Creating a De Novo Expansion Playbook
Challenge: Leadership wanted to expand into new markets but lacked a repeatable framework for disciplined growth.
Work: Built a de novo clinic-launch model covering site selection, hiring cadence, ramp timelines, capital deployment, and early KPIs.
Outcome: Reduced execution risk and enabled confident, repeatable expansion.
Designing Clinician Economics That Actually Worked
Challenge: Clinician turnover and inconsistent productivity were driven by opaque, misaligned compensation structures.
Work: Redesigned clinician compensation models to improve transparency, predictability, and alignment with access, quality, and sustainability.
Outcome: Improved retention and utilization while preserving margins and rebuilding trust with clinical teams.
Creating a De Novo Expansion Playbook
Challenge: Leadership wanted to expand into new markets but lacked a repeatable framework for disciplined growth.
Work: Built a de novo clinic-launch model covering site selection, hiring cadence, ramp timelines, capital deployment, and early KPIs.
Outcome: Reduced execution risk and enabled confident, repeatable expansion.
Navigating Growth Without Losing Clinical Integrity
Challenge: Leadership feared that rapid expansion would dilute culture and clinical quality.
Work: Embedded clinical excellence and values directly into hiring, onboarding, supervision, and performance management systems.
Outcome: The organization scaled responsibly, maintaining strong outcomes while improving access and financial performance.
Building an Executive
Team That Could Scale
Challenge: A founder was carrying too many functional responsibilities, slowing growth and decision-making.
Work: Designed and helped recruit a true executive leadership structure, clarified decision rights, and coached leaders through the transition from “doers” to “leaders of leaders.”
Outcome: The organization shifted from founder-centric operations to a durable leadership model capable of supporting long-term growth and investor scrutiny.
Turning Operational
Chaos Into Clarity
Challenge: Rapid growth outpaced infrastructure, leading to clinician burnout, scheduling inefficiencies, and inconsistent patient experience.
Work: Diagnosed bottlenecks across intake, scheduling, utilization, and billing, then implemented standardized workflows, accountability, and operational dashboards.
Outcome: Improved clinician retention, increased capacity without adding headcount, and restored leadership confidence in the organization’s ability to scale sustainably.
Preparing a Behavioral Health Company for Private Equity
Challenge: A fast-growing behavioral health organization wanted to explore a sale but lacked institutional reporting, deal-ready governance, and a clear equity story.
Work: Rebuilt financial reporting, clarified true EBITDA, strengthened KPIs, and helped leadership articulate a credible growth narrative tied to outcomes and scalability.
Outcome: The company completed a premium-multiple transaction and retained meaningful upside through rolled equity.
Scaling a Founder-Led Practice Into a Multi-State Platform
Challenge: A founder-led outpatient behavioral health practice had strong clinical outcomes but inconsistent growth, fragile middle management, and no clear expansion playbook.
Work: Led the transition from operator-dependent execution to system-driven scale by professionalizing leadership, standardizing workflows, and building a repeatable clinic-launch model.
Outcome: The organization scaled to dozens of locations across multiple states, materially improved EBITDA margins, and completed a successful majority recapitalization with a leading healthcare private equity firm.