Selected work · 09 of 09
One operating system for a platform built by acquisition.
The Situation: A PE-backed specialty healthcare platform had grown quickly by acquiring practices, dozens of sites across several regions, with a sale on the horizon. The sponsor needed EBITDA to rise and an operating story a buyer's diligence would hold up against.
The Constraint We Identified
The platform grew by acquisition. Its operations never became one platform.
Leadership assumed practice-level operations and marketing would standardize as the platform grew. They hadn't. Each practice ran its own way: scheduling, patient flow, marketing and reporting all varied.
That meant cost and capacity couldn't be managed on one basis, and couldn't be shown to the board on one basis either. The equity story rested on numbers the platform couldn't yet produce consistently.
What We Built
A shared practice system, modern patient marketing, and a board-grade strategic cycle.
Structural pattern Before / after
The structural pattern. Scheduling, patient flow, marketing and reporting ran on one shared system across every practice, which fed a quarterly strategic cycle and board reporting the sponsor could underwrite.
- MapWe mapped operations practice by practice: scheduling, patient flow, marketing and reporting, and where cost and capacity were lost between them.
- AssessThe binding constraint was variance. Without one way of running a practice, no improvement could be scaled or evidenced across the platform.
- DecideStandardize practice operations around a shared efficiency system, modernize patient marketing, and run the platform on a strategic cycle with board reporting the sponsor could underwrite.
- ExecuteImplemented the practice efficiency system, the marketing automation and the quarterly strategic cycle with board reporting, working as the transformation lead on the sponsor's behalf.
What the Engagement Produced
An operating story that could be evidenced.
$9M → $11M
EBITDA
Over about two years, ahead of the sponsor's exit.
−14%
Costs
From standardized operations across practices.
110%
Revenue ramp
Supported by modernized patient marketing and added capacity.
Growth in a roll-up has many drivers, including the acquisitions themselves. The contribution here was making the platform run, and report, as one business.
What carried forward into Zero Fog's work today
Building the evidence trail before the buyer asks for it. It is how every exit-readiness cycle is run now.
Facing a similar decision?
Zero Fog Advisory Group · quarterly execution cycles · founder-led