Multi-site physician services platform
M&A Infrastructure Build
One opportunistic deal → M&A infrastructure the deal and integration teams ran across 20+ launches and $100M+ in capital deployment
THE SITUATION
An email arrives from a retiring physician group. They want to sell. The platform has three growth pathways. None of them work for this. There’s no evaluation framework, no transaction playbook, no integration process. The deal walks if there isn’t a system.
Beyond this one inquiry, the underlying problem is structural: every new practice launch (across all pathways) requires coordinating 12+ departments across months of preparation. Without a system, execution depends on heroic individual effort that can’t scale with deal volume.
WHAT I BUILT
Deal evaluation
• Structured criteria assessing strategic fit, financial viability, and operational risk
• RAPID decision process defining who recommends, approves, and decides at each stage from initial assessment through LOI
Transaction execution
• Due diligence request lists (financial, operational, legal), data room structure, valuation methodology
• Deal sequencing from NDA through LOI acceptance, with third-party diligence coordination across legal, financial, and medical workstreams
Post-close integration
• TSA preparation: corporate development (AR reporting, loan payoffs, liability resolution), finance (bank accounts, lease payments, legacy contract disposition), HR (employee census, compensation analysis, day-one coordination), and medical (equipment assessment and procurement)
• Implementation countdown: department-by-department execution plan across five milestone windows (3 months, 2 months, 1 month, 1-2 weeks, go-live) with defined deliverables and owners for operations, IT, HR, finance, credentialing, medical, marketing, and ancillary services
• Launch quality standards: explicit go/no-go criteria across every function before any practice opened
• Post-implementation monitoring: structured debriefs at 30, 60, and 90 days with proficiency checklists and escalation protocols
• Coordination infrastructure: weekly cross-functional standups, shared dashboards, milestone reviews
The three layers were interdependent. Deal evaluation without transaction execution produces approved deals that stall at LOI. Transaction execution without post-close integration produces closed deals that fail at launch. Post-close integration without evaluation discipline produces an operating model that absorbs bad deals. The infrastructure had to span all three to compound.
THE RESULT
• The deal and integration teams ran 20+ practice launches across four new markets over three years
• They deployed $100M+ in total capital
• They improved time-to-operational-stability with each successive launch
• They cut credentialing delays by building appropriate buffers and earlier trigger points into the system
• They hit Year 1 patient volume targets consistently
• They brought the retiring physician segment, previously unaddressable, into systematic growth strategy
Business development uses the evaluation framework to qualify acquisition opportunities. Legal and finance execute from the transaction playbook. The integration team owns the M&A playbook. Operations owns the de novo and affiliation playbooks. They run the coordination infrastructure, milestone reviews, and launch quality standards as standard operating rhythm. Post-implementation monitoring at 30, 60, and 90 days runs for every new location.
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