M&A Infrastructure Build

One opportunistic deal → M&A infrastructure that supported 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

• 20+ practice launches across four new markets over three years

• $100M+ total capital deployed

• Time-to-operational-stability improved with each successive launch

• Credentialing delays dropped as the system built appropriate buffers and earlier trigger points

• Year 1 patient volume targets became consistently achievable

• Retiring physician segment, previously unaddressable, became part of 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. The coordination infrastructure, milestone reviews, and launch quality standards continue as standard operating rhythm. Post-implementation monitoring at 30, 60, and 90 days runs for every new location.

Where is the platform stuck?

Opportunistic deal you need to turn into a repeatable system? Let’s talk.

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