A PE-backed urgent care platform expansion

The Setup

The operator was a 51-year-old healthcare executive who had previously been COO of a regional hospital system and then GM of a national urgent care chain's mid-Atlantic region. The PE fund (a $400M lower-middle-market healthcare-focused fund) had identified him as a CEO-in-Residence equivalent and committed capital to back him in finding and operating an urgent care platform acquisition.

After 6 months of partnership, they identified the target: a 6-clinic urgent care chain in the mid-Atlantic, founded by an emergency medicine physician. The founder was burning out and ready for a partner who could professionalize the business and scale it.

The Deal

$32M EV. Structure: - $18M senior debt from a healthcare-specialty lender - $12M equity from the PE fund - $2M of founder rollover at deal value

The founder stayed on as Chief Medical Officer for a defined 24-month transition.

The Scaling Strategy

The operator and the PE fund had agreed on a clear thesis pre-close: combine de novo clinic openings (in geographies where they could be first-to-market) with strategic acquisitions of competitor or adjacent platforms (where the entry cost made acquisition more efficient than greenfield).

Over 36 months: - 9 de novo clinics opened (average opening cost $1.2M, ramp to break-even by Month 7-9, target steady-state EBITDA of $400K per clinic) - 3 acquisitions: a 4-clinic platform ($8M EV), a 2-clinic platform ($3.5M EV), and a 1-clinic specialty (occupational health) ($1.5M EV) - 1 clinic divested (the geography was structurally weak)

Total platform: 22 clinics, $48M revenue, $9.5M EBITDA at Month 36.

The Operating System

The operator built a centralized operating model that became the platform's competitive advantage. Five components: - Standardized clinical protocols. Every clinic operated on the same clinical pathway documentation, EHR template, and quality metrics. New clinic openings could plug in to the operating system on Day 1. - Centralized revenue cycle. Insurance billing, denials management, and patient collections were consolidated into a single team. Realization rates improved 9 percent across the platform within 12 months. -