Marketing for PE-backed healthcare platforms and roll-ups

Buyers don't pay for growth. They pay for growth they can re-run.

CC — PRESENTING COMPLAINT

Same-store flat while the unit count rises

Platforms present with EBITDA bought and growth rented — every acquisition brings another website, another agency, another CRM. Same-store growth stalls after integration, and post-close organic growth decays by acquisition cohort while the unit count keeps climbing. Multiple expansion is a marketing problem long before it's a finance one, which is why preparing a platform for sale is reporting work rather than deck work.

SUBJECTIVE

What we hear from operating partners and platform CEOs

"Same-store growth stalls after integration." · "We're running six marketing stacks and can't compare any of them." · "Our growth story is a slide, not a system."

DX — BLENDED COST

Blended CAC is rising and nobody can say why

The platform-level acquisition cost goes up, quarter over quarter, and the explanation offered is always the same word: auctions. Sometimes that is true. More often a rising blended CAC is an artefact of arithmetic, and it is rising because the mix changed underneath it.

A blended figure across sites acquired in different years, in different markets, at different maturities, running different stacks, is not a measurement — it is an average of things that were never comparable. Add three add-ons in secondary markets and the blend moves without any site's own performance changing at all.

The decomposition is the deliverable: cost per new patient by site and by acquisition cohort, on one definition, built from the ledger rather than from six ad dashboards. That is usually the first quarter's work, and it typically reveals that the platform does not have a rising cost problem — it has two or three sites with one, and a reporting layer that has been hiding them inside a mean.

OBJECTIVE — what we find on intake

What we find on intake at a platform

Post-close organic growth decaying by acquisition cohort · a separate marketing stack per add-on · CAC unmeasurable at platform level · diligence data assembled retroactively, per raise

ASSESSMENT

If acquisition can't be shown as a repeatable, operator-independent system, the exit multiple prices your growth as luck. Instrumented and re-runnable, it prices as a machine. That delta is the cheapest multiple expansion available.

PLAN

What we do: same-store instrumentation, site-level CAC decomposition, diligence-grade reporting

One acquisition system rolled across cohorts · platform-level CAC and payback instrumentation, decomposed by site · banker-ready growth narrative with re-runnable data · post-close integration playbook per add-on

WHAT WE MEASURE

What we measure: same-store growth, CAC by site, payback, dispersion

Same-store organic growth, by acquisition cohort
Cost per new patient by site, on one definition, from the ledger
Payback period on acquisition spend, per site
Dispersion — the spread between best and worst site on the same measure
Marketing stacks in use, counted, and the attribution coverage of each
Modelled multiple impact, stated as a model and never as a comparable
Months to system

In a platform, the spread is usually the opportunity and the mean is usually the distraction.

REFERENCE RANGES

Reference ranges across platform specialties

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