Engagements
Fixed scope. Fixed fee. No surprises.
Every engagement is scoped to a defined deliverable rather than an outcome outside our control, and quoted as a single fixed fee before any work begins. No hourly billing, no open-ended retainers, no invoice you didn't expect.
Where the commercial function actually stands, and what to do about it, in priority order.
Includes: stakeholder interviews with founders, the commercial team, current customers and lost prospects; commercial readiness scored across all ten Foundation First domains; competitive and targeting review; a written diagnostic with a prioritized 90-day roadmap; and a board-ready presentation of findings.
Best for: companies that know something isn't working commercially but can't yet name it — and boards who want an independent read before committing capital to a build.
The commercial system, actually built. Not a strategy deck — working infrastructure.
Includes: market and competitive research; targeting model; messaging and positioning platform; commercial model, pricing and contract structure; complete sales collateral; documented sales process; CRM selected, configured and adopted; sales-to-operations handoff design; cross-functional growth cadence; and a written playbook the team can run without us.
Compare the alternative: a full-time healthcare CRO costs $250K–$400K base plus equity and benefits, takes three to six months to hire and another six to ramp. The Foundation Build costs a fraction of year one and leaves a documented system behind either way.
Senior commercial leadership for a company that has the foundation and needs someone to run the build-out.
Includes: commercial team hiring, onboarding and coaching; comp plan and territory design; pipeline and forecast discipline; the cross-functional growth cadence; board and investor communication; and deliberate enablement of the person who will eventually own the function.
Explicitly excludes: carrying a quota or a bag. This is written into the scope of work.
Often called a fractional CRO or fractional chief revenue officer. The work is the same; the name here is more honest about what actually gets built.
Commercial due diligence for private equity and venture investors. Is this a product problem or a go-to-market problem — and is it fixable?
Pre-investment: independent assessment of a target's commercial function, pipeline quality, sales process maturity, and the credibility of its growth assumptions — from someone who has been the buyer these companies are selling to.
Post-close: a 100-day commercial plan for a portfolio company, with the sequencing and cost of the build laid out.
Training a commercial team and its leaders in the method that actually works in healthcare.
The method: interview the customer first. Surface the problems they have — including the ones they haven't named yet. Then marry your solution to what they told you. And when your solution doesn't fit, say so out loud. That last part is what builds the relationship no competitor can dislodge.
Includes: two-day onsite intensive; the methodology documented as a durable internal asset; call and meeting frameworks; manager coaching on how to reinforce it; and 60 days of follow-on coaching so it survives contact with reality.
The same discipline at the other end of the scale. A four-physician practice and a $600M organization leak revenue for the same reasons — nobody built the commercial foundation, and nobody has looked under the hood since.
Why now: most independent practices read the 2026 fee schedule headline and concluded they got a raise. The conversion factor did go up. Then a 2.5% efficiency adjustment landed on 91% of services, and facility practice-expense payment fell 7% while office-based rose 4%. The headline rate went up. Actual payment often went down. Where it went is specific to a practice's specialty and its site of service.
Five domains, scored the same way every time: reimbursement reality against the 2026 changes; payer contracting and where the bargaining power actually sits; revenue leakage across denials, undercoding and aging AR; missed opportunity in service lines, sites of service and APM participation; and whether the technology stack is helping or taxing the practice.
What comes back: a written findings document where every finding carries a dollar figure or a range. Three actions for the next 30 days that require no new hires, and two or three structural moves for the next 90.
Explicitly not: a chart audit, a coding or compliance review, or a valuation. Those are different disciplines carrying different obligations, and conflating them helps nobody.
Delivered through management services organizations (MSOs) and practice networks — so it stays affordable for the medical practices that need it most. How that works →
Questions about scope, cost or fit? Direct answers here.
How We Engage
Four things we agree on before we start.
An executive sponsor
Someone with real authority who has agreed in advance to act on the findings. Analysis without a decision-maker is theater.
An acknowledged gap
You already believe there's a commercial problem. We're not here to convince a leadership team it has one.
A cash budget
No equity in lieu of fees. No deferred compensation. Performance upside is available — in cash.
Real access
To your customers, your data and your team. We can't diagnose a commercial function from the outside.
Most engagements start with the Diagnostic.
Three to four weeks, one fixed fee, and a clear answer about what's actually broken and what to fix first.
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