A PE-backed medical group: one map before any platform

What it is

A private-equity-backed medical group with dozens of offices, assembled by acquisition. Each office arrived with its own tools, website, vendor contracts and doctor-partner, and nobody owned the whole. Leadership named IT vendor sprawl in a HIPAA-regulated environment as the biggest pain, and the group wanted people moved into better work rather than cut. An earlier platform conversion had cost $50,000 to $100,000 per office and had not reduced the ongoing IT bill.

The group is not named. It came to Common Ground through a capital partner in July 2026. Common Ground holds the fractional COO seat on a ninety-day operations and efficiency audit across IT, HR, FP&A, marketing and revenue cycle, and writes the roadmap that follows it.

What Common Ground did

• Before any contract existed, Fowler built an acquisition vetting engine: a hosted scoring rubric with five weighted criteria and a composite out of 100, run on practice-level operational and financial inputs only, never patient records. Rather than pitch a buyer of practices, he scored five practices that were for sale that week, from 85 down to 45, and let the client argue with the output.
• Common Ground scoped the audit as map first, govern second, build third: audit, analysis and recommendation only, with any build as its own statement of work once the question in front of it is answered.
• The first open question is the practice-management platform's topology, one database or one per office, because it decides whether any data work takes about two weeks or about three months.
• Vendor governance comes before vendor replacement: a register with a business associate agreement, service levels, renewal dates and one owner for every vendor that touches protected health information. The IT work was framed as vendor rationalization, not an audit of a department. Stated rates went into the register as rates, never multiplied out: websites at $725 and about $750 per office per month, a data connector at $50, practice analytics at $300 to $500, and per-location connectors and VPN at $400 to $600.
• Patient communications run only on infrastructure covered by a business associate agreement. GoHighLevel, a general marketing-automation platform, was ruled out for protected health information; the layer is built on Twilio under a BAA, HIPAA-capable email, n8n self-hosted on infrastructure covered by a BAA, and a language model under a BAA.
• Clinical AI (Overjet, Pearl and Videa are the names in the class) is bought and integrated rather than built, with the build budget spent on the integration layer the group will own.
• The money flows with weak controls come first: payroll computed about 75 percent centrally and 25 percent in the offices, doctor-partner compensation checked only by spot checks, and insurance reimbursement landing in 30 to 60 days. The first moves are one payroll view, a control on the compensation calculation and an accrual policy.
• Each thirty-day cycle surfaces quick wins near day 25, such as duplicate tools, security settings never switched on and vendors paid twice, so every report opens with something already done.

Results

• The introduction became a signable audit contract in 18 days. The retainer went from a second draft to a thirteenth under outside counsel, and on August 14, 2026 the client walked through the portal, the live scoring engine and the near-final contract as one decision.
• Common Ground is under retainer and the ninety-day audit is under way.
• Built so far: a current-state systems map, a vendor-rate register, the revenue-cycle analytic for the second cycle, a vetting scorecard template and the cycle plan.

External links

• Public data room: A PE-backed medical group: operating audit (2026) data room

Stories from this work

At a glance