Behavioral Health CFOs
Fractional CFO, controller & accounting · Behavioral health only

Financial operating systems for behavioral health.

We build the financial operating system owner-operators run on: a 13-week cash forecast, a weekly CFO email that says what happened and what to do next, and pricing built on real unit costs. From strategy to bookkeeping, month to month.

Book your free 60-minute audit →Explore the MoneyMap Method

60 minutes with Josh. Three deliverables, $0, and you keep the analysis.

We help you
  • → see cash 13 weeks ahead
  • → build a 4-month reserve
  • → choose exit vs. operate
  • → price from real unit costs
Small line chart: actual cash, then a dashed 13-week forecast, updated weekly, that dips toward but stays above a shaded 4-month reserve target band.
Illustrative example. 13-week cash forecast vs. 4-month operating reserve target.

We run a 13-week cash forecast, updated weekly, against a 4-month operating reserve target.

WeeklyForecast & CFO email

In past engagements: −5.2% → 10%+ operating margin over two years (therapeutic boarding school) $300K+ overhead reduced in the first three months (~$25M RTC) Results vary. See the case studies →

Behavioral health onlyOutpatient · IOP · PHP · Residential · Inpatient
The problem

Who's watching your numbers?

Not prepping financial reports. We mean "here's what happened and what to do next." Most programs don't have that.

  • Cash slips through the cracks.
  • Payroll creeps, and nobody notices until it's bad.
  • The bank balance is a lagging number; it tells you what already happened.

We offer behavioral-health-specific CFO support that fixes this, with no need for a full-time hire.

What we see: timing

Often it isn't a cash problem. It's a timing problem.

Care is delivered in January, billed in February, and collected in April. That gap is the cash conversion cycle, and a weekly forecast shows it coming before it hurts.

Timeline: care delivered in January, billed in February, collected in April. A brace marks that gap as the cash conversion cycle, and payroll keeps coming due every pay period.
Illustrative example. Care delivered in January and collected in April leaves a gap that payroll doesn’t wait for.
What we see: payroll

Rising payroll isn't always bad news.

At one program we support, payroll costs rose 20% and leadership was about to take drastic action. Cost per client was steady. The weekly CFO report caught it first.

Two small line charts. Growth: payroll and clients served rise together, and cost per client holds steady. Drift: payroll rises while clients served stay flat, and cost per client rises.
Illustrative example. Payroll rising with clients served is growth; payroll rising while clients served stay flat is drift.
The MoneyMap Method

Not compliance. An operating system.

Immunize against volatility, predict cash, optimize unit economics, then run the rhythm with leadership every week.

01
Step 1 · Immunize

Immunize against volatility.

Build the risk buffer: a four-month reserve (2 months cash + 2 months collectible A/R), so leaders decide from strength, not scarcity.

02
Step 2 · Predict

Predictability creates control.

A live 13-week cash forecast replaces reactive bank-balance checking, so payroll week holds fewer surprises.

03
Step 3 · Optimize

Improve profit per service unit.

Work on Profit Per X through pricing, cost per service, service volume, and payor mix.

04
Step 4 · Integrate

One system, one rhythm.

Connect tools, live dashboards, weekly actions, and monthly strategy into one operating rhythm.

The growth formula

We focus on profit per service unit, not just revenue.

Profit Per X = Revenue per service − Cost per service
Operating income = Profit Per X × Total services
Chart: revenue per service holds flat while cost per service falls as total services rise; past break-even, the gap between them is Profit Per X.
Illustrative example. Past break-even, the gap between revenue per service and cost per service is Profit Per X.
Three levers
IncreaseRevenue per servicePricing, payor mix, positioning
DecreaseCost per serviceEfficiency & expense control
IncreaseTotal servicesCapacity, retention, fewer premature discharges

See the full method →

Results

Two anonymized engagements.

Summaries of real client work, with identifying details removed.

Case study · Residential
−5.2% → 10%+
Operating margin, over two years
Operating margin for one anonymized past engagement: −5.2% before, 10%+ two years later, crossing a 0% reference line. Only the two endpoints are data; the dotted line between them is a connector.
Anonymized client result. Only the two endpoints are data.

Willow Ridge Academy (pseudonym)

Therapeutic boarding school20 students100% private payFounder-owned

Leadership could not see why the program was losing money. Census-linked metrics, payroll-per-student visibility, new systems for bill pay, spend controls, and payroll/HR, and pricing based on true cost per treatment day moved the owner out of financial firefighting.

Identifying details anonymized. Margins are exact.

Case study · Large RTC
$300K+
Overhead reduced in the first three months

Red Mesa Behavioral Health (pseudonym)

~$25M RTC300+ employees3 service linesWestern U.S.

The organization had outgrown its financial architecture. Decision-grade dashboards, a new chart of accounts, Ramp for bill pay, and census-driven department budgets followed, plus a one-time tax savings of over $100,000 from a change in tax reporting method.

Identifying details anonymized.

Results from individual engagements. Every organization is different, and past results don't guarantee future outcomes.

How we serve you

Three tiers, month to month.

Strategy, close, and day-to-day accounting from one behavioral-health-only team. Engage at the level you need today, then adjust as the business changes.

Fractional CFO

We own your financial strategy without a full-time hire.

  • Fractional CFOStrategy, capital plan, board & investor reporting.
  • Strategic AdvisoryVision facilitation, exit-readiness & deal support.

Includes the full MoneyMap Method

What's included →Fractional CFO for behavioral health →

Controller

We close the books and own the accounting function.

  • Fractional ControllerGAAP-aligned close, internal controls, audit-ready monthly.
  • Outsourced AccountingEnd-to-end finance operations in one engagement.
What's included →

Accounting Operations

We run the daily back office that keeps cash moving.

  • BookkeepingBehavioral health chart of accounts, reconciliations, trend review.
  • Accounts PayableApproval workflows, vendor management, spend control.
  • Private-pay A/R managementWe manage private-pay accounts receivable on your behalf, as an extension of your in-house team: invoicing, payment reminders, and prepayment protocols. We don't handle insurance billing or claims.
  • Payroll & TaxPayroll processing and tax compliance with an operator's lens.
What's included →
Month-to-monthScale up or downÀ la carte or as a packageCustom quote after your audit

Run a residential program or therapeutic boarding school? Financial leadership built for residential programs.

Compare services →

What we track

The 7 numbers that drive 80% of financial performance.

Cash, Profit Per X, the cash conversion cycle, and four more measures we track consistently for every client.

See all 7 numbers →
Seven tiles, one per number we track: cash balance, Profit Per X, cash conversion cycle, service volume, A/R days, payroll as a percentage of revenue, and blended daily rate, each with its review cadence.
Illustrative example. The seven numbers, each on its own review rhythm.

The seven financial numbers we track are cash balance, Profit Per X, the cash conversion cycle, service volume, A/R days, payroll as a percentage of revenue, and blended daily rate.

Start here

The Free Financial Systems Audit

A 60-minute working session with Josh. You keep all the analysis, even if we never work together. Pricing for any ongoing work is a custom quote after the audit.

60Minutes
3Deliverables
$0Cost
Book your free 60-minute audit →

Questions first? Email josh@bhealthcfo.com or Call Josh 435-429-2855.

Audit findings are preliminary and based on the information you share with us. The free audit doesn’t create an advisory or client relationship. Details

Josh or Tyler leads your onboarding, and Tyler leads your engagement day to day, with Josh involved in strategy.

What you walk away with
  1. Your top 3 profit levers, quantified in dollars.
  2. A redlined P&L showing where margin is hiding.
  3. A 90-day sprint plan you can run with us, or without.
Built for outpatient, IOP, PHP, residential, and inpatient behavioral health operators.