What does a fractional CFO do for a behavioral health provider?
A fractional CFO runs the forward-looking side of your finances on a part-time basis: cash forecasting, pricing, unit economics, and strategy. In behavioral health, that means a 13-week cash forecast updated every week, profit per session or treatment day, and a weekly email to leadership listing each action item, its owner, and the next step.
Your bookkeeper records transactions. A controller closes the month. A CFO looks ahead and makes a recommendation.
That forward view matters more in behavioral health than in most industries. 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.
The result is a program that can be profitable on paper and still be short on cash. Revenue is booked, but the deposits haven't arrived yet. A CFO's first job is to make that gap visible and plan around it.
Who's watching your numbers?
If you built a program without a finance background, you may not know what you don't know. You have a bookkeeper. You have an outside CPA who prepares your taxes. What you may not have is someone who reads the numbers every week and tells you what to do about them.
Each role does different work:
- Your bookkeeper records transactions, reconciles accounts, and keeps the books current.
- Your outside tax CPA prepares returns and advises on tax matters. That work is essential, and we don't replace it. We coordinate with your CPA.
- A fractional CFO builds the forecast, tracks the measures that move margin, and brings leadership a recommendation every week.
Without that third role, problems surface late. Cash slips through the cracks. Payroll creeps, and nobody notices until it's bad.
The reverse also happens: a number looks alarming when it isn't. 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.
How is a fractional CFO different from a bookkeeper or an outside CPA?
A bookkeeper records what happened, and an outside CPA typically handles tax returns and tax questions. A fractional CFO looks forward. That means a 13-week cash forecast, unit economics such as profit per treatment day, and a weekly recommendation to leadership. The three roles work together, and a CFO doesn't replace your CPA's services.
Behavioral Health CFOs is a financial consulting firm, not a CPA firm. We coordinate with the professionals you already trust.
What's included in a fractional CFO engagement?
A fractional CFO engagement gives your leadership team forward-looking finance on a part-time basis. Depending on what your program needs, the work can include:
- A rolling 13-week cash forecast, updated weekly.
- A weekly CFO email with action items, owners, and next steps.
- Unit economics, such as profit per session or per treatment day.
- Pricing analysis against your market position and cost structure.
- Tracking the cash conversion cycle, the time from service to deposit.
- Executive dashboards and reporting for leadership, boards, lenders, or investors.
- Strategy and capital planning, plus finance support during diligence alongside your broker or banker and attorney.
- A monthly review and strategy session, and an annual vision reset.
We can also support the monthly close, financial controls, and day-to-day accounting, including private-pay A/R management on your behalf and tax-ready books and coordination with your CPA. See all services.
Every program is different, so the specifics of an engagement depend on your program's unique needs. We scope the work with you after the free audit.
The MoneyMap Method in practice: Immunize, Predict, Optimize, Integrate
The MoneyMap Method is the operating system behind every engagement. It has four steps.
1. Immunize. Build a risk buffer: a four-month reserve made up of two months of cash plus two months of collectible A/R, so leaders decide from strength, not scarcity. That reserve is the target we use with clients. See the 4-month operating reserve.
2. Predict. A live 13-week cash forecast replaces reactive bank-balance checking, so payroll week holds fewer surprises. See how to build one.
3. Optimize. Improve profit per service unit, not just revenue.
Net Income = Profit Per X × Total Services
There are three levers: raise revenue per service (pricing, payer mix, positioning), lower cost per service (efficiency and expense control), and increase total services (capacity, retention, fewer premature discharges).
4. Integrate. One rhythm. Each week brings a cash forecast and a CFO email. Each month brings a close and a strategy session. Each year brings a vision reset.
Exit vs. Operate: aligning finance to the path you've chosen
Every financial decision depends on one choice: exit or operate. Most operators we work with already know which path they're on. We keep the finance system aligned to that choice as the business changes.
- Path A, Exit: build earnings quality and buyer-ready reporting. EBITDA hygiene and add-back discipline, buyer-ready financial reporting, and debt and capital-structure planning (general, coordinated with your lender and attorney).
- Path B, Operate: optimize for cash flow and sustainability. Distribution-ready free cash flow, a conservative capital structure, owner-operator tax planning built on tax-ready books and coordination with your CPA, and reserves engineered for resilience.
Behavioral Health CFOs is a financial consulting firm, not a business broker, investment banker or broker-dealer. On the Exit path, we prepare your finance function for a buyer's review.
Not sure which path you're on? We'll map it in your free audit. Read more on Exit vs. Operate.
Do you work with outpatient, IOP, PHP, residential, and inpatient programs?
Yes. Behavioral Health CFOs works only with behavioral health operators, across outpatient, IOP, PHP, residential, and inpatient levels of care. We don't serve other industries. The unit we measure changes with the setting: profit per session in outpatient, and profit per treatment day in IOP, PHP, and residential.
Each setting puts pressure on a different number:
- Residential treatment, therapeutic boarding schools, and youth programs: staffing to census, cost per treatment day, and private-pay versus insurance cash timing.
- Addiction treatment: census, length of stay, and the gap between service and payment.
- IOP and PHP: short stays, service volume, and cash timing.
How an engagement runs
- Free Financial Systems Audit (60 minutes). A working session with Josh. You leave with three deliverables: your top 3 profit levers, with an estimated dollar impact where your data allows; a redlined P&L showing where margin is hiding; and a 90-day sprint plan you can run with us, or without. You keep all the analysis, even if we never work together.
- Custom quote. A month-to-month package scoped to what the audit found.
- Onboarding. Josh or Tyler leads your onboarding. Week 1 covers access, data, and baseline; the cash forecast is typically live by week 2. Timing varies.
- The rhythm. A weekly forecast and CFO email, a monthly close and strategy session, and an annual vision reset.
Estimates are preliminary, based on information you share, and not a guarantee of results. The free audit doesn't create an advisory or client relationship.
How quickly does a fractional CFO deliver a cash forecast?
With Behavioral Health CFOs, the 13-week cash forecast is typically live by week 2 of an engagement. Week 1 covers system access, data, and a baseline. Timing varies with the state of your books and systems. After launch, the forecast is updated every week and paired with the weekly CFO email.
How are fractional CFO engagements priced?
Behavioral Health CFOs quotes each engagement after the Free Financial Systems Audit. We don't publish package prices. Scope drives cost: which services you need, how many entities and service lines you run, the condition of your books, and your meeting cadence. Every engagement is month to month and can scale up or down.
In past engagements
Therapeutic boarding school. A 100% private-pay, founder-owned program with capacity for 20 students went from a −5.2% operating margin to more than 10% over two years. The work included census-linked metrics, payroll-per-student visibility, new bill-pay, spend, and payroll systems, and pricing based on true cost per treatment day. Results vary.
Tax planning. Identified tax-planning opportunities that, implemented with the client's CPA, saved more than $100,000. Results vary.
These are results from individual engagements. Every organization is different, and past results don't guarantee future outcomes.
When should a treatment center hire a fractional CFO instead of a full-time CFO?
Hire a fractional CFO when the business is too complex to run without forward-looking finance but doesn't need a full-time executive yet. Common signs: cash feels tight despite profits, payroll is rising, a new location or service line is coming, or an exit is on the horizon. A full-time CFO fits when daily, in-house finance leadership is required.
Many owners sit in an awkward middle. The bookkeeper and tax preparer were enough while the program was getting off the ground. Now there's a second location, a new level of care, or a partner asking harder questions, and nobody owns the forward view.
A fractional engagement gives you a CFO's cadence (weekly forecast, weekly recommendation, monthly strategy) without a full-time salary. If you later need someone in the building every day, the forecast, dashboards, and reporting we build carry over.
Who you'll work with
- Josh Gardner, MBA, Founder & Fractional CFO. Josh founded Behavioral Health CFOs in 2020 to serve behavioral health providers exclusively. In 12 years inside the industry, he has served as CFO, COO, and executive director at The Hope Group and Havenwood Academy, and co-founded two programs. B.S. Accounting and MBA, Southern Utah University.
- Tyler Edgel, CPA, Partner · Fractional CFO. Tyler spent seven years at EY before joining Behavioral Health CFOs as a fractional CFO. His CPA is an individual credential; the firm is a financial consulting firm, not a CPA firm.
- Isaac Van Drimmelen, GTM & Business Development Lead. Isaac helps owners and operators find the fractional CFO, controller, or accounting support that fits their business.
Book your free 60-minute audit
If you don't know what you don't know, start here. In 60 minutes, Josh reviews how your financial systems work. You leave with your top 3 profit levers, with an estimated dollar impact where your data allows; a redlined P&L; and a 90-day sprint plan. It costs nothing, and you keep the analysis whether or not we work together.
Questions first? Email josh@bhealthcfo.com or call Josh at 435-429-2855.
Estimates are preliminary, based on information you share, and not a guarantee of results. The Free Financial Systems Audit is a working session, not an audit or attest engagement, and it doesn't create a client relationship. See our Disclaimer.