Financial models for behavioral health and ABA providers
Capacity modeled from billable hours by credential, authorized units against delivered units, staffing ratios that decide the margin, and clinic-level contribution. Built to order, checked before it ships.
How the money moves
Revenue is clinician hours, billed by credential at a rate the payer sets per code, and capped by the units an authorization actually allows. That makes this business a capacity model wearing a healthcare costume: headcount times billable hours times realization, against a payroll that is fixed the moment someone is hired. Two numbers decide the year — the share of a clinician's paid hours that are billable, and the share of authorized units that get delivered before they expire. Neither of them appears on a standard P&L, which is why so many providers grow revenue and lose money at the same time.
What we build for behavioral health and ABA providers
The workbooks this business runs on
- 01
Capacity and staffing model
Clinicians by credential, paid hours, billable ratio, rate per code, and the supervision ratio the payer requires — with headcount as the driver rather than an expense line.
- 02
Authorization utilization reporting
Units authorized against units delivered against units remaining, by client, with the expiry date that turns unused authorization into revenue that never existed.
- 03
Clinic contribution model
Contribution by clinic after direct staff, supervision and occupancy, so a group can see which sites carry the others.
- 04
New clinic pro forma
Caseload ramp against the hiring plan, the months where staff are paid before they are billable, and the census the site needs to break even.
- 05
Diligence pack
The quality-of-earnings shaped set a buyer asks for: revenue by payer, rate and volume bridges, clinician productivity and retention.
Every one of these is a request on your board, not a project with a scope document. All of them are on the one subscription — there is no build type you have to move up a plan to reach.
Where these models usually go wrong, and what we do instead
Four mistakes a model makes when the builder has never seen this business
- 01
Revenue driven by client count rather than delivered units, which ignores the authorizations that quietly expire
What we do instead. We drive revenue from delivered units against authorized units, with expiry dates surfaced early enough to still deliver against them.
- 02
One blended hourly rate across credentials and codes, when the mix between them is the margin
What we do instead. We rate every hour at its own credential and code, so the model can say what a change in mix is worth before you hire for it.
- 03
Billable ratio assumed rather than measured, which is the single most common reason a plan misses
What we do instead. We measure the billable ratio out of your own payroll and session data, then show what the plan needs it to be to hold.
- 04
Supervision modeled as overhead instead of as the ratio the payer requires, which breaks the moment headcount grows
What we do instead. We model supervision as the ratio the payer requires, so the supervisory hire appears in the plan at the headcount that triggers it.
When people call us
Usually one of these has just happened
- Private equity or a strategic buyer running diligence
- Opening a clinic, or expanding into another state
- A payer rate change or a new contract
- Hiring ahead of authorizations, or authorizations ahead of hiring
- A board that wants the unit economics rather than the P&L
Want this built for your numbers?
Every workbook is recalculated with a formula engine, its checks are proved able to fail, and a second pass re-derives the headline numbers before it ships.
Not ready? Get a free teardown of a sheet you already rely on.