Organic Growth Podcast: Hope Is Not a Strategy: The Real Drivers of Organic Growth in Healthcare
Recorded live at the McGuireWoods Healthcare Private Equity & Finance Conference, tthis episode of the Organic Growth Podcast takes a financial and operational look at what really drives growth in healthcare.
Stewart Gandolf speaks with Jonny Rosch of PBMares about how organizations can uncover hidden opportunities by focusing on the fundamentals—rather than chasing growth targets alone.
From revenue leakage to payer mix and operational efficiency, this conversation highlights how disciplined execution—not just ambition—creates sustainable performance.
Why Listen?
- Understand how financial fundamentals drive organic growth
- Learn where hidden opportunities like revenue leakage exist
- Discover how payer mix impacts risk and profitability
- See why process and execution matter more than growth targets
Key Insights and Takeaways
- Revenue Leakage Is One of the Most Immediate Growth Opportunities.
Before pursuing new growth strategies, organizations should ensure they are capturing all the revenue they’ve already earned. Fixing leakage can deliver immediate bottom-line impact without additional investment. - Untapped Capacity Can Drive Growth Without Expansion.
Many organizations have existing capacity that isn’t fully utilized. Improving scheduling, throughput, and operational efficiency can unlock growth without adding new locations or providers. - Payer Mix Plays a Critical Role in Financial Performance.
The composition of payer mix directly impacts margins and risk. Organizations must regularly evaluate whether their mix aligns with long-term sustainability while balancing mission and access to care.
4. Quality of Revenue Matters More Than Speed of Growth.
Not all growth is equal. Consistent, predictable revenue with healthy margins is far more valuable than volatile or acquisition-driven spikes. Buyers and investors look for stability and sustainability.
5. Growth Targets Without Process Are Ineffective.
Setting a goal like “10% growth” isn’t enough. Organizations must focus on the underlying levers—processes, operations, and financial discipline—that actually drive results.
Jonny Rosch, CPA
Partner, Healthcare Industry Leader, PBMares LLCSubscribe for More
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Note: The following AI-generated transcript is provided as an additional resource for those who prefer not to listen to the podcast recording. It has been lightly edited and reviewed for readability and accuracy.
Read the Full Transcript
Stewart Gandolf (Healthcare Success): Welcome again to the Healthcare Success Podcast—our final episode live from the McGuireWoods Healthcare Private Equity & Finance Conference. Thanks again to our friends at Levin Associates who co-hosted this event with us.
My last interview of the conference is Jonny Rosch, a CPA with PBMares. First of all, welcome, Jonny.
Jonny Rosch (PBMares): Thank you, Stewart. It’s a pleasure to be here.
Stewart Gandolf (Healthcare Success): Great to have you. So, the first thing I want to talk about is organic growth.
The theme we’ve been hearing a lot is that over the last couple of years, it’s been “roll-up, roll-up, roll-up”—M&A-driven growth. Not that there’s anything wrong with that, but now we’re hearing much more demand for organic growth.
From your perspective, working with healthcare clients, what are some areas of untapped organic growth we should be thinking about?
Jonny Rosch (PBMares): It’s interesting coming from the CPA lens—we tend to focus heavily on the numbers and value creation.
When I think about organic growth, a few key areas stand out. First is revenue leakage—making sure nothing is slipping through the cracks. Fixing that can immediately improve the bottom line.
Second is untapped capacity. Are there existing resources that aren’t being fully utilized?
And third is payer mix. Are organizations being strategic about their payer mix, and are they regularly evaluating whether it’s the right fit?
Stewart Gandolf (Healthcare Success): That last point is fascinating—and not something we deal with directly. Are you able to consult clients on payer mix? There’s often fear around it—some payers don’t reimburse well, but they bring volume. How do you quantify and manage that risk?
Jonny Rosch (PBMares): Managing that risk is definitely complex. We help from the financial perspective and often bring in specialists to evaluate contracts.
It comes down to understanding best practices, evaluating contracts, and determining what mix is sustainable and aligned with the organization’s goals.
Stewart Gandolf (Healthcare Success): When organizations are preparing for growth or even an eventual sale, what financial indicators signal a healthy business?
Jonny Rosch (PBMares): I look at both the income statement and the balance sheet.
On the income statement, it’s about the quality of revenue—not just growth. Is it consistent, sustainable, and flowing through to strong EBITDA?
On the balance sheet, I focus on working capital management, key ratios, and capital expenditures. Are those being managed effectively? Are investments being utilized properly?
Understanding trends across both statements is critical.
Stewart Gandolf (Healthcare Success): When you say “quality revenue,” what does that mean for someone who may not be familiar with the concept?
Jonny Rosch (PBMares): It ties back to revenue leakage and payer mix. Are you capturing all the revenue you should? Is your payer mix balanced and appropriate?
It’s also about consistency. Are you seeing steady, organic growth, or are there spikes driven by one-off events? Smooth, predictable growth is a strong indicator of quality.
Stewart Gandolf (Healthcare Success): There’s a lot of change in healthcare—especially around reimbursement. I imagine Medicaid-heavy businesses can present more risk.
Jonny Rosch (PBMares): Yes, absolutely. There’s definitely more risk in certain payer mixes, which is why it’s so important to evaluate whether the mix aligns with the organization’s goals.
At the same time, providers have a mission to serve their communities, so it often becomes a balance between financial sustainability and patient care.
Stewart Gandolf (Healthcare Success): That makes sense. From an operational standpoint, what are some of the most powerful financial levers you see for improving performance?
Jonny Rosch (PBMares): We’ve already touched on a couple—revenue leakage and payer mix are big ones. Those are often the lowest-hanging fruit.
Making sure the right processes are in place in those areas can have a significant impact.
Stewart Gandolf (Healthcare Success): From our side, marketing is often an underutilized lever. Many organizations rely solely on referrals, but depending on the specialty, marketing can drive significant growth.
Jonny Rosch (PBMares): That’s a great point. Marketing is often underappreciated, and it highlights the importance of having the right team of advisors.
When CPAs, marketers, and other experts collaborate, organizations can have more strategic conversations and unlock more opportunities.
Stewart Gandolf (Healthcare Success): We can actually get along!
Jonny Rosch (PBMares): Absolutely. It just requires a different mindset—thinking beyond traditional roles and focusing on the overall health of the organization.
Stewart Gandolf (Healthcare Success): As we wrap up, what’s a common mistake you see organizations make?
Jonny Rosch (PBMares): Focusing too much on the end goal—like “we want 10% growth”—without focusing on the underlying drivers.
Growth doesn’t happen by itself. You need the right processes and operational levers in place. For us, it’s about building the foundation first and letting that drive the results.
Stewart Gandolf (Healthcare Success): Hope is not a strategy.
Jonny Rosch (PBMares): Exactly.
Stewart Gandolf (Healthcare Success): Jonny, thank you. It’s been a pleasure.
Jonny Rosch (PBMares): Thank you so much.
