Off Mandate: How Healthcare Roll-Ups Create Value (and Where They Break)
The EBITDA math on healthcare roll-ups looks clean until integration hits the wall. These are the problems that break the model:
Integration capacity doesn't scale with deal volume — it lags. Three months dry, three months slammed. Platforms never staff up, and when volume spikes, they lose the EBITDA they just bought.
Corporate infrastructure costs — enterprise software, benefits, POS systems — get pushed onto acquired clinic P&Ls. If your ERP can't segment those costs cleanly, sellers see charges that weren't there before and push back on every line item.
Functional integration is treated as a systems migration. It's not. HR integration means getting people on board, not just on payroll. Platforms that skip this step are measuring system deployment instead of ROI.
Corp Dev and integration operate in separate lanes. By the time integration owns the problem, due diligence is closed, leverage is gone, and the operational red flags nobody wanted to raise are now someone else's problem to solve.
Session Focus
Eiron Roffey, Robin Younkin, Michael Gremley, and Marie Kennedy bring experience across clinic integration at scale, HR functional leadership, corp dev ownership, and integration project management. The format is a debate-driven working session — six structured discussion themes, each built around a real practitioner decision.
The Format
60 minutes total. Six structured discussion themes with open debate between practitioners:
Volume vs. Readiness: The Roll-Up Reality Check (10 min)
The Hidden Cost of Corporate Charges (10 min)
Functional Integration Is Not Optional (12 min)
Early Integration: Why Corp Dev Needs to Own It (10 min)
Seller Experience = Future Deal Flow (8 min)
The Most Underfunded Line Item in M&A (5 min)
Audience Q&A (10-12 min)
Live Q&A via chat and raised hands throughout. Audience members can submit real scenarios at registration — the panel will pull from them directly.
What You'll Learn
When the EBITDA math on a roll-up stops working — the volume and staffing thresholds where integration investment becomes non-negotiable
How to structure corporate charge allocation so it doesn't blow up seller relationships during earnout periods
What right-sized functional integration staffing looks like at 5 deals a year vs. 20 — and why the Canada/US gap in dedicated integration leads matters
How to measure people adoption (not just systems deployment) and why that distinction determines where ROI actually lands
How to build the internal case for operational diligence when the deal team is focused on speed — and where Corp Dev has to draw the line on what it owns
Why seller experience is a pipeline asset in healthcare ecosystems where physicians and clinic owners compare notes — and what platforms consistently get wrong
The math on integration investment vs. value erosion — and why it stays off the board agenda even when the numbers are obvious
Who Should Attend
Corp Dev and M&A teams at PE-backed healthcare platforms. Integration leads, IMO owners, and functional integration leads (HR, IT, Finance). Operators running or preparing to run high-volume roll-up strategies. Anyone who's handed an integration problem that due diligence should have caught.
Agenda
Total runtime: 60 minutes
11:00 AM Opening frame — Kison sets context, Eiron frames the problem
11:05 AM Theme 1: Volume vs. Readiness: The Roll-Up Reality Check (10 min)
11:15 AM Theme 2: The Hidden Cost of Corporate Charges (10 min)
11:25 AM Theme 3: Functional Integration Is Not Optional (12 min)
11:37 AM Theme 4: Early Integration: Why Corp Dev Needs to Own It (10 min)
11:47 AM Theme 5: Seller Experience = Future Deal Flow (8 min)
11:55 AM Theme 6: The Most Underfunded Line Item in M&A (5 min)
12:00 PM Audience Q&A (10-12 min)
12:10 PM Takeaways + Close
Speaker Bios
Kison Patel — Facilitator
Kison built DealRoom to ~$10M ARR and has led M&A execution across hundreds of transactions. He founded M&A Science to extract and share the patterns strong buyers use to win deals, turning practitioner experience into searchable, reusable intelligence.
Eiron Roffey — Senior Director, Clinic Integration Lead | Lifemark Health Group
Eiron brings over a decade of hands-on M&A integration experience spanning healthcare, managed services, and technology platforms. He built the post-merger integration function at FYidoctors, Canada’s largest eye care consolidator, before expanding his practice at Deloitte’s Value Creation Services team and across several high-volume acquisition programs. He currently leads clinic integration at Lifemark Health Group. His experience navigating the ebb-and-flow staffing problem and the hidden costs of corporate charge allocation anchors two of the session’s core discussion themes. He holds the Certified Post Merger Integration Specialist (CPMI) designation from IMAA.
Robin Younkin — Senior Director, HR Integration | OneDigital
Robin has led the HR side of over 60 acquisitions, integrating more than 3,000 employees while maintaining low turnover and high engagement. She brings nearly 20 years of HR leadership experience, including roles at Ivy Rehab Physical Therapy and The Innovation Institute before joining OneDigital as Senior Director of HR Integration. Her current work focuses on measuring people adoption — not just systems deployment — and she’s building a metric framework for exactly that. She holds an MBA and the Senior Professional in Human Resources (SPHR) certification.
Michael Gremley — Vice President of Corporate Development | Mable Health
Michael has spent his career in Corp Dev at Canadian healthcare platforms, including Nova Leap Health Corp., Lifemark Health Group, and now Mable Health, where he serves as Vice President of Corporate Development. Since joining Mable in 2024, he has completed four partnership acquisitions and expanded to 26 locations across three provinces. He brings the full deal-cycle perspective — from sourcing through integration — and will anchor the discussion on where Corp Dev ownership has to start earlier than most teams are willing to accept. He holds an Executive Education certification in M&A from Columbia Business School.
Marie Kennedy — Director of M&A Integration and Project Management | Victoria Park Medispa
Marie brings more than 13 years of leadership in plastic surgery, dermatology, and medical aesthetics, with deep experience in multi-location operations, private equity partnership, and M&A integration. She spent over six years at GraceMed leading M&A integration and operations before joining Victoria Park Medispa as Director of M&A Integration and Project Management. Her background spans both the strategic and operational layers of integration — she’s run the playbook and lived what happens when seller trust breaks down post-close. She’ll anchor the session’s discussion on seller experience as a pipeline asset.
Recording & Confidentiality
This session will be recorded for the M&A Science member library. We operate under no-attribution/Chatham House ground rules — what's shared in the room stays attributed to the room, not to individuals or their companies.
Member Access
M&A Science members get:
Full session recording access inside the Membership library
Session takeaways (key insights organized for practitioners)
Access to the broader M&A Science member library (plays, templates, and real-world frameworks)
If you want access: Become an M&A Scientist. Join the community of the best practitioners in M&A.
→ Membership: $995/year → mascience.com/membership
FAQs
Will this session be recorded?
Yes. The recording and Structure Cards will be available in the M&A Science Intelligence Hub for members. Non-members can register to attend live.
Is this session attributable?
No. We operate under Chatham House ground rules. You can share what was discussed, but not who said it or which company they represent.
What if I can't attend live?
Register anyway. The recording will be available through the Intelligence Hub. Intelligence Hub members get access before public release.
What is the M&A Science Intelligence Hub?
The Intelligence Hub is M&A Science's practitioner library — recordings, frameworks, and session deliverables from Off Mandate events and podcast interviews, organized by topic and searchable. Membership is $995/year at mascience.com/membership.