Multi-dimensional ICP framework for RCM opportunity identification
Here's the thing about the traditional ICP model: it lies to you. Not maliciously, but through omission. It tells you that all "residential SUD facilities with 50+ beds" are functionally the same opportunity. They're not. Not even close.
A PE-backed residential facility in Texas and a county-run OTP in rural Oregon might both check the same boxes on a legacy ICP checklist, and that's where the similarity ends. The ownership structure alone changes everything about how decisions get made, how value gets defined, and whether you're looking at a 30-day close or a 300-day procurement cycle.
This document introduces a dimensional ICP model. Instead of a flat list of criteria, it crosses ownership structure with care level, payer mix, and buyer persona to generate conditional qualification paths. The point isn't more criteria. The point is asking the right questions in the right context, and knowing when to push, when to pivot, and when to walk.
Each one reshapes the entire sales conversation.
Dictates decision authority, budget constraints, approval chains, and how "value" gets interpreted. A founder processes ROI differently than a PE-backed COO reporting to a board.
Drives documentation burden, billing complexity, and RCM intensity. A PHP/IOP network has a fundamentally different billing profile than a residential facility with mixed payers.
Tells you revenue predictability and how intense the value proposition needs to be. 70%+ commercial is a different world than Medicaid reimbursement timelines.
| Ownership | Decision Authority | Budget Horizon | RCM Value Language |
|---|---|---|---|
| PE-Backed | Board-driven, quarterly | 90-day pressure cycles | EBITDA impact, margin expansion |
| VC-Backed | Founder-centric | Runway-dependent | Scalability, competitive moat |
| Owner-Operator | Single decision-maker | Annual, conservative | Peace of mind, compliance, legacy |
| Hospital-Owned | System-level committee | Fiscal year cycles | Integration, standardization |
| State/County | Agency approval, political | Appropriations-dependent | Grant compliance, audit readiness |
| Nonprofit | Board/ED, mission-aligned | Grant cycles | Mission advancement, outcomes data |
Billing complexity and documentation burden vary dramatically across ASAM levels.
| ASAM Level | Care Setting | Billing Complexity | Documentation Burden | Typical RCM Pain |
|---|---|---|---|---|
| 3.7 | Inpatient Detox | High | Very High | Prior auth delays, concurrent review |
| 3.5 | Clinically Managed Residential | High | High | LOC downgrades, medical necessity denials |
| 3.1 | Low-Intensity Residential | Moderate | Moderate | Census-to-collection gaps |
| 2.5 | Partial Hospitalization (PHP) | High | High | Session doc compliance, group billing |
| 2.1 | Intensive Outpatient (IOP) | Moderate | Moderate | No-show revenue leakage, scheduling |
| 1.0 | Outpatient | Low-Moderate | Low-Moderate | Volume-based, high throughput |
| OTP | Opioid Treatment Program | Specialized | Very High (42 CFR Part 8) | SAMHSA compliance, dispensing docs, DEA audits |
The payer profile determines revenue predictability and the intensity of RCM need.
| Payer Profile | RCM Complexity | Revenue Predictability | Primary Pain Points | RCI Modifier |
|---|---|---|---|---|
| Commercial-Heavy (>60%) | High | Moderate-High | Prior auth burden, network negotiations, denial mgmt | 1.2x |
| Medicaid-Heavy (>60%) | Moderate | Low-Moderate | Low reimbursement, state variation, volume pressure | 0.9x |
| Out-of-Network Dominant | Very High | Low | SCAs, patient collections, balance billing | 1.4x |
| Private Pay Dominant | Low | High | Collection processes, payment plans, minimal RCM need | 0.5x |
| Hybrid/Balanced | Moderate-High | Moderate | Multiple workflow complexity, varied doc requirements | 1.0x |
How ownership, timeline, and payer mix shape the Revenue Capture Index.
Patterns from discovery, pipeline analysis, and observation. Not hypotheses.
A 30-bed facility with a single owner-operator closes faster than a 200-bed hospital-owned division where the BH budget has to survive three committees and an IT integration review.
PE-Backed → fastest when value is clear. VC/Startup → founders move quick. Owner-Operator → slow, but one approval. Nonprofit → grant cycles. Hospital → committees. State/County → procurement.
Qualify decision authority and approval process early. Stop assuming census correlates with buying readiness.
When the EMR is already Kipu, you're not doing competitive displacement. You're doing platform extension. The conversation starts from trust, technical barriers drop, and the value proposition shifts to unrealized potential.
The existing customer motion should look nothing like new logo. Treating them the same leaves velocity on the table.
42 CFR Part 8, SAMHSA oversight, DEA registration, dispensing documentation that doesn't exist anywhere else. Qualify early for: SAMHSA accreditation, dispensing system integrations (ScriptPro, Omnicell), callback tracking, take-home dose docs, state regulatory variations, mobile med units.
Treating OTP as another LOC checkbox = failed implementations.
Not at the billing desk. Clinical staff who don't complete notes on time, don't use compliant templates, or don't understand the billing connection create denial patterns no RCM system can fix.
Red flags: clinician turnover >30%, doc backlogs past 48h, inconsistent templates, no clinical champion, prior tech failures.
Billing problems + solid clinical docs = great fit. Broken clinical workflows = needs EMR remediation first.
These close. Push them.
ASAM 3.1-3.7 • 100+ census • Commercial/Hybrid
DM: COO or VP Revenue Cycle
&zap; Board pressure on margin, 3rd-party biller underperformance
ASAM 2.1-2.5 • 50+ patients • Commercial-Heavy
DM: Founder/CEO or Clinical Director
&zap; Scaling pains, doc inconsistency across sites
OTP • 500+ patients • Medicaid-Heavy/Hybrid
DM: VP Ops or Compliance Director
&zap; Audit prep, SAMHSA survey pending, dispensing gaps
501(c)(3) • Mixed LOC • 75+ patients • Medicaid/Grant-Funded
DM: ED or CFO
&zap; Grant reporting, outcomes data, audit readiness
ASAM 3.1-3.5 • 40-80 beds • Commercial/Private Pay
DM: Owner
&zap; Biller frustration, compliance, succession planning
Any LOC • Variable census • Enterprise EMR requirements
&zap; System-level BH initiative, Epic/Cerner willingness
Often OTP or community MH • Procurement constraints • Multi-year timelines
&zap; Budget cycle timing, grant funding
Revenue Capture Index. Math over gut feel.
| Ownership | RCI Mult. | Rationale |
|---|---|---|
| PE-Backed | 1.3x | High urgency, board accountability |
| VC-Backed | 1.2x | Growth mandate, tech receptiveness |
| Startup/Growth | 1.0x | Standard baseline |
| Owner-Operator | 0.9x | Lower velocity, conservative adoption |
| Hospital | 0.8x | Long cycles, integration complexity |
| Nonprofit | 0.9x | Grant dependencies, board approval |
| State/County | 0.6x | Procurement requirements, political cycles |
| Profile | RCI Mult. | Rationale |
|---|---|---|
| Commercial-Heavy | 1.2x | High auth burden, denial mgmt need |
| Out-of-Network | 1.4x | SCAs, collections, balance billing |
| Hybrid/Balanced | 1.0x | Multiple workflow complexity |
| Medicaid-Heavy | 0.9x | Low reimbursement, volume pressure |
| Private Pay | 0.5x | Minimal RCM need |
| Kipu Status | RCI Mult. | Rationale |
|---|---|---|
| Existing Kipu EMR | 1.25x | Integration advantage, lower implementation risk |
| Non-Kipu EMR | 1.0x | Standard competitive displacement |
Private pay dominant (>80%), no billing need. Nationwide telehealth-only, no physical ops. Census under 20, no growth trajectory. Active bankruptcy. Failed Kipu implementation within 18 months.
No decision-maker after 3 discovery attempts. Existing biller contract >18 months remaining. IT leadership blocking adoption. Clinical leadership turnover during evaluation.
Not scripts. Starting points. The intent maps to what each ownership type cares about.