About the client
Aprio’s client is a virtual-first cardiology provider that is redefining how patients connect with cardiologists through telemedicine. The company is taking a model of care that has traditionally relied on in-person visits and providing patients with diagnostic data remotely and supporting continuous cardiovascular disease management between appointments.
The company is private-equity backed and structured as a management services organization (MSO) with six entities and has built an effective clinical model and used a traditional software for its accounting needs.
The challenge: six entities, one limited view
The previous accounting software had supported the company through its early development, but it could no longer keep pace as the company prepared for its next stage of growth. The investors wanted a platform built to scale and the finance team agreed. With six entities operating under the MSO structure, the accounting system could not capture the full financial picture, causing the finance team to close the gaps manually every month and under deadline pressure.
The strain was especially evident during monthly invoicing, struggling to show consolidated reporting, intercompany activity, and provider cost allocations—all of which required manual time-consuming offline calculations, exports, handoffs, and reconciliations that increased the risk of error. Because service-volume data was disconnected from the general ledger, leaders lacked timely, transaction-level visibility into margins by service, customer, and provider. Most importantly, the chart of accounts, segmentation, controls, and audit trail were not yet designed to meet the demands of a PE-backed business preparing for a future transaction or public offering.
The team knew where it wanted to go. Both the CFO and accounting manager had used NetSuite at previous companies, and they evaluated it alongside a top-market technology system competitor. The challenge was finding a practical path forward. When pricing from a previous implementation partner proved cost-prohibitive, the initiative stalled before it could begin.
The solution: understand the business first, configure the technology second
After outgrowing their current accounting system, the company was introduced to Aprio by the NetSuite Alliance Partner Program because they realized they needed a firm to be an advisor, not just a software installer.
Aprio began with working sessions, not a configuration checklist. The team examined the business process-by-process across all six entities to understand how work happened today, where it broke down, and what the future state needed to support:
- Revenue, end-to-end: How services translate into revenue, how cash is collected, and where the current process loses time or visibility.
- Purchasing and expenses: How spending is approved, recorded, and allocated across all six entities.
- Reporting and consolidation: What leadership, the board, and investors need to see, and how far the existing process was from delivering it.
With that foundation in place, Aprio designed the future state and mapped each requirement to NetSuite capabilities:
- True multi-entity consolidation with transaction-level drill-down.
- Automated intercompany transactions and eliminations to replace entries booked manually on both sides.
- Statistical accounts that bring service volumes into the general ledger so the finance team can report volume-based unit economics in-house.
- Native allocation capabilities to streamline calculations, including the provider cost split between cost of goods sold and operating expense.
- A scalable financial architecture with a clean chart of accounts, intentional segmentation, stronger controls, and an audit trail designed for where the company is going, not only where it is today.
The outcome: a stronger foundation at go-live and more possibilities ahead
At go-live, the company was able to:
- Consolidate financials across all six entities
- Drill into transaction-level detail
- Manage intercompany activity and allocations within the system
- Capture service volumes in the general ledger
- Produce unit economics independently
- Better prepare financials for investors and auditors
The larger opportunity comes next. What began as a software challenge is creating a foundation for better decisions, with the team already considering opportunities to draw on Aprio’s healthcare experience in areas, such as financial analysis, budgeting support, multi-state tax planning, custom reporting, and additional NetSuite enhancements.
