The Evive 2026 Conference panel didn’t mince words when asked about when treatment centers are ready to scale. One panelist pointed to a high-profile failure as his case study.
“I think we should look at Landmark as a case study of what not to do,” he said, referencing Landmark Recovery’s well-publicized implosion.
His point wasn’t schadenfreude. It was to highlight what happens when treatment centers grow too fast – a pattern multiple panelists have witnessed repeatedly.
“If you’re in this industry, you’ve probably come across some really well put together decks from fancy brokerage shops that are really telling the story of really impressive platforms that are worth a ton of money at a 14 multiple of pretend EBITDA that screwed up big time,” one operator observed. “If you read between the lines, you could understand where they went wrong. And more often than not, they went wrong because they grew too fast.”
So when should you grow? The panel laid out essential criteria. The consensus came down to two fundamental rules. Just two. But most treatment centers that fail get at least one of them wrong.
Rule One: Stabilization
“If you haven’t figured it out yet, don’t keep doing it. Figure it out.”
Seems obvious, right? Yet Abigail, one of the panelists, emphasized that she regularly sees portfolios of four or five facilities where not a single one is profitable.
“Why?” she asked. “Why did you go to that point? Why did you get to that point?”
The pressure to scale is real. Investors want growth. Competitors are expanding. There’s a sense that you need to get bigger to survive. But the panel’s rule is uncompromising: Stabilization first.
This doesn’t mean you need to be maximally profitable or have every system perfected. It means you’ve figured out the fundamentals. You know your model works. You’ve proven you can operate sustainably at your current scale.
As Abigail put it: “I think that the name of the game is having a facility that’s stable before you go to that next level of opening up another facility.”
The benefit of this approach isn’t just de-risking your expansion. It’s learning. “Going that route gives you the opportunity to really see what works, what doesn’t work, and to really learn from that when you’re actually going to scale and grow,” she noted.
Every mistake you make at one facility is a mistake you don’t have to replicate across five facilities. Every system you perfect becomes a template you can deploy.
Rule Two: The Right Team
Here’s where the panel’s criteria get more nuanced – and more important.
“Maybe you’ve figured it out how to do one or two, but at some point you are not going to be able to do it all,” one panelist explained.
Stabilization matters, but it’s not sufficient. You also need the right team in place. And the panel was specific about what “right team” means.
“You need a team that in your gut feels aligned with your mission,” the operator explained. That’s table stakes. But alignment isn’t enough.
“Not only aligned with your mission, but smart and can see past. Let’s say you have the vision to be able to see from 1 to 20, but they could see from 20 to 30. That’s what you need.”
This is a profound insight that’s easy to overlook. Many founders and operators hire people who can execute their vision. That’s necessary but insufficient for scaling. You need people who can see past your vision.
If you can see the path from where you are to 20 facilities, you need people who can see the path from 20 to 30. You need people who are thinking about problems you haven’t encountered yet. You need people who can build systems that scale beyond your current imagination.
The Challenge Factor
But the panelist added one more crucial element: “Crucially important, will challenge you and challenge your assumptions.”
This is where many operators fail. They hire people who are aligned with the mission and smart enough to execute the vision. But they don’t hire people who will push back.
The result is what panelists see in those fancy brokerage decks: platforms that scaled quickly with impressive-looking metrics that ultimately collapsed because no one challenged the assumptions underlying the growth strategy.
You need people in the room who will say “I don’t think that will work” or “Have you considered this risk?” You need people who care enough about the mission to fight for getting it right, even when that means disagreeing with the founder.
If everyone in your leadership team always agrees with you, you’re not ready to scale. You’ve built an echo chamber, not a team.
Focus Before Expansion
Greg Keilin from Prosperity added another dimension to the growth conversation: focus. His advice was to find the thing that you and your team are best in the world at – whether that’s treating veterans, pregnant women, or people in rural areas – and double down on that core competency.
“One of the patterns that I’ve observed in my own life and in the lives of a lot of the leaders that I’ve worked with is it’s really hard to say no to things,” Greg noted. “Find the thing that you’re best in the world at and grow in a very intentional, thoughtful way around that core focus because that’s what’s gonna allow you to outperform all of your peers and competitors.”
This ties directly into stabilization. You can’t prove your model works if you’re trying to be everything to everyone. Focus allows you to perfect your approach before scaling.
What This Means Practically
The panel’s two rules sound simple, but implementing them requires discipline that runs counter to industry pressures.
On stabilization: This means saying no to growth opportunities that come before you’re ready. It means disappointing investors who want faster expansion. It means watching competitors grow while you focus on getting your foundation right.
On team: This means hiring people who might make you uncomfortable. It means paying for talent that seems expensive relative to your current scale. It means creating a culture where challenging assumptions is rewarded, not punished.
It also means being honest with yourself. Panelists talked about needing people who feel right “in your gut.” This isn’t about formal credentials or impressive resumes. It’s about assembling a team where you genuinely trust each person’s judgment and instincts.
The Numbers Connection
The scaling criteria connect directly to the panel’s discussion of KPIs and dashboards.
One operator wakes up every morning to detailed reports showing census, revenue projections versus actuals, and performance across every level of care in each facility. But he doesn’t just look at single-day numbers – he reviews 30-day charts with averages.
This discipline of having data while maintaining perspective is essential for knowing when you’ve achieved stabilization. You need the insight to understand whether your current operations are truly stable or just having a good month.
And you need a team that can interpret those numbers with you, challenge your assumptions about what they mean, and see patterns you might miss.
The Promised Land of Growth
Earlier in the panel, operators called the intersection of improved patient outcomes and financial performance “the promised land” that everyone’s trying to reach.
Sustainable scaling is another promised land. Everyone wants to grow profitably without compromising quality. The panel’s two rules don’t guarantee you’ll get there. But they significantly increase the odds.
Figure it out first. Build the right team. Everything else is tactics.
As the panel made clear: If you can do those two things, you’re ready to grow. If you can’t, don’t.
