In the rapidly evolving behavioral health landscape, some of the fast-growing behavioral health companies in the U.S. are proving that success isn’t solely about clinical excellence. Strategic community engagement, strong partnerships, and robust operational infrastructure are proving just as crucial. According to the Inc. 5000 list, several emerging mental health companies have achieved growth rates typically seen in technology startups, taking advantage of the persistent supply-demand imbalance in behavioral health nationwide as well as in local markets.
These companies demonstrate that rapid growth in behavioral health is achievable—but only with careful planning, a commitment to quality care, and a deep understanding of community needs.
Building Infrastructure for Sustainable Expansion
Rapid growth is not without risks. Companies that scale too quickly without proper infrastructure can face challenges in consistency, quality, and operations. Transformations Care Network, a platform backed by Chicago-based Shore Capital Partners, illustrates how infrastructure can enable growth while maintaining clinical excellence.
Formed in August 2021 through the consolidation of four outpatient mental health practices, Transformations Care Network saw its annual revenue grow by 125% from 2018 to 2021, according to the Inc. 5000 list. The company seeks outpatient mental health practices led by clinicians dedicated to becoming the leading provider in their state.
“Our No. 1 goal is to help someone make their brand the leader in that state on an in-network, all-payer business,” said Brian Wheelan, CEO. By acquiring controlling stakes in outpatient practices, providing centralized back-office systems, and offering continuing education and training, Transformations allows clinicians to focus on care rather than administrative burdens.
Wheelan explained, “You will meet very few founders, no matter how unbelievably clinically motivated they are, that are excited about doing payroll. We allow them to go back to what they got into the business for originally—to be a clinical leader, a supervisor, a trainer, a member of their human services community—not to be payroll hockey.”
Centralizing critical functions also ensures consistency across growing networks, a challenge many fast-growing behavioral health companies face. “The disadvantage is if you’re moving so quickly that you don’t actually have the infrastructure, the systems, and the processes to ensure consistency… Those are actually complicated processes,” Wheelan said, noting that even patient intake procedures can be complex and vary widely across locations.
Insurance Partnerships: A Cornerstone of Growth
Another key strategy for rapidly expanding behavioral health companies is establishing strong relationships with health plans. Operating on an in-network basis not only increases patient access but also builds credibility and stability.
Ellie Mental Health, based in Mendota Heights, Minnesota, exemplifies this approach. The company owns and operates multiple practices in Minnesota and sells franchise locations to local investor-clinician teams. Its revenue grew 544% from 2018 to 2021.
Ellie Mental Health follows a “trifecta” approach, according to co-founder and CEO Erin Pash:
- Generating bargaining power and respect with payers through national systems, standardized operating procedures, and clinical outcomes.
- Maintaining a small-practice feel for therapists while providing the support and resources of a larger system.
- Involving local investors and entrepreneurs to handle business operations, allowing clinicians to focus on patient care.
“The macro mental health care system involves working with insurance companies,” Pash said. “Insurance companies don’t want to contract with independent practices without standard operating procedures that best support what’s best for insurance companies.”
This approach highlights the importance of combining clinical quality with administrative and operational sophistication. In 2020, approximately 64.3% of all healthcare spending in the U.S. was paid for by private health insurance, Medicare, and Medicaid, according to the American Medical Association—underscoring the critical role insurance partnerships play in behavioral health growth.
Similarly, Quince Orchard Psychotherapy, led by Carrie Singer, emphasizes the importance of being in-network. “Being in-network with payers drives patients to the practice with little need for marketing,” she said. By coupling insurance partnerships with a strong community focus, Quince Orchard built a robust referral pipeline and grew revenue by 87% from 2018 to 2021.
Meeting Multiple Needs Through Community and Quality
Beyond infrastructure and insurance relationships, successful fast-growing behavioral health companies focus on addressing multiple needs at once—expanding access while maintaining high-quality care.
Proven Behavior Solutions LLC, an autism treatment provider based in Norwell, Massachusetts, grew revenue 170% from 2018 to 2021 by strategically opening locations southeast of Boston, where autism care providers were limited. Founder Scott Snider explained that the lack of local competition helped the company establish itself quickly, but trust and clinical quality were the real differentiators.
“A lack of provider density to begin with helped us because once you got started it wasn’t too difficult to put our flag up and say ‘Hey, we’re open,’” Snider said. “But establishing trust via a really high bar for clinical quality became a huge differentiation for us. That’s what really fueled the growth.”
Proven Behavior Solutions offers Applied Behavioral Analysis (ABA) therapy, speech therapy, occupational therapy, special education advocacy, and assistive technology services in each of its centers. The company also proactively built a corporate structure akin to multi-state providers, preparing the organization for future expansion.
“You have to get the scaffolding put together first to enable more rapid growth,” Snider said. “Being proactive is No. 1 for us.” Their approach has been validated through investment from New York City-based Health Enterprise Partners, positioning Proven Behavior Solutions as a growing behavioral health platform across Southern New England.
Challenges of Fast Growth
While these examples highlight success, even fast-growing behavioral health companies face significant challenges. Controlling spending is critical, particularly for companies expanding across multiple sites. Snider noted, “We have to make sure that we’re watching that burn rate and not running ourselves to a point where we can’t keep the doors open.” Foresight Mental Health previously faced near-collapse due to overspending, highlighting the risks of uncontrolled growth.
Staffing shortages also pose challenges. Behavioral health providers often compete for a limited workforce, and clinicians may be selective about roles or patient populations. Singer pointed out that finding therapists willing to treat children under 10 is difficult, even when therapists are fully qualified.
Wheelan emphasized that building a positive workplace culture is essential for retaining staff. “Our biggest competitor is not some other well-capitalized firm, it’s the viability of not participating in a network… When we do that, the payers are willing to pay us more because we’re an alternative to emergency rooms.”
The Role of Community in Sustained Success
Community engagement remains a key driver of growth. By building relationships with local stakeholders, families, and referral networks, fast-growing behavioral health companies strengthen their brand and generate word-of-mouth referrals that reduce the need for costly marketing campaigns. This dual focus on community and infrastructure allows companies to scale responsibly while maintaining quality care and access.
Looking Ahead
The experience of these leading organizations underscores an essential lesson: growth in behavioral health is not only about capital investment but also about relationships, infrastructure, and strategic foresight. Fast-growing behavioral health companies that prioritize community connections, develop scalable operational systems, and maintain high clinical standards are well-positioned to meet the increasing demand for behavioral health services while supporting clinicians and communities alike.
By integrating these strategies, fast-growing behavioral health companies can achieve rapid growth, expand access to care, and ensure sustainability in an increasingly complex healthcare environment.
