Jay Fischbach, Chief Operating Officer of Keel Digital Solutions, joins Consero to share valuable insights into navigating rapid business growth, strategic pivots, outsourcing benefits, and key practices for operational success.
His journey from a unique academic background to leading two Canadian banks and then co-founding Keel Digital offers a unique perspective on building and scaling a successful company in a dynamic market.
Year-One Breakout: Acquisitions & COVID-Driven Growth
Fischbach’s journey into healthcare began with an unconventional background in physical geography and chemistry, eventually leading him through 20 years in capital markets before co-founding what would become Keel Digital Solutions.
Keel Digital, originally Vector Health Laboratories, started in January 2021. The company quickly capitalized on the COVID-19 testing demand, turning two licences and three staff into a multimillion-dollar lab business:
“Year one was unbelievable; we produced just over$ 8 million in revenue and $2 million in EBITDA, and I’d say we needed zero to start with.”
The company’s initial focus on COVID testing proved highly profitable during the pandemic’s peak, providing testing services for travelers and hotels.
The Telehealth Pivot: Reorganizing for Margins and Scalability
Recognizing the COVID-19 testing market was temporary, Keel Digital proactively reorganized to higher-margin, scalable opportunities by strategically acquiring Tulip Health (telehealth) and Get Ahead (mental health platform).
“We knew that COVID was going to end and we needed to transition the business…
My partner and I were sitting around… we started talking to this team called Get Ahead…One thing we knew was that if we were to project forward in five to 10 years, we won’t be saying, ‘Do you remember when mental health was a thing?’”
Anticipating Market Trends: Identifying mental health as a significant future trend, Keel Digital invested and built out services in this area, eventually securing a $1 million provincial pilot contract with the government for mental health sessions.
Adaptability to Policy Changes: Despite favorable initial conditions, the company had to adjust when government funding rules changes impacted their telehealth business.
Agile, Acquisition-led Adaptation: The company’s acquisitions led a shift from COVID-19 testing to create 3 business lines: lab services, telehealth, and mental health.
Focus on High-Margin Businesses: Pivoted telehealth from low-margin individual visits to scalable models using digital “one-way mirror” technology, significantly boosting margins to around 40% and top-line growth.
One-way Mirror Model: Enabled one MD to supervise six physician-assistants, lifting visit revenue from CA $40 per 1-to-1 call to nearly CA $1,000 per hour.
Results: Revenue increased by an additional $10 million in the second year.
“By the end of ‘22, we had added about another $10 million in revenue and another $2.3 million in EBITDA.”
Managing Rapid Growth Challenges Through Outsourcing
In short order, Keel Digital had acquired four companies and was managing 70 staff, 28 locations, and a government contract for 40,000 mental health sessions. Managing multiple business lines and locations created significant operational complexity.
To gain time back for strategic focus, Fischbach decided to aggressively outsource key functions, including:
- HR & recruiting: partnered with a specialist tech recruiter and an HR-tech platform to handle contracts and compliance.
- Fractional CFO: hired an external finance leader while revenue was still ramping.
- Web & AI development: farmed out front-end work plus an Africa-based AI team for specialized modules.
- Governance: one internal staffer managed all vendor relationships, freeing leadership to focus on scaling.
“My CEO, like any good CEO, was just looking at the next deal in my chair – I was struggling…(so) I looked 100% to outsource what I could.”
Key takeaways on outsourcing:
- Strategic Delegation: Outsourcing non-core functions like finance, HR, and web development allowed the internal team to focus on core business objectives and strategic growth.
- Leveraging External Expertise: Bringing in specialized firms and contractors filled critical knowledge gaps and provided necessary support during a period of intense growth.
- Trusting Measured Deliverables: Managing outsourced teams through clear, measured deliverables rather than daily oversight proved effective.
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Schedule ConsultationBusiness Line Optimization and Focus
As the company matured, leadership recognized the importance of focusing on the right priorities and not getting sidetracked by numerous “skunkwork projects” that might dilute efforts.
They made difficult decisions to eliminate underperforming business lines and double down on the highest-revenue, highest-margin opportunities, which included closing the telehealth business, significant staff reductions in the telehealth division, and hiring 20+ developers to support their core mental health offerings.
Strategic Moves:
- Closed telehealth business line due to poor profitability prospects.
- Terminated 35 staff from telehealth operations.
- Hired 20-22 developers to support remaining business lines
- Invested heavily in advertising campaigns for mental health solutions
- Expanded lobbying efforts with US and Canadian government agencies
The company has achieved significant milestones, reaching almost $31 million in revenue and $6 million in EBITDA by the end of their third year, with over 100 team members and $50 million in future funding contracts. They are also currently engaged in their largest acquisition to date.
Funding & Financial Discipline
Keel Digital’s experience with financing highlighted the critical importance of proper financial infrastructure. Their initial reliance on high-yield debt due to lack of audited financials created unnecessary constraints and costs.
Key Takeaways:
- Initial $17 million deal required high-yield debt due to insufficient financial history
- Lack of audited financials limited traditional banking options
- After obtaining audited financials, banks were eager to provide better terms
- Clean cap table structure important for future funding and acquisition opportunities
- CFO expertise crucial for navigating complex financial decisions
- Year-1 Notice-to-Reader → Year-2 audit: shifting to full audits unlocked cheaper debt and higher valuations.
- Simple cap-table: one share class avoids dilution traps in future VC or PE rounds.
- Early investment in governance (audits, CFO, clean contracts) cuts costs “by thousands later on.”
Key Lessons and Reflections from Rapid Growth
Based on three years of rapid growth and strategic pivots, Jay identified several critical success factors for scaling healthcare technology companies.
Focus on “Big Rocks”
Executives must prioritize major initiatives that drive the company forward, rather than getting caught up in daily emails or “firefighting.” Regular weekly check-ins ensure accountability and progress on these key objectives.
Teamwork and Communication
In a hybrid work environment, consistent and clear communication from leadership is vital. This includes articulating the company’s mission, celebrating team successes, and fostering a sense of connection that can be challenging to build remotely.
Setting Up for Long-Term Success
Startups should establish clear exit plans and foundational structures from the outset. This includes having a single class of shares to avoid complications during funding rounds or acquisitions and securing audited financials, which are crucial for securing debt financing from banks or investment from VCs and PEs.
Outsource for speed
Own the deliverables, not necessarily the workforce, so you can focus on high-margin pillars and minimize distractions.
Partner With the Team That Scales Behind the Scenes
Outsourcing was the accelerant that let Keel Digital leap from an idea to CA $31 million in three years—freeing leadership to focus on strategy while specialists handled the heavy lifting.
If you’re ready for the same back-office leverage, our outsourced finance and accounting solutions are designed specifically for CEOs, CFOs, and founders who need expert financial infrastructure without the overhead of building it in-house.
Why high-growth firms trust Consero:
Fractional CFOs, controllers, and accountants deploy in weeks, not quarters, so you never outgrow your finance stack.
We integrate and manage leading ERP, FP&A, and reporting tools for you – no internal IT lift required.
Convert fixed payroll into a predictable service fee that flexes up or down as your needs change.
Consero’s controls and monthly close discipline give you the clean, investor-grade financials that opened bank doors for Keel.
When your ops and finance run themselves, your executives can chase the next acquisition, market, or product line.
Ready to put your growth on the fast track? Let’s talk.
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