How we replaced an entire back office with 300+ automations for a healthcare company
automations running in production daily
The Situation
Horizons ABA is a US-based Applied Behavior Analysis healthcare company. When they came to us, they were growing fast - adding clinicians, onboarding new clients, expanding to new locations. But every new client meant more admin work, not just more revenue. Clinician schedules were managed in spreadsheets. Compliance deadlines were tracked manually. When a new client signed up, someone had to touch six different systems to get them set up: CRM entry, clinician assignment, insurance verification, scheduling, folder creation, and notifications to three departments. A single onboarding took 45 minutes of manual work across multiple people. And things were falling through cracks - missed compliance deadlines, duplicate records, scheduling conflicts that nobody caught until a clinician showed up to the wrong location.
The Challenge
The real complexity was that nothing at Horizons operated in isolation. A change in one department cascaded across five others. Reassigning a clinician affected scheduling, billing, compliance tracking, parent notifications, and internal reporting - simultaneously. Their CRM lived in Monday.com, but the workflows connecting it to everything else were humans copy-pasting between tabs. Previous automation attempts had been one-off fixes: a Zapier here, a manual webhook there. None of it was architected as a system. None of it had error handling. When something broke, nobody knew until a client called to ask why their appointment was missing.
What We Built
Make.com Automation Infrastructure (300+ scenarios)
- Client intake: a new inquiry comes in and the system captures their information, verifies insurance eligibility, assigns the right clinician based on location and specialization, creates records across every internal system, and sends welcome materials to the family. What used to take 45 minutes of manual coordination now finishes in under 30 seconds.
- Interview and hiring pipeline: new clinician applications move through automated screening, interview scheduling, credential verification, background check tracking, and onboarding setup. A multi-week process with constant follow-up now runs on its own, and nothing gets lost.
- Clinician scheduling: automated matching based on availability, location, specialization, and client needs. Conflict detection catches double-bookings before they happen.
- Compliance engine: monitors certification expiry dates, training requirements, and documentation deadlines across every clinician. Sends escalating alerts at 30, 14, and 7 days out.
- Cross-department notifications: when a status changes anywhere in the system, every affected team gets notified in their own channel with the context they need.
- Every scenario built with error handling, retry logic, and monitoring. If something fails at 2 AM, we know about it before the team arrives at 8.
Monday.com Automations (200+)
- Status-triggered workflows that move tasks between boards as work progresses through departments
- Automated task assignment based on team capacity and specialization
- Deadline management with escalation chains - if something sits untouched for 24 hours, it gets bumped to a manager automatically
- Custom dashboards giving leadership a real-time view of operations across every department
Custom Internal Tools
- Client-clinician matching system: an internal tool that recommends the best clinician for each new client based on location, availability, specialization, insurance, and language - replacing what was previously a 20-minute manual lookup
- Custom scheduling interface designed specifically for clinical operations, replacing the generic calendar tools that did not account for ABA-specific scheduling constraints
Documentation & Maintenance
- Every automation documented with standardized naming conventions, Loom walkthroughs, and written maintenance guides
- The team can troubleshoot, modify, and extend automations without calling us - though they usually do, because we keep building new ones
Results
- 300+ Make.com automations running daily across six departments
- 200+ Monday.com automations managing internal operations
- Client intake process dropped from 45 minutes to under 30 seconds - fully automated end to end
- Clinician hiring pipeline automated from application to onboarding - no more manual follow-ups slipping through cracks
- Zero missed compliance deadlines since the system went live
- Operations team went from reactive firefighting to proactive management - they spend their time on exceptions, not routine tasks
“What Etherwise has done for my business goes far beyond building a few automations - they've reshaped how we operate day-to-day. Their workflows haven't just improved efficiency; they've given us a level of clarity and scalability I didn't think was possible this early on. Abhi himself is exceptional - sharp, honest, and remarkably responsive. Working with Etherwise has been one of the best decisions we've made.”
Running a growing business on manual processes?
That is exactly where Horizons was before we started. Book a 30-minute call and we will map out what your version of this looks like.