Fulcrum Health Partners is an independently owned reimbursement advisory firm, headquartered in Nashville and working nationally. We negotiate, analyze, implement and defend the payer economics that decide whether a provider organization can keep doing what it does.
Fulcrum was built out of the organizations that set the rules and the organizations that live with them — national payers, hospital operators, physician and ASC platforms, and the strategy and technology firms that serve them.
Organizations where members of the Fulcrum team have previously worked. All company names, logos and trademarks are the property of their respective owners. Their inclusion reflects individual professional experience only and does not imply any endorsement, sponsorship, affiliation or ongoing relationship between those organizations and Fulcrum Health Partners.
Reimbursement is not a back-office function. It decides which practices stay open.
A provider organization's payer contracts set its margin. Margin decides whether it can recruit, invest in technology, open another location, or stay independent at all. And whether it stays open decides whether the people in that community can get care close to home.
We work at the reimbursement layer because that is where the leverage sits. Every point of margin recovered for a provider is capacity that stays in the market — which is the only version of a patient mission a reimbursement firm can honestly claim.
Rate compression rarely announces itself. It shows up as a hiring freeze, a deferred equipment purchase, a service line quietly discontinued, a practice sold because staying independent stopped penciling.
By the time those decisions are being made, the reimbursement conversation that would have changed them is years past. We would rather have it early.
“Reimbursement is where a healthcare organization’s financial trajectory is actually set. Changing it takes people who have set it from the other side of the table.”
I founded Fulcrum to build the country’s leading healthcare reimbursement advisory firm — and to build it out of people who have sat in genuinely different seats. Payer executives. Provider operators. Clinicians. Economists. Deal-side advisors. That range is not a footnote in how we work; it is the product.
Every organization we advise is trying to move the same thing: the financial trajectory of the business. Our job is to accelerate it — with evidence at the table, execution after the signature, and people who have already done this work from the inside.
Samuel Barnes is the Founder and Chief Executive Officer of Fulcrum Health Partners. He has more than a decade of healthcare leadership experience, advising organizations on managed care strategy, payer contracting, reimbursement, and the complexities of scaling multi-site, multi-state operations.
Before founding Fulcrum, Samuel held managed care leadership roles across some of the country’s largest healthcare organizations. As Director of Managed Care at Envision Healthcare, he was responsible for a portfolio of managed care contracts representing approximately $2 billion in annual revenue. At the forefront of the implementation of the No Surprises Act, he led the development of arbitration processes used to resolve reimbursement disputes involving out-of-network providers delivering services at in-network facilities.
He was subsequently recruited by InTandem Capital Partners to build the managed care platform for Vivo Infusion, one of the country’s largest networks of ambulatory infusion centers. Over a five-year tenure, Vivo grew from approximately $90 million to more than $1.4 billion in annual revenue. As Chief Managed Care Officer, Samuel built and led the organization’s managed care infrastructure — payer negotiations, provider credentialing and enrollment — supporting rapid expansion across multiple states and markets.
That experience spans complex payer relationships, reimbursement strategy, building managed care organizations from the ground up, and carrying healthcare companies through periods of significant growth and transformation.
Samuel founded Fulcrum Health Partners to assemble a team of leading reimbursement experts with deep payer, provider, operational and financial experience. Today the firm advises hospitals and health systems, physician organizations, healthcare companies, private equity firms and investment banks on complex reimbursement, managed care and healthcare economics challenges.
Not values. Commitments — each one describes something we will actually do, or refuse to do, on your engagement.
We do not open a negotiation with an argument. We open it with your rates, benchmarked against the market by payer, product, code and geography.
Our people have sat in payer contracting and network leadership. Knowing how a plan builds its position — and where its flexibility actually lives — is not learned from the outside.
Not every contract should be renegotiated. Sometimes the right advice is to protect what you have and spend the leverage somewhere it will actually move.
A rate on paper is not revenue. We stay through enrollment, payment configuration and claim-level validation, because that is where negotiated value quietly goes missing.
The person who scopes your engagement is the person who runs it. There is no layer of junior staff between you and the decision.
Fulcrum is not a generalist consultancy with a healthcare practice attached. Payer economics is the center of the work, not an adjacent service line.
The people negotiating your contracts have sat on the other side of the table.
Knowing how a plan builds its position, where its flexibility actually lives, and which arguments will survive a committee is not something learned from the outside. It is learned by having been the one writing the position.
That is what changes at the table. A Fulcrum negotiation opens with an accurate read of what the other side can actually do — not a guess dressed up as a strategy.
Tell us a little about your organization. A senior advisor — not a sales rep — will follow up within one business day.
Fulcrum Health Partners is headquartered in Nashville — the center of gravity for provider-side healthcare in the United States, and the city where more of this industry's operating executives, investors and management teams sit within driving distance than anywhere else in the country.
Proximity is not a marketing point. It is why a payer escalation, a diligence question, or a board conversation can be handled in person on short notice, and why the firm's relationships run through the operating side of the industry rather than around it.
The team is not all in one place. Fulcrum also has people in Minnesota, Ohio, North Carolina, Florida, Texas, New York City and Chicago — markets that carry real weight of their own in healthcare operations and private equity, and that keep the firm close to where provider and capital decisions actually get made.
The work itself is national. We negotiate, analyze and defend reimbursement across every major payer category — commercial, Medicare Advantage, managed Medicaid and the exchanges — in all 50 states.
Memberships current as of publication.
Trusted by leading healthcare organizations nationwide
Reimbursement was opaque for decades. Rates were set behind closed doors, benchmarks were unavailable, and providers were asked to accept terms they had no way to evaluate. Price transparency changed what is knowable — but knowable is not the same as usable.
Fulcrum exists to close that gap: to put market-grade reimbursement intelligence in the hands of the organizations actually delivering care, and to build the infrastructure that keeps it there long after an engagement ends.
Whether you are renegotiating a payer contract, weighing a transaction, or rethinking your reimbursement strategy, Fulcrum brings the data, the relationships and the senior representation to move the outcome.
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