Managed Care Analytics
Expected reimbursement & rate benchmarking
Contract & scenario modeling
Payer scorecards & fee-schedule comparisons
Negotiation priorities & expected ROI
Fulcrum Health Partners combines advanced analytics, payer intelligence, reimbursement modeling, market transparency, and executive reporting to help healthcare organizations make faster, smarter, and more profitable reimbursement decisions.
The strongest reimbursement strategies are built on analytics — not assumptions. Every engagement begins by understanding how reimbursement performs today, where the financial opportunity is, how the market compares, and which actions create the most enterprise value. Our platform powers everything from transaction diligence and payer negotiations to revenue cycle optimization, expected pay modeling, IDR support, and executive decision-making.
Every workstream draws on the same connected analytics engine — so diligence, negotiation, and operations all speak the same data.
A Fulcrum Analytics view built for hospital and health system leadership — where the revenue comes from, how each payer performs, and where the commercial opportunity sits.
| Payer | Charges | Net Payments | GCR | NCR |
|---|---|---|---|---|
| BCBS | $86M | $58.0M | 67% | 96% |
| UnitedHealthcare | $63M | $40.3M | 64% | 92% |
| Aetna | $46M | $29.9M | 65% | 94% |
| Medicare | $51M | $34.7M | 68% | 99% |
| Medicaid | $23M | $12.6M | 55% | 90% |
| Humana | $17M | $10.5M | 62% | 93% |
| Total | $286M | $186M | 65% | 95% |
* Illustrative Fulcrum Analytics sample. Built from your Epic, Oracle Health, or billing data.
Commercial reimbursement benchmarking, Medicare comparisons, and competitive market intelligence — visualized so the opportunity is obvious.
* Illustrative Fulcrum Analytics sample — each bubble is one provider, placed left to right by commercial rate as a percent of Medicare and sized by relative contracted volume. Vertical spacing separates the bubbles only and carries no value. Positions are representative, not measured.
Source: RAND Corporation, Prices Paid to Hospitals by Private Health Plans, Round 5.1 (published 2024), Table 2 — 2022 commercial claims, 49 states and DC. Maryland is not in the study and is shown in grey. Fulcrum benchmarks your own markets and contracted rates against this baseline.
For oncology and infusion platforms, the drug book is the business. This Fulcrum Analytics view breaks down revenue for the top 10 physician-administered drugs by payer — the foundation of buy-and-bill strategy.
* Illustrative Fulcrum Analytics sample. Built from your practice-management and dispensing data, by J-code and regimen.
The same intelligence engine, applied to the decisions that matter most.
Every engagement produces boardroom-grade output. This is an executive summary from a Fulcrum reimbursement diligence report — the format buyers and sellers rely on.
* Illustrative Fulcrum deliverable. Full reports include contract inventory, benchmarking, expected reimbursement, and a negotiation roadmap.
White papers, market reports, policy briefings, and negotiation playbooks. Filter by category or search.
Federal arbitration gave rural and critical access hospitals a credible alternative — and the leverage to negotiate stable in-network agreements.
A 37% cut to 340B drug payment, a 6.6% cut to office infusion administration, and a widening HOPD / office gap — modeled by code.
White bagging is usually argued as a drug-sourcing and safety question. For a rheumatology practice it is first an economic one — and the payer contract, not the pharmacy debate, decides how it ends.
Medicare has underpaid complex spine care for two decades, and many commercial contracts import the cut through a percentage-of-Medicare peg. Commercial contracting is the decisive lever.
A urology group’s leverage is unevenly spread across its payers. Covered-lives and market-share intelligence turn a long contract list into a ranked plan for the negotiations that move margin.
Biosimilars and ASP erosion are thinning the anti-VEGF spread while step therapy dictates agent choice. Coding, waste capture, and step-therapy discipline decide what the practice keeps.
Anesthesia subsidies are usually explained as a workforce shortage. That is only half the story — and the difference determines what a hospital or ASC can actually do about them.
Where commercial reimbursement sits relative to Medicare in 2026 — and how to use benchmarks without being misled by them.
The organizations holding rate walk into negotiations with the same data the payer has. Most providers still don’t.
Medicare Advantage now covers the majority of eligible beneficiaries — and its payment behavior increasingly sets the tone for the rest of the book.
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Whether supporting payer negotiations, healthcare transactions, revenue cycle optimization, expected pay modeling, market expansion, or executive decision-making, Fulcrum Analytics delivers the intelligence healthcare leaders rely on.