Reimbursement Intelligence for Complex Care

Reimbursement should reflect the care being delivered. We help prove where it does not, and what to do next.

HealthPulse Advisors connects payer-contract strategy, claims evidence, and reimbursement execution for hospitals, advanced-therapy programs, government agencies, and life-sciences organizations navigating complex-care economics.

FY2027 CAR-T Medicare Payment: Key Findings
FY2027 illustrative national IPPS base payment for MS-DRG 018, effective October 1, 2026
CMS FY2027 final-rule Tables 1B, 1D and 5; +6.1% versus FY2026
$333,445
FY2027 IPPS fixed-loss amount, effective October 1, 2026
+22.2% versus FY2026
$49,346
Illustrative national operating-plus-capital base payment for MS-DRG 018, calculated using the FY2027 final MS-DRG relative weight of 45.1272, national operating standardized amount of $6,848.98, capital federal rate of $540.03, and assumed wage index and capital geographic adjustment factor of 1.000. Assumes submission of quality data and meaningful EHR use. Excludes hospital-specific wage and geographic adjustments, IME, DSH and uncompensated-care payments, NTAPs, transfer adjustments, quality-program adjustments, and outlier payments.
Advanced Therapy Benchmark, one research domain among several HealthPulse analyzes.

Reimbursement breaks first. Access breaks next.

When reimbursement no longer reflects the care being delivered, access becomes financially fragile. HealthPulse identifies the specific point where clinical economics, payer contracts, and actual claims payment diverge, before that gap threatens a service line, a program, or a hospital's ability to keep operating.

What We Solve

The gap between what a contract says and what actually gets paid.

Reimbursement drift shows up differently depending on where you sit. HealthPulse tests for the specific mechanism in play, rather than starting from a generic assumption.

A rate exhibit that was never updated after a program or service line changed.

Example of what HealthPulse may test for, where relevant.

A single-case agreement negotiated after care had already begun, rather than before.

Example of what HealthPulse may test for, where relevant.

An outlier or stop-loss threshold that no longer reflects current cost of care.

Example of what HealthPulse may test for, where relevant.
How We Work

Start with the evidence. Expand only when the case is proven.

HealthPulse uses the Boaz Model, a stage-gated engagement structure. Each stage has a bounded scope, a defined decision gate, and a valid stopping point.

01

Validate

Determine whether the evidence establishes a material issue.

02

Stabilize

Contain immediate reimbursement leakage or financial exposure.

03

Repair

Correct recurring contract, payment, and operating weaknesses.

04

Build

Create durable data, governance, and access infrastructure.

Not every engagement should proceed past Validate. “No material finding” is a valid, billable outcome. It is not a failure.
The Reimbursement Fidelity System

The method behind every stage.

Where the Boaz Model structures the engagement, the Reimbursement Fidelity System is the analytical method applied inside it.

Clinical Economics Contract Terms Claims Remittances Denials Appeals Cash Access
Proof

Public evidence and firm experience, kept separate.

Public Market & Research Data
$333,445: illustrative national IPPS base payment, MS-DRG 018, FY2027CMS FY2027 IPPS Final Rule, Tables 1B, 1D and 5, Federal Register, Aug 4, 2026
80.7%: Medicare Advantage denials overturned on appealKFF Medicare Advantage Data, 2024
$63K–$304K: published per-case loss after outlier paymentsPenn/JCO 2020; Avalere Health 2025
HealthPulse Firm & Founder Experience
Founder's prior professional experience includes service as a healthcare administrator in the United States Air Force Medical Service Corps (June 2020–2023).Founder credential, not a firm-level or market claim
Founder's prior professional experience includes management of a $2.5B managed-care portfolio at UCHealth (2023–2025).Founder credential, not a firm-level or market claim
Research roles at Harvard Medical School and the Harvard T.H. Chan School of Public Health.Founder credential
HealthPulse Intelligence

Original research and benchmarking.

Benchmark Research

The CAR-T Reimbursement Gap: A 2026 Benchmark Analysis

A sourced comparison of FY2026 Medicare reimbursement against documented CAR-T delivery costs, drawn from CMS, KFF, and peer-reviewed sources.

Request the full report →
Working Thesis

Reimbursement Breaks First. Access Breaks Next.

HealthPulse's working framework on the relationship between reimbursement divergence and downstream access risk.

Read the thesis →

The conversation starts with one question.

Does the evidence in your program support further investigation? A short conversation is how HealthPulse answers that, honestly, including when the answer is no.

Discuss a Reimbursement Problem →