Expertise.
Treatment-center economics for advanced-therapy payment, purchasing and expansion decisions.
Two routes lead the practice. Each starts from the decision in front of the client and ends with a deliverable the team can use.
Hospitals and cancer centers running CAR-T, TIL or transplant programs
- The question
- Whether the program is being paid what its contracts and the Medicare rule support, payer by payer.
- What HealthPulse examines
- Payer contracts, single-case agreements, outlier thresholds and Revenue Code 891 billing, checked against current CMS baselines.
- What you receive
- An assessment of payment gaps and financial exposure, with quantified scenarios where the available evidence supports them.
- The decision it supports
- Which contracts to renegotiate or restructure first, and what the program's forecast should assume.
- Where it starts
- One payer and one product.
Life-sciences companies bringing an advanced therapy to market
- The question
- How coverage policy, billing mechanics and outcomes-based agreements will interact at the state and payer level.
- What HealthPulse examines
- Coverage policy, provider billing mechanics and outcomes-based agreement terms, for the provider settings that will treat patients.
- What you receive
- A written assessment of how those terms are likely to pay out at the treating provider, and which terms drive the result.
- The decision it supports
- Launch planning, coverage-policy positions and agreement design, while the plan can still change.
- Where it starts
- One product and the setting where it will be given.
Other reimbursement work.
Rural and critical access hospitals
Sustainability once temporary funding declines, and the recurring economics that keep care open.
Managed-care contracting and reimbursement drift
Where the contract and the payment stop matching.
Government and public sector
Reimbursement policy and program sustainability.
Payer diligence for healthcare investors
What the revenue-quality assumption depends on.
Teaming and subcontracting
Reimbursement subject-matter work inside a larger team.
The full lists: who HealthPulse works with, capabilities and the contract-to-payment gap.
Not sure which route fits?
Describe the decision. HealthPulse will say whether it is work the firm should take, including when the answer is no.
Discuss a decision