Client assignments, institutional contracts and research on payment, purchasing and program economics.
Client assignments, contracts and independent analysis.
Client Assignment
Advanced-therapy expansion brief
Decision
Whether, and in which regions, a multi-state health system should expand its CAR-T and other advanced-therapy capacity. HealthPulse supported the advisory firm working with the health system.
Work delivered
Directional analysis of payer pathways and the financial considerations for regional expansion. The pathways ran from 340B-eligible outpatient care to Medicare Advantage.
Use
A board-ready investment brief in editable slides, for use in the board's own materials.
Client Assignment
Oncology payment and purchasing analysis
Decision
How purchasing routes compare under stated payment and cost assumptions, for a pharmaceutical company's oncology team deciding how its therapies are bought and paid for at treatment centers.
Work delivered
An analysis of each purchasing route against hospital payment rules, with every input traced to its source.
Use
Editable readouts for the client's leadership meetings, and an editable decision model for the client team to test scenarios.
University Contract
University of Georgia: selected provider under a campus-wide academic consulting contract
Mandate
The University of Georgia awarded HealthPulse a place on its campus-wide contract for academic healthcare consulting firms providing strategic advisory services.
HealthPulse's role
A contracted provider of strategic advisory services that university units can call on.
Scope
Units commission specific work through individual orders under the contract's terms.
Independent Analysis
PPS-exempt cancer-center reimbursement and CAR-T economics
Question
Where CAR-T financial exposure sits at a cancer hospital that Medicare pays outside the inpatient prospective payment system.
Analysis
Medicare pays the eleven PPS-exempt cancer hospitals their reasonable costs, up to a hospital-specific limit that rises each year by an update factor, rather than an MS-DRG rate. The analysis follows what that means for CAR-T: no DRG outlier or new-technology add-on payment, a separate outpatient cancer-hospital adjustment, and commercial contracts with no DRG rate to anchor them.
What it shows
What a CAR-T payer-contract review at such a center would test: cost growth against the limit, outpatient exposure as treatment moves out of the hospital, and contract terms set without a DRG anchor.
Independent Analysis
Rural hospital payer economics after grant funding
Question
Will recurring payer economics sustain care after temporary grant funding ends?
Analysis
Patient-service economics read from a critical access hospital's own public Medicare cost reports, which showed operating expenses well above net patient revenue, with other income closing part of the gap. It then sets out what decides recurring revenue: payer-contract terms, how payment varies against those terms, and whether rates keep pace with the cost of keeping services open.
What it shows
A cost-report deficit does not prove recoverable leakage, and the analysis does not claim it. Percentage gaps were modeled as scenarios, not savings. Answering the question takes the contracts and the remittances, which is where a review would start.
HealthPulse advises one side of a negotiation and says so. It never implies it represents all sides impartially.
An outcome-linked rebate does not, by itself, establish the treatment center's payment terms.
Italy's published 2019 Kymriah arrangement
AIFA determination of 2019: the treating center pays the manufacturer in stages
The center's exposure. Part 1 is owed at infusion whatever the outcome, and the registry duty runs on every patient. The center's own funding from the region sits outside these terms.
The U.S. Medicaid CGT Access Model
Gene therapy for sickle cell disease, under CMS's model terms
The center's exposure. The rebate runs from the manufacturer to the state, not to the center. The center's payment depends on the state's terms and on meeting the registry condition; its timing is not set by the model.
Money that moves whatever the outcome
Money that depends on the outcome
The record that decides an outcome or a payment
The treatment center
What it means for a treatment center
Under Italy's published 2019 Kymriah terms the treating center pays the manufacturer in stages. Under the U.S. CGT Access Model the manufacturer's rebate goes to the state Medicaid program. A center still has to establish its own payment timing, purchasing obligations, evidence requirements and financial exposure.
What it does not show
The European terms are not U.S. Medicare or Medicaid rules. The U.S. comparison is the CGT Access Model, whose first condition is sickle cell disease, not CAR-T.
Primary documents where they exist (AIFA, GKV-Spitzenverband, NICE, CMS); amounts and timings marked as reported come from a peer-reviewed review and are labeled on the page. Read the full analysis
Why an outlier CAR-T case is paid less in FY2027 when the base payment rose 6.1%.
The outlier threshold rose 22.2%. For a case above it, the higher threshold takes away more than the higher base payment adds: minus $3,316 per case at CMS's national illustrative rates, same case cost in both years.
A program forecasting FY2027 on the base-rate increase alone overstates payment on the cases that cost the most.
Every input from the CMS FY2026 and FY2027 IPPS tables; assumptions and limits stated on the page.