THIRD HORIZON
AdvisoryActuarialData SolutionsFoundry

Providers

Health systems, hospitals, and behavioral health providers

Margins are thin. Labor costs are high. Payers are consolidating and sophisticated. And after years of silence, consumers are asking what care costs. Negotiations that once relied on trust and history now turn to data, and too often, providers come to the table with data that is less current than what sits across from them.

Third Horizon stands with health systems, hospitals, and behavioral health providers who are done negotiating with inaccurate information. We bring the advisors, actuaries, and data to navigate a tougher market with clarity and confidence.

Advisory Services

Strategy is not a deck, it's a sequence of decisions leaders must make, each with real consequences. Our advisors have worked alongside CFOs, service-line leaders, and hospital executives through the hardest of those decisions, helping them arrive at plans boards can support and operators can execute.

KEY CAPABILITIES
  • Service line strategy and performance improvement
  • Reimbursement consulting and contract strategy
  • Value-based care design and payer partnership
  • Business case and financial modeling

Actuarial Services & Health Services Research

Before a risk contract is signed, a bundled payment is priced, or a service line is rebuilt, the math has to hold. Our actuaries and health services researchers help provider finance and strategy teams price real risk, forecast achievable volumes, and defend the numbers to the board.

KEY CAPABILITIES
  • Risk contract and value-based payment modeling
  • Bundled-payment and episode pricing
  • Reimbursement benchmarking
  • Independent actuarial validation and peer review

Data Solutions

Providers have data. They don't always have data they trust. Rates vary across payers. Codes collide. The story changes depending on the source. Starset Analytics brings it together. We clean, validate, and enhance price transparency data to create a trusted benchmark dataset that is delivered through subscriptions, APIs, and advisory support when you need it.

The pipeline is proprietary and the work is deliberate, transforming fragmented data into a trusted foundation. Through multi-stage ingestion, we clean and normalize the data into a schema aligned to external benchmarks, validate it with actuarial rigor using confidence scoring based on completeness and consistency, and enhance it with provider intelligence so it can be interpreted and applied across networks and care settings.

This is decision-grade data built for finance, contracting, and strategy teams who need numbers that hold up.

WHAT YOU GET
  • National dataset of cleaned, validated, and enhanced commercial payer-provider negotiated rates
  • All active MS-DRG codes for inpatient; top CPT/HCPCS codes representing approximately 95% of typical employer medical spend for outpatient
  • Facility and professional rates, sliced at state, MSA, or county level
  • Broad PPO coverage across BlueCard, BCBS, Anthem, United, Cigna, and Aetna, with additional networks available by scoped expansion
  • API-enabled data feed or parquet delivery, quarterly refreshes, unlimited organizational users
  • Optional analytic and advisory support from actuaries, health services researchers, data analysts, and engineers
  • Custom AI agent for natural-language querying and automated insights

Putting it to work

HOW PROVIDERS PUT IT TO WORK
  • Competitive benchmarking compare your negotiated rates against peer competitors in your operating markets
  • Contract negotiations develop regional benchmarks to substantiate internal pricing reviews and anchor payer discussions
  • Service line strategy segment by care setting, clinical category, billing code, and geography to focus on the areas most material to revenue and margin
  • Behavioral health parity identify systematic underpayment and build defensible rate books by payer and service line
REPRESENTATIVE OUTCOME
$22M
Annual revenue opportunity identified

A multi-site academic behavioral health system came to Third Horizon to build payer-specific benchmarks for high-volume inpatient and outpatient services. We anchored rates to peer, market, and claims-based benchmarks. We built a negotiation-ready rate book by payer and service line, and delivered a contracting strategy. The work uncovered systematic underpayment for non-physician services despite parity for physicians — and identified $22 million in annual revenue opportunity through market per diem benchmarks.

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If you represent a health system, a hospital, or a behavioral health provider trying to build something durable, we can help.

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