Our Services

Speaking & Seminars

Fulcrum Strategies offers professional speaking services for conferences, meetings and more. Ron Howrigon has been speaking professionally since before founding Fulcrum Strategies. With 18 years of experience in the managed care industry, and 17 years as a physician consultant, Ron incorporates his experience on both sides of the negotiation table into his presentations, which are informative, engaging and entertaining.

Some of the engagements in our speakers' portfolios include:

  • Medical Group Management Association (MGMA)
  • Radiology Business Managers Association (RBMA)
  • Ohio Association of Rheumatology (OAR)
  • Ohio State Medical Society (OSMA)
  • Association of Community Cancer Centers (ACCC)
  • American College of Emergency Physicians (ACEP)
  • Coalition of Hematology and Oncology Practices (CHOP)
  • Cancer Care Business Summit
  • Bayer Pharmaceutical / ICPME - Business IQ
  • American Association of Orthopedic Executives (AAOE)
  • American Healthcare Radiology Administrators (AHRA)
  • Southern Oncology Association of Practices (SOAP)
  • Indiana Medical Group Managers Association (IMGMA)
  • Indiana Association of Orthopedic Executives (IAOE)
  • Indiana Oncology Society (IOS)
  • Georgia Association of Orthopedic Executives (GAOE)
  • Professional Association of Healthcare Office Management (PAHCOM)
  • Association of Otolaryngology Administrators (AOA)
  • Medical Office Managers Society of South Jersey
  • Medical Group Managers Association (MGMA)
  • Southern Association of Therapeutic Radiation Oncology (SATRO)
  • The Arizona Clinical Oncology Society (TACOS)
  • Ascent - Administrator Support Community for ENT
  • EDPMA - Emergency Department Practice Management Association

Ron Howrigon

President and Founder

Here is a list of our current speaking topics:

  • Dancing with the Devil: Negotiating with Managed Care Companies
  • Healthcare Evolution...or Revolution? Exploring the Shift from Fee for Service to Value-Based Approaches
  • Patient-Centered Healthcare: Improving the Patient Experience
  • Reimbursement Trends in a Post-Healthcare-Reform World
  • Accountable Care Organizations
  • Flatlining: How Health Care Could Kill the U.S. Economy and How We Can Stop it
  • The Future of Health Care. What Will it Look Like in Five Years?
  • Population Health Management
  • To Be Par or Not to Be Par, That Is The Question
  • Strategic and Tactical Practice Management
  • Physicians vs. Managed Care
  • Pay-for-Performance and Tiered Networks
  • Big Pharma and PBMs: How it all Works and Who are the Winners and Losers
  • Improving Patient Experience in Patient-Centered Health Care

Upcoming Speaking Engagements for 2021. View our FS Speaking Packet.

Here’s what others are saying about Ron Howrigon and his presentations:

"Ron Howrigon has presented at the ACEP Reimbursement Conference for the past three years, earning exceptional evaluations. He is an excellent speaker, offering the payer side perspective in contract negotiations that is very helpful for emergency physicians in understanding that process."

David McKenzie, Reimbursement Director, American College of Emergency Physicians

Read More on our Testimonials page

Contract Negotiation

Managed care companies come to the negotiation table with highly skilled negotiators who are trained to make sure that physicians are paid as little as possible for the services they provide. They know that physicians and practice managers simply don’t have the time to fully understand the intricacies of the contracts they are signing. At Fulcrum Strategies, our goal is to help physicians to succeed in the business of healthcare. We can determine if you are getting fairly reimbursed from the payers, or if there is potential for better rates and contract language. Our team, skilled in contract negotiation strategies, will handle all of your managed care contract negotiations. You maintain complete decision-making control throughout the entire process while we do all of the work.

Before we take on a new client, we want to get a realistic picture of the group’s situation. We look at things that could help or hurt future negotiations – for example; local competition, any unique aspects of the group, and contract language and rates. If we don’t think we can help a particular practice, we don’t want to take their money. To determine if we can help, we will perform a complimentary data analysis of your contract rates. We will ask you to provide us with a utilization report of your top codes with volume and fee by payer, along with the contracts themselves. From the hard data, and our knowledge of the various payers’ practices, we will normalize your contracts to a single year of Medicare so they can be compared accurately to each other, and allow us to identify which contracts can be improved. From there, we will determine how much money could be available if you were to engage Fulcrum Strategies to renegotiate your contracts.

“You don’t get what you deserve – you get what you negotiate!”

When a group decides to become a client, we’ll draft up Consulting Agreement for your review. Once signed, we begin the negotiation process. We use the previous analysis we performed to organize a “plan of attack.” We recommend which contracts should be negotiated first and predict what the likely outcomes will be. This is a collaborative process and we always defer to the client's wishes. As negotiations proceed, the client is updated as often as they wish. Once the documents are finalized, we keep images of all contracts in our database for future reference. For our clients’ peace of mind, we maintain a calendar of all contractual renewals for as long as the client remains with us.

Alternative Payment Negotiations

The healthcare landscape is changing – especially with regard to how physicians are paid and who pays them. Today, healthcare professionals are being bombarded with new terms like: Accountable Care Organizations, Patient Centered Medical Home, Tiered Networks, Episode of Care, Shared Savings and Pay for Performance, to name a few. Physicians and medical practice managers who don’t fully understand these new payment models could unknowingly sign unfavorable contracts and incur substantial revenue losses.

Now more than ever, you need a trusted ally at your side – someone who has your best interest in mind and who understands these new approaches to reimbursement methods. Fulcrum Strategies is uniquely suited to be your best advocate in these difficult and complex negotiations. At Fulcrum Strategies, our team of former insurance professionals will make sure you are protected before you enter into one of these new agreements. We can help you to understand the frequent changes that are taking place, how they will impact your practice, and how these changes can be tailored to actually benefit your practice.

Contact us today to discuss how we can help with contract negotiation services.

Strategic and Financial Planning

In the book Art of War, Sun Tzu wrote: "Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat." Unfortunately, this is true of most medical practices. Without a well-defined, researched and developed strategy, they are just creating the noise before defeat.

For most people, including physicians, it's very hard to devote time and energy to something today that may not pay off for a year or more. Understanding the importance of having a strategic plan is one thing, but the bigger issue is how to get it done. Typically, very few people inside the practice have the time or experience necessary to complete this process. With the addition of our newest team member, Cindy Nyberg, Fulcrum Strategies is ready to assist you, protect your business, and prepare for your future.

Cindy comes to Fulcrum with a wealth of experience in the financial and operational management of medical practices. Most recently, Cindy served as Chief Financial Officer for one of the largest private neurology practices in the country. In addition to overseeing Accounting and Finance, Business Office, Compliance, Information Technology and EMR, Financial Services, Pre-Authorization, and MRI Departments, Cindy also managed strategic projects including: improved access with same day appointments and improved utilization of midlevel capacity, EMR implementation, improved departmental and cost accounting, and new patient collections workflows. A certified public accountant with CMPE credentials, Cindy brings real world experience in EMR implementation, strategic planning, expense management, and operational efficiencies to the Fulcrum team.

We realize that no two practices are alike, so we are able to tailor our services to meet your needs and bring value to your organization.

Does your practice need ongoing assistance and consultation for your business operations and financial planning and reporting? 

Fulcrum Strategies can do the following: 

  • Assist with overall management consultation.
  • Develop and deliver ongoing management reporting and communication with physicians, including: calculation, tracking and communication of key performance indicators.
  • Perform specific project-related data analysis.
  • Assist with cash management and debt reduction strategies.
  • Review physician's compensation.
  • Assist with operational reviews and project management.

Is your practice operating towards future success or only reacting to the daily challenge?

Fulcrum Strategies can assist in developing a comprehensive strategic plan for your practice. 

  • Comprehensive analysis of your group's financial data.
  • Formal report outlining what your business will look like over the next five years.
  • Projections for each partner's income of the next five years.
  • Full analysis of your group's strengths, weaknesses, opportunities, threats, financial projections, and evaluations.
  • Detailed strategic plan with suggestions for improving operational efficiency, ancillary income, and overall business success.

Is your practice ready for shared savings or value based reimbursements? Do you know the cost of services provided?

Fulcrum Strategies can assist in developing and maintaining an activity based costing system. 

  • Develop a general ledger accounting system that provides accurate cost data.
  • Analysis of the cost of providing services from overall practice expense down to a specific service such as an office visit.
  • Report and communicate with physicians and administration.

At Fulcrum Strategies, we understand your day-to-day challenges of running a practice, and our goal is to come alongside and assist you with a forward-thinking approach. We are confident that our team has the knowledge, depth, expertise, and vision to support your practice in planning for the future and operating in this ever-changing healthcare environment.

For more information, please contact us today. We will setup a call to learn more about your practice and discuss your specific needs, and we will provide you with a detailed proposal for our strategic and financial planning services.

Capitation Assistance Program

Entering into a capitation contract, or any kind of value-based or shared-savings agreement, can be a daunting prospect. It can also be incredibly damaging to a practice if done incorrectly. Advanced payment models are like any other tool: In the hands of a skilled, experienced craftsman, they can produce great things. In the hands of someone without the necessary skills and experience, they can do significant harm. For this reason, Fulcrum has created a set of services and tools to make sure our clients are able to build long lasting, beneficial contracts.

ACO Participation Selection and Negotiation

We work with our clients to evaluate options for ACO participation and will negotiate the terms and language of any ACO agreement your practice decides to join.

Advanced Payment Model Negotiation and Evaluation

As payers offer opportunities to participate in advanced payment models, including capitation and other forms of shared risk and shared savings, practices need the expertise and tools to analyze those payment models. Fulcrum will provide your practice with exactly that. We will also represent your practice in negotiating these agreements once the analysis is done.

Payment Model Reporting and Management

Negotiating and entering into capitation is not the end, it’s actually only the beginning. Unlike fee for service agreements, the real work of any shared savings or capitation agreement begins after the agreement is signed. The key to making these contracts work is managing them and making sure your practice is doing the what’s necessary to ensure success in the new healthcare environment. That’s where Fulcrum really shines. We will take your data and produce meaningful, actionable quarterly reports that will give you the information and analysis necessary to succeed.

For more information, click here to view our CAP booklet.

Merger Evaluation Services

Fulcrum Strategies has the experience and skills to help you evaluate a possible merger or acquisition of another group. Our areas of expertise lie in revenue pro-forma evaluation, payer contract review and post-merger strategic planning considerations.

Revenue Evaluation

The first question in any possible merger or acquisition is the impact, positive or negative, that the merger could have on current revenue levels. This involves a “black box” evaluation of the contracts for each of the groups involved. Fulcrum Strategies has performed multiple black box evaluations and can quickly determine the revenue impact that a merger or acquisition could have on the groups involved. We will evaluate the revenue impact if Group A rolls under Group B’s contracts, if Group B rolls under Group A’s contracts, or in the situation where the merger will produce a new entity: a Group C, as a combination of Group A and Group B. For new entities, Fulcrum would evaluate what rates would need to be achieved in these new contracts to maintain or grow revenue. This analysis can be done such that neither group violates the confidentiality clauses in their current contracts.

Contract Language Review

Mergers and acquisitions are not as simple as adding the doctors from one group into the other group. Payer contracts contain language that would prevent medical groups from unilaterally being able to do just that. In addition, the contracts from the smaller group can follow their physicians until the contract is actually terminated. Fulcrum Strategies will review the contract language in the major payer agreements for each practice and point out any areas of concern that need to be addressed.

Strategic Planning Considerations

One of the most important activities involving a merger or acquisition is what happens after the groups are brought together. How does the new, larger group take advantage of the change in a way that would be beneficial to all physicians within the practice? Fulcrum Strategies can help you build a post-merger strategic plan to take full advantage of your new situation.


These services are included in our retainer contracts for existing clients, at no additional cost. For all other potential clients, please contact Fulcrum Strategies and we will develop a proposal to meet your specific needs and situation.