AI-powered analysis of healthcare contracts and payments to help providers detect underpayments, compare their negotiated rates, and identify opportunities to boost revenue from insurers. 

If you know senior finance execs in health systems, partners in healthcare PE, or mid to large sized healthcare practice owners, please do connect us. We won’t waste their time: +1 628 468 3232.
Boosting contracted revenue for US healthcare providers
Title: Fuse: Boosting contracted revenue for US healthcare providers | Y Combinator

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### Boosting contracted revenue for US healthcare providers

AI-powered analysis of healthcare contracts and payments to help providers detect underpayments, compare their negotiated rates, and identify opportunities to boost revenue from insurers. If you know senior finance execs in health systems, partners in healthcare PE, or mid to large sized healthcare practice owners, please do connect us. We won’t waste their time: +1 628 468 3232.



Fuse

Founded:2024

Team Size:2

Location:London, United Kingdom

### Active Founders

### Sho Sugihara, Founder

Sho is a repeat founder. He scaled his last business to $6m ARR within twelve months from launch. Before that, he worked on data analytics projects at McKinsey for some of the largest healthcare systems in the world, including the NHS and several of the top ten private healthcare insurers. He studied Social Sciences at Cambridge and Global Health at the Karolinska Institutet.



### Oscar Wilsby, Founder

Oscar has built large-scale payments and credit data analytics models that outperformed incumbents like Experian by a significant margin. These models helped power the first startup he co-founded and scaled to a multi-million $ run rate. Before tech, Oscar was a post-doc researcher and completed an MEng and PhD in Machine Learning and Computational Physics at Cambridge. He’s worked in research divisions for companies like McLaren F1 and Dyson, applying machine learning to complex data problems.



### Company Launches

[### Fuse - Underpayment detection for healthcare providers](

**TL;DR:** [Fuse]( offers AI-powered analysis of healthcare contracts and payments to help providers detect underpayments and collect the revenue they’re owed from insurers.

**❌ Problem**
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Our “aha” moment came when healthcare provider execs repeatedly told us they had no idea if their revenue was accurate. One even described their insurance claims process as a “black hole”.

Several factors contribute to this issue:

1.  Growing usage of AI. Insurers are using sophisticated models to analyze claims and find ways to subtly underpay.
2.  Too many contracts: An average hospital has over 50 contracts with insurers with varying reimbursement rates for the same procedure, making payment accuracy verification costly and near impossible.
3.  M&A wave: Mergers are forcing providers to consolidate contracts and revenue tracking systems, adding further complexity.

As a result, providers spend months analyzing revenue and chasing payments, forfeiting up to 11% of topline revenue if they cannot afford the overhead to do so.

With provider operating margins already negative since COVID-19, the situation creates severe margin compression and cash flow risk.

**Solution**
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We use LLMs to extract data from the stacks of contracts that dictate provider payment terms from insurers. We reconcile the data against remittances to identify underpayments and auto-generate appeals.



Our mission is to level the playing field for providers with AI-powered contract analytics. Beyond this, we want to aid the transition towards Value-Based Care by powering sophisticated contract modeling as payment models become even more complex.

**Team**
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Our team specializes in complex financial data analytics. We previously co-founded a business that grew from $0 to $6M ARR in 12 months, developing large-scale data models for payment and credit analytics that outperformed major players like Experian.



[Oscar]( (CTO) was an academic who completed a PhD and postdoc in Machine Learning at Cambridge. He’s worked in research divisions for companies like McLaren F1, and brings expertise in building top performing data models in highly regulated industries.

[Sho]( (CEO) met Oscar during their first week of undergrad at Cambridge. He’s a repeat entrepreneur and closed a $100k contract within a year for his first company, and has worked on data analytics projects for some of the largest providers and insurers in the world at McKinsey.

**🙏 Our Ask**
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**If you know senior finance execs in healthcare systems or partners at healthcare PE firms please do connect us!** [**founders@fuseinsight.com**](
