Cleargate Capital Backs Fellow Health Partners — PE Doubles Down on Mid-Market RCM

Fellow Health Partners, a Bay Shore, NY-based RCM services firm serving physician groups and ambulatory surgery centers, has received a strategic investment from Cleargate Capital Partners. Terms were not disclosed. This is exactly the kind of deal the market keeps producing — and there's a reason why.

What Fellow Health Partners Does

Fellow Health Partners provides end-to-end revenue cycle management services — billing, coding, denial management, collections — to physician groups and ambulatory surgery centers across the country. That's the segment everyone is fighting over right now: independent and physician-owned practices that don't have the scale to build internal RCM infrastructure but generate enough volume to make outsourcing economics work.

ASCs in particular are a high-value target. Procedure-heavy, often out-of-network or partly out-of-network, and historically underserved by the big RCM outsourcers who focus on hospital systems. The billing complexity — implants, modifier stacking, facility vs. professional split — creates real margin opportunity for firms that know the coding patterns cold.

Who Is Cleargate Capital Partners?

Cleargate is a new entrant — founded in 2025 — with a declared focus on founder-led, lower middle market healthcare businesses. The "long-term partnership" language in the announcement is deliberate. It signals a buy-and-build orientation: acquire a platform, retain the founders, add adjacent capabilities or tuck-in acquisitions, and grow into something that commands a larger exit multiple in 5–7 years.

That's been the playbook for virtually every successful RCM PE deal of the last decade. Revenue cycle is sticky — once you're embedded in a practice's EHR workflows and payer contracts, you don't leave easily. The churn metrics look good on a diligence deck. Cleargate knows this.

What This Means for the Market

A few things worth noting for RCM professionals watching M&A activity:

• Physician group and ASC RCM is heating up. The large health system market is largely spoken for — Ensemble, Optum, R1, Conifer have those relationships locked. The growth edge is in the independent practice and ambulatory surgery center segment, where consolidation is still early and pricing power exists.
• New PE firms are entering healthcare services specifically to play this trade. Cleargate founded in 2025 is not unusual — the post-2022 private credit environment has made lower middle market healthcare an attractive sector for smaller GPs who can't compete for billion-dollar assets.
• Terms not disclosed means relatively small check. Any deal above $50–75M in the RCM space tends to get sized in press releases. The absence of a number here puts this in the platform/seed range for Cleargate — the announcement is partly a market signal to other founder-owned RCM firms that Cleargate is open for business.
• The AI narrative is coming. Every PE-backed RCM services company is going to need a credible AI automation story within 18 months. Cleargate will be looking to bolt one onto Fellow — whether through a technology partnership, a tuck-in acquisition of an AI denial management tool, or building internal capability. Watch for that next move.

The Bottom Line for RCM Teams

This deal won't change your workflow tomorrow. But it's another data point in a pattern that should inform how physician practice administrators and ASC revenue cycle directors think about their vendor relationships. PE-backed RCM vendors are under pressure to grow revenue quickly. That creates both opportunity (more competitive pricing, technology investment) and risk (staff turnover post-acquisition, service disruption during integration).

If Fellow Health Partners is your RCM vendor, or if you're evaluating them: ask directly about the Cleargate investment thesis, the timeline, and what operational changes are planned in the first 12 months. Those are the questions that separate informed buyers from ones who find out at contract renewal.

Source: BusinessWire, June 15, 2026