Relentless Health Value
EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso
Why It Matters
Price‑transparency data gives employers and providers concrete leverage to cut healthcare spend, a line item that often ranks second on corporate balance sheets, directly impacting shareholder value and employee benefits costs. As more entities adopt these tools, the competitive pressure intensifies, making the episode timely for anyone looking to stay ahead in the evolving landscape of healthcare financing and delivery.
Key Takeaways
- •Employers benchmark health plan rates against competitors using EIN searches
- •Transparency data reveals high-cost billing codes for targeted negotiations
- •Firms can verify TPA discount claims and negotiate better contracts
- •Clinics benchmark reimbursements, identify new revenue channels via price data
- •Direct contracts and carve‑outs model alternative plans, driving savings
Pulse Analysis
The 2016 transparency mandates and subsequent 2019‑2022 regulations forced hospitals and carriers to publish negotiated rates for every billing code. That flood of data has become a strategic asset for self‑insured employers, unions, and plan sponsors who now can see exactly what they pay versus what competitors pay. By entering an employer’s EIN into the public files, a company can benchmark its health‑benefit line item—often the second‑largest expense on the balance sheet—against industry peers. This visibility exposes hidden cost differentials and gives shareholders concrete evidence of avoidable overspending.
Armed with granular rate information, plan sponsors can pressure their third‑party administrators (TPAs) to renegotiate inflated contracts. They can carve out high‑cost service lines—such as infusions or orthopedic procedures—and negotiate direct agreements with centers of excellence that deliver better outcomes at lower prices. The data also supports objective calculations of projected savings, eliminating reliance on vendor‑provided “homework.” Moreover, employers can model alternative designs, comparing PPO, HMO, or EPO structures to determine which configuration preserves provider access while reducing per‑service spend. These tactics turn price transparency from a compliance checkbox into a competitive advantage.
Independent clinics and smaller health systems gain equal footing when they can compare their negotiated reimbursements to those of consolidated networks. Transparency data highlights under‑reimbursed codes, prompting providers to adjust pricing or seek new payer contracts in untapped geographies. By pairing cost data with quality metrics, practices can justify rate increases and negotiate from a position of strength. Preserving indie providers also curbs market concentration, preventing monopolistic pricing that drives overall healthcare inflation. In short, price‑transparency analytics empower both purchasers and providers to make data‑driven decisions that improve affordability and sustain a more balanced health‑care ecosystem.
Episode Description
Stacey Richter interviews Jerry DiMaso, CEO of Payerset, about how hospital and carrier price transparency data (mandates beginning with hospitals in 2019 and carriers in 2022) is being used by plan sponsors and providers. For self-insured employers and unions, DiMaso highlights three key uses: benchmarking against competitors via EIN to compare negotiated rates and carve-outs, identifying high-cost billing codes, and exposing "discount shell games" by validating whether claimed discounts reflect real savings.
Employers can use the insights to guide TPA negotiations, implement service carve-outs/direct contracts and calculate objective savings, and model alternative plan types (e.g., PPO vs HMO) while maintaining access. For clinics, transparency data can level information asymmetry by enabling rate benchmarking, revealing new contracting opportunities with previously unknown carriers, and supporting rate increases by pairing price comparisons with quality/outcomes; the discussion also addresses concerns about prices rising and an emerging transparency "arms race."
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00:00 Introduction to this episode.
00:50 How does transparent pricing data fit into the "inches all around us"?
03:13 A quick overview of what plan sponsors do with these price transparency insights.
05:52 The specific ways that clinical organizations can leverage price transparency data.
08:13 How price transparency infrastructure started and how it's grown to where we are now.
09:21 What are the insights that can be gleaned from the price transparency data available?
10:01 How price transparency data is a treasure trove for self-insured employers.
11:21 How employers can utilize this transparency data.
12:31 EP472 with Eric Bricker, MD.
14:48 How employers can help TPAs negotiate.
15:18 Why employers should be thinking about carving out services.
16:11 EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky.
16:21 Why employers need to direct contract.
17:16 LinkedIn post by Chris Deacon.
17:38 A quick summary of advice for plan sponsors.
18:04 LinkedIn post by Andrew Tsang.
18:41 LinkedIn post by Pearly Chen.
19:32 How rates get set and how small providers can see this and benefit from it.
20:55 How small providers can use rate transparency to negotiate better rates.
22:18 EP489 with Dan Greenleaf.
25:46 Have prices increased due to price transparency?
29:25 Why price transparency makes it more important to eliminate lazy networks.
29:41 EP501 with Ivana Krajcinovic, PhD.
31:10 What is the transparency arms race, and what is happening because of it?
34:39 What Payerset does.
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