Transparency in Coverage: One Year Later

Price transparency regulations have been in effect for over a year. What's changed? What hasn't? Here's our assessment.

What's Working

Data availability: Machine-readable files are now publicly available from hospitals and insurers. The information exists in a way it never did before.

Price variation visibility: Employers can now see the dramatic variation in negotiated rates—sometimes 5-10x differences for the same procedure at different facilities.

Carrier accountability: Employers have new leverage in carrier conversations when they can see actual negotiated rates.

What's Not Working

Data usability: Raw transparency files are massive and complex. Most employers can't use them without specialized tools or vendors.

Compliance gaps: Some providers and plans still have incomplete or difficult-to-access files. Enforcement has been inconsistent.

Consumer impact: Despite the regulations' consumer-protection framing, most individuals aren't accessing or using transparency data directly.

Employer Applications

How employers are using transparency data:

Reference-based pricing: Setting payment limits based on transparent pricing data rather than accepting whatever providers charge.

Center of excellence programs: Identifying high-quality, fairly-priced facilities for specific procedures.

Network evaluation: Assessing whether their network includes fairly-priced providers.

Carrier negotiations: Using transparency data as leverage in renewal discussions.

Practical Challenges

Barriers to widespread adoption:

Volume: Files contain millions of records requiring technical capability to process.

Quality: Data accuracy and completeness vary significantly.

Interpretation: Understanding what constitutes a "fair" price requires context and expertise.

Actionability: Having data and implementing strategies based on it are different challenges.

Looking Ahead

Price transparency is a long-term shift. Over time:

• Data quality will improve
• Tools to interpret data will mature
• Employer strategies will become more sophisticated
• Price variation may compress as transparency increases

We're still in early innings, but the direction is clear.