Health Plan Pricing Transparency: Essential Insights for Employers

Industry Insights: Transparency in Health Plan Pricing and Employer Engagement

The Purchaser Business Group on Health (PBGH) has released a comprehensive report analyzing hospital and health plan price transparency with crucial insights for employers purchasing health insurance. The study uncovers hidden fees that complicate transparency in pricing, raising concerns about undisclosed data from hospitals and health plans.

In an interview, PBGH President and CEO Elizabeth Mitchell highlighted the disparity between hospitals' reputations and their actual quality, noting that "value networks" often fail to deliver cost-effectiveness for self-insured employers. The report, released on October 14, merges price, quality, and safety metrics to provide essential data for employer partnerships with health providers.

Peter Wehrwein of Managed Healthcare Executive emphasized the report's illumination of financial pressures on companies, where increasing healthcare costs potentially lead to wage suppression and layoffs. The report offers a comparative analysis of healthcare spending across major metropolitan areas, showcasing potential savings through improved contract negotiations.

The historical lack of transparency in healthcare pricing has led to excessive charges for employers and beneficiaries. Mitchell asserts that the comprehensive data in the report allows employers to demand accountability from healthcare providers and secure better rates.

Transparency regulations introduced in 2021 and 2022 mandate hospitals and insurers to publish prices in machine-readable files and for shoppable services. Access to this data equips employers to challenge and renegotiate unjustified costs effectively.

The implications of these findings are significant for self-insured employers, who dominate the employer-provided insurance landscape. Most allocate funds to cover employee health costs, only resorting to reinsurance for substantial, unexpected expenses. KFF data shows healthcare cost inflation continues to burden wages and economic spending power.

Mitchell notes that while healthcare cost inflation boosts insurer revenue and profits, insurers lack incentives to reduce expenses, often misaligning with self-insured employers' goals. The report's preparation involved extensive data gathering over a year, facing resistance from health insurers and hospitals, indicating that transparency still grapples with industry resistance.

Looking forward, future analyses will examine how insurers and healthcare providers utilize employer funds, advocating for more strategic health benefit management. High healthcare costs, as highlighted by labor disputes and their impact on negotiated raises, underscore the complexity of health insurance premiums on economic structures.

By Joseph Burns

© 2026 AHCJ

Tags: Insurance Industry, Healthcare Costs, Employer Health Plans, Transparency, Self-Insured Employers