How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso
Episode Description
Hospital price transparency mandates took effect in 2019. Carrier transparency mandates followed in 2022. That means plan sponsors have had access to negotiated rate data for every billing code, every provider, and every carrier in the country for years — and most still aren't using it. The rate disparities from one employer to another for the exact same service codes are, in Jerry DiMaso's words, huge.
In this episode, Stacey Richter speaks with Jerry DiMaso, CEO of Payerset, a healthcare pricing intelligence and price transparency data company, about what self-insured employers, unions, and independent clinical organizations can actually do with this data — and why the carriers and consolidated health systems are already using it against them.
WHAT YOU'LL LEARN
✅ How self-insured employers can search transparency files by EIN to benchmark their own negotiated rates against competitors in the same industry — and why, given that health benefits are often the second largest corporate line item, activist shareholders may not be far behind
✅ How to use billing code-level data to identify high-cost outliers, expose "discount shell games" — validating whether a TPA's claimed 90% discount reflects real savings or just a gross aggregated discount on codes nobody actually uses — and calculate objective savings without relying on vendors to grade their own homework
✅ How plan sponsors can use this data to direct TPA negotiations, implement service carve-outs and direct contracts for high-volume codes like musculoskeletal procedures, and model whether an HMO plan would save money while keeping access to the providers employees already use
✅ Why independent clinical organizations are using transparency data to discover carriers active in their geography they didn't know existed, justify rate increases by pairing price benchmarks with quality and outcomes data, and avoid being forced to sell their practice — because when an independent practice gets acquired, prices go up
✅ How carriers are already running the transparency arms race in the other direction — sending letters to providers saying they spotted lower rates accepted from a competitor and will now renegotiate accordingly — and why having the data at your fingertips is the only defense
✅ Why price transparency is shifting fiduciary responsibility for plan sponsors: since hospital data has been available since 2019 and carrier data since 2022, "I didn't know" is no longer a viable explanation for a plan that spent a million dollars more than necessary on the same drug at a provider down the street
WHY THIS MATTERS
A dysfunctional market is defined by wildly divergent prices for the exact same service in the exact same geography. That is precisely what price transparency is exposing — and it is making steering and tiering not just a strategy but a fiduciary obligation. The goal, as Jerry DiMaso frames it, is a regression to the mean: a fair price for a given procedure in a given market, after which competition shifts to quality. We are not there yet, but the data to get there now exists.
=== LINKS ===
🔗 Show Notes with all mentioned links:
https://cc-lnk.com/EP506
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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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