Price Transparency Data: How Employers, Shareholders, and Clinics Use It, With Jerry DiMaso (EP506)

The Price Transparency Arms Race: What Self-Insured Employers and Clinics Can Both Do With the Data. Episode 506.

Health price transparency data isn't just a compliance exercise anymore — it's becoming a competitive weapon for plan sponsors, shareholders, and clinics alike. Stacey Richter talks with Jerry DiMaso, co-founder and CEO of Payerset, about how self-insured employers can use hospital and carrier transparency files to benchmark against competitors, catch overpriced billing codes, and expose "discount shell games," while independent clinics use the same data to level an historically asymmetric market.

WHAT YOU'LL LEARN

✅ How plan sponsors can use an EIN to look up their own or a competitor's negotiated rates and carve-outs, exposing which companies in their industry are quietly getting better pricing

✅ Why the "discount shell game" is exposed by transparency data — a TPA's claimed 90% discount can be checked against real negotiated rates instead of taken on faith

✅ How plan sponsors can direct their TPA to renegotiate rates, implement service carve-outs and direct contracts, and calculate objective savings instead of relying on vendors to grade their own homework

✅ How independent clinics use the same rate data to benchmark reimbursement, discover new payer contracts they didn't know existed, and defend their prices during negotiations using quality metrics

✅ Why identifying high-cost billing codes matters — including the kind of million-dollar infusion overpayment discussed in the recent episode with Ivana Krajcinovic, PhD

WHY THIS MATTERS Health benefits are often the second-largest line item on a corporate balance sheet, yet most plan sponsors have never checked whether they're paying more than their competitors for the exact same care. Price transparency data turns that blind spot into an "arms race" — plan sponsors can benchmark and negotiate harder, while independent clinics can use the same data to keep from being squeezed out by consolidated health systems that would otherwise inherit all their volume, and all their pricing power.

MENTIONED IN THIS EPISODE

EP472 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps

EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky: Apple Podcasts | Spotify | Other Apps

LinkedIn Post by Chris Deacon

LinkedIn Post by Andrew Tsang

LinkedIn Post by Pearly Chen

EP489 with Dan Greenleaf: Apple Podcasts | Spotify | Other Apps

EP501 with Ivana Krajcinovic, PhD: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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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.

14:48 How employers can help TPAs negotiate.

15:18 Why employers should be thinking about carving out services.

16:21 Why employers need to direct contract.

17:38 A quick summary of advice for plan sponsors.

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.

25:46 Have prices increased due to price transparency?

29:25 Why price transparency makes it more important to eliminate lazy networks.

31:10 What is the transparency arms race, and what is happening because of it?

34:39 What Payerset does.