EP506: How Other Employers, Shareholders, and Clinics Are Using Price Transparency Data—And It's an Arms Race, With Jerry DiMaso

·36 min·3 clips

Jerry DeMasso reveals how employers use price transparency data to find hidden fees and negotiate better rates in an arms race.

This episode of Relentless Health Value focuses on the practical applications of healthcare price transparency data. Host Stacey Richter introduces the topic as part of a miniseries about finding 'hidden fees' and friction in healthcare. Guest Jerry DeMasso, CEO of Payerset, outlines the regulatory background, noting that transparency mandates began with hospitals in 2019 and expanded to carriers in 2022. For plan sponsors like self-insured employers, the data offers three key insights: benchmarking against competitors using EINs, identifying high-cost billing codes, and exposing misleading discount claims. Employers can then use this information to direct TPA negotiations, implement service carve-outs or direct contracts, and model alternative plan types. The episode pivots to discuss clinical organizations, emphasizing how independent practices can leverage transparency data to benchmark rates, discover new carrier contracts in their geography, and justify rate increases by pairing price data with quality outcomes. Jerry provides examples, such as a behavioral health practice that successfully negotiated higher rates by demonstrating superior patient outcomes. The conversation addresses potential pitfalls, including whether transparency drives prices up or down, with Jerry noting instances of both outcomes. He describes a 'transparency arms race' where carriers use the data to renegotiate lower rates with providers. The episode concludes with Jerry discussing Payerset's role in aggregating and processing transparency data and highlighting ongoing policy pushes for more transparency from CMS.

As heard by us

A focused look at price transparency as negotiating leverage for employer healthcare plans.

Price transparency lands here as a practical bargaining tool, with Jerry DeMasso focusing on the wide rate gaps between employers and the leverage sitting inside transparency files.

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Why you'd press play

You want to know whether your plan is paying the going rate? Start with the transparency data and look for the inches hiding in plain sight.

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