Episode Details

Stacey Richter interviews Jerry DiMaso, CEO of Payerset, about how hospital and carrier price transparency data (mandates beginning with hospitals in 2019 and carriers in 2022) is being used by plan sponsors and providers. For self-insured employers and unions, DiMaso highlights three key uses: benchmarking against competitors via EIN to compare negotiated rates and carve-outs, identifying high-cost billing codes, and exposing "discount shell games" by validating whether claimed discounts reflect real savings.

Employers can use the insights to guide TPA negotiations, implement service carve-outs/direct contracts and calculate objective savings, and model alternative plan types (e.g., PPO vs HMO) while maintaining access. For clinics, transparency data can level information asymmetry by enabling rate benchmarking, revealing new contracting opportunities with previously unknown carriers, and supporting rate increases by pairing price comparisons with quality/outcomes; the discussion also addresses concerns about prices rising and an emerging transparency "arms race."

=== 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

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