The show starts where the company did. Matt Phillips sits down with Payerset co-founders Jerry DiMaso and Jacob Little to talk about why they launched The Price Transparency Project and what listeners can expect from the conversations ahead.
They reflect on how price transparency has changed since the Transparency in Coverage data first landed in 2022, from early confusion and technical obstacles to a source of insight the whole market now draws on, and on the continued need for education, advocacy, and open dialogue between groups that too often operate apart.
Transcript
Matt Phillips: Hello, and welcome to the Price of Healthcare podcast. This is an initiative of the Price Transparency Project that we’ve recently launched as an avenue for us to create advocacy, policy tips, best practices, really for anyone working with healthcare pricing data. And so today I’m with Jacob Little and Jerry DiMaso, co-founders of Payerset.
Jacob Little: Thank you.
Matt Phillips: Want to give a little intro of yourselves?
Jacob Little: Absolutely. My name is Jacob. I started this with Jerry when all of this began with the tick data in July of 2022. It’s been an amazing journey since then, getting this information into people’s hands, helping so many different organizations with it. And we’re just really excited to see where price transparency is today in 2026, as this is being recorded, compared to when it started. So it’s been a wonderful journey.
Jerry DiMaso: I’m Jerry DiMaso, Jacob’s co-founder. Very excited to get this started with the Price Transparency Project, trying to get this out there for everybody.
Matt Phillips: All right. So starting a price transparency company, Payerset, it’s kind of always been a mix of policy and advocacy along with company building, building a technology company. Why did it make sense to break out Price Transparency Project to its own thing?
Jacob Little: There’s still so much education that needs to happen. I was at a conference, this really sweet person was talking about price transparency. It was a conference for hospital financial leaders.
And this really sweet person approached me after I had done a talk and said, hey, is what you’re doing legal? Is this information supposed to be out there? And I was like, well, I guess we have a lot of work to do.
So there’s still, I think, a lot of people in the space that either think that don’t know about it at all, a nd are really surprised that the contracted rates are out there and can be accessed and used. They don’t even realize it’s being used against them sometimes, which is even worse.
And then if they do know, there’s just been a lot of, I think, negativity and frustration because it was much harder than everybody thought it was going to be. But guess what? Surprise, surprise.
Healthcare pricing is complicated, right? It’s a complex system that has built up over many, many years. And luckily, we’re making all of that simple.
But we needed to start with education and we needed a vehicle to do that in a really focused way that wasn’t about the tools we’re building or the solutions we’re delivering, just about making sure that there was a community that could help each other, that knew where the policy was, that knew how this could be used.
Jerry DiMaso: And something that was separate from a company, separate from technology, just more about helping people understand where the price transparency data is, where it’s going. So we’ll talk a little bit about policy. We’ll talk a little bit about where we were with price transparency, where it first came out and the journey it’s gone through, the schema 1.0, then to schema 2.0, now schema 3.0 is going to be coming out soon, which we’re really, really excited about.
Matt Phillips: A little teaser. We do have one of the originators of the transparency and coverage legislation. That’s going to be a guest.
But speaking of policy, you guys were both just recently in D.C. meeting with various leaders talking about schema 3.0. I mean, maybe give us a little bit of taste. Like, I know you can’t talk that much about in the room, but what’s coming? Highlights.
Jerry DiMaso: There’s actually a lot. There’s actually a lot coming. Schema 2.0 was a huge step forward in terms of just having one continued investment and reinvestment in the price transparency data in the first place. So there was a schema 1.0 came out a couple of years in between, had a lot of learnings, a lot of different technical snags and the carriers, learning how to publish, learning how to turn their contracts into data, which, you know, they’re written long documents that are very complicated. So kind of turning those into a data set. So there was a bit of a learning curve there with the posting.
Schema 2.0 came out, added a couple of new fields that we really needed to make the data even more useful. It also allowed the payers kind of an opportunity to refresh and refresh their processes. And so we saw a lot of cleanup in the data just in the last few months, which is really exciting.
Schema 3.0 is going to be adding a lot more capability from an analytics standpoint to the data. So we’re looking at potentially getting some utilization data. We’re looking at even just more semantic meaning behind some of the provider groupings and trying to get more information about carve-outs and outliers and things like that, because contracts are pretty complicated.
So ultimately trying to get to, can we codify a contract into a data set and make that available and useful for everybody? So it’s very exciting to be there. The final rule is actually undergoing review now.
So we will have some information on that soon in the coming weeks and months. That’s a very exciting time. So it’s a very exciting time for price transparency.
Matt Phillips: I know you’re excited about the recent hospital price transparency updates too.
Jacob Little: Yeah, it’s actually a really important point because when you say the word price transparency, depending who you’re talking to in the industry, as I said earlier, they either don’t know what it is or depending on who they are, they’re associating it with maybe the thing that you’re not talking about. So if you talk to somebody in a hospital about price transparency, they’re going to be thinking about their regulation. Oh yeah, those are those files that we have to put together and that’s so hard.
And oh, there was another update and it has to be on our website. It has to be linked in the footer, all of those things. The transparency and coverage rule that affects commercial insurers is a completely different rule, different enforcement, different schema, completely different.
That’s coming out of the insurance company’s actual systems and being populated. So that when we talk about 3.0, we’re talking about that from the commercial insurers out of their system. So there’s kind of two branches of price transparency.
And I think there is a vision that over time they will be able to kind of at least compliment, talk to each other, say the same thing. We’re not there yet, but they can be used in a really powerful way to triangulate and kind of understand. And there’s a lot of interesting contract language that is in the hospital data today that is not in the in the data from the insurer.
So I think that’s really, really exciting. And there’s just so much movement right now.
Matt Phillips: Yeah, a lot going on. All right. So just talking about price transparency project.
So we’ll wrap up here soon. But what can people expect? And really, I guess maybe the first part of that is who are we even trying to talk to?
Who are the different stakeholders that we’re really building this for?
Jacob Little: It’s really just anybody in the healthcare ecosystem that wants to understand prices. That goes for patients, patients really above all. We’re trying to enable the care delivery organizations.
Some people call them providers. We’re enabling employers. There’s so many employers that are self-funding insurance.
And so there’s just a lot of education. There’s a lot of policy happening kind of separate from this price transparency rule that’s affecting kind of what they can see. Are they even allowed to see claims for the things that they’re paying for?
It’s a whole other topic. We’re going to be talking about all of that. And then patients from an education perspective, understanding their EOB, advanced EOB, understanding their actual bill.
What does it all mean? Why is the gross charge, why is the charge different than what the insurance company is reimbursing to the care delivery organization? So there’s just so much.
And what we’re really trying to do is bring all of those perspectives together to get on the same page. Because if we can’t get on the same page, if everybody’s just on the opposite sides of the aisle kind of pointing at each other and, oh, I think you’re the problem, you’re the one making health care in this country expensive.
We’re not going to get anywhere. And we all know, right, the situation now is untenable. This is not sustainable. So that’s really who we’re trying to help.
Matt Phillips: Yeah. You know, before we wrap up, do you have anything else you want to share with the community?
Jerry DiMaso: If we can get real pricing out there for everybody and if people can predict what their pricing is going to be for any given health care service or anything that they need, ultimately that’s going to help kind of at least flatten out the market a little bit and start to turn it into an actual market where you can shop around for health care and you can understand kind of what the pricing is going to be before you get a procedure.
Right now, that’s kind of difficult, but there’s a lot of legislation coming out. This is a bipartisan effort in Washington, which is a really, really important thing. It’s definitely a top focus.
A lot of the employers are struggling. Premiums are going up. Care costs are going up for care delivery organizations.
This whole concept of transparency is eventually going to allow us to lead to deregulation in a lot of places. The more transparent people are, the more transparency we have. We can deregulate and reduce the administrative burden on care delivery organizations, on carriers.
And that’s going to ultimately drive the cost down.
Matt Phillips: I love the call on bipartisan. I love the call out on different perspectives, and that’s really what this is about is bringing together different voices that sometimes can be in echo chambers.
Jacob Little: That’s right. Oh, there are very serious echo chambers. We go to all the conferences representing the self-funded employers, representing the hospitals.
Everybody has a slightly different perspective. There was a conversation with somebody that led policy and a hospital leader. And the policy expert said, hey, well, I think all all hospitals should get paid 140 percent of Medicare no matter what.
And then the hospital leader said, well, my commercial mix is only 40 percent. And so if that happened, our independent hospital would go out of business. And so do you think it’s going to make health care cheaper or more expensive if one giant system just buys up all of the independent system?
Matt Phillips: Which is happening in that market, because we know what market that is.
Jacob Little: Yes. Then the policy person was like, that’s a really good point. Let’s keep talking. And they shared information. And that’s what we want to do at scale.
Matt Phillips: Yeah, I think that’s a beautiful, beautiful way to sum it up of what we’re trying to do here. So thank you both for taking the time to do this. And thank you all for listening.
Episode one is actually out now. So go take a listen.