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Latest episode · Episode 4 · October 2026 · 42 min

How Montana's state health plan climbed from near-insolvency to $112 million in reserves

with Marilyn Bartlett, Senior Policy Advisor, National Academy for State Health Policy

Marilyn Bartlett took Montana's state employee health plan from near-insolvency to $112 million in reserves. She explains how employers can follow their healthcare dollars, from claims data to hospital costs.

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Show notes & transcript

Latest Analysis

New · October 2026

The Payer Files Get a Rewrite: What the Final Transparency in Coverage Rule Keeps, Cuts, and Starts

1 file per provider network, replacing one rate file per plan. The first are due April 1, 2027.

The final Transparency in Coverage rule keeps most of what CMS proposed in December, drops two proposed features, and adds an accuracy attestation tied to a named executive. The first rebuilt payer files are due April 1, 2027.

Read the analysis

Employer

Verification Has Replaced Belief: What Self-Funded Employers Can Now Check, and What Happens When They Do

100% the PPO renewal one employer received, after years of single-digit increases

Compliance by dimension Q2 2026

Blue Cross Blue Shield

Strong Acceptable Needs work Poor

Scorecard · Q2 2026

Payer Compliance Scorecard

100+ payers graded on three dimensions of their machine-readable files

Explore the scorecard

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The full library

Policy

The Payer Files Get a Rewrite: What the Final Transparency in Coverage Rule Keeps, Cuts, and Starts

October 2026 · 12 min read

Episode

Employer ·Policy

How Montana's state health plan climbed from near-insolvency to $112 million in reserves

Episode 4 · October 2026 · 42 min

Episode

Employer ·Policy

How employers are taking control of healthcare costs in the modern benefits market

Jeff Hogan runs forensic reviews of employer health plan contracts. He explains where the money leaks, what fiduciary law now demands of plan sponsors, and the first moves a self-insured employer can make.

Episode 3 · October 2026 · 74 min

Episode

Policy ·Employer

Unpacking the mechanics and award sizes of the IDR process

Actuary Tia Goss Sawhney unpacks the No Surprises Act's independent dispute resolution process: how qualifying payment amounts are set, why awards run so high, and what self-funded employers can do.

Episode 2 · September 2026 · 42 min

Employer

Verification Has Replaced Belief: What Self-Funded Employers Can Now Check, and What Happens When They Do

Self-funded employers are opening renewals of 39, 33, and 100 percent. The negotiated rates behind their network discount and what their vendors are paid are now public, and the employers who rebuilt their plans started by checking both.

September 2026 · 7 min read

Episode

Policy

From a sketch to a rule: the origins of price transparency

Randy Pate helped write the federal price transparency rules at CMS. He walks through the original theory behind them, what the first pass got wrong, and what the data can accomplish for buyers today.

Episode 1 · September 2026 · 43 min

Episode

Policy

Welcome to The Price of Healthcare Podcast

Payerset co-founders Jerry DiMaso and Jacob Little on why they launched The Price Transparency Project, how the data has matured since 2022, and what to expect from the conversations ahead.

Introduction · September 2026 · 12 min

Analysis ·Guides

Gaining Leverage by Uncovering Contract Structures

A single negotiated base rate can price most of a hospital's inpatient DRG grid. Here is how to back into it from price transparency data, and turn it into negotiation leverage.

August 2026 · 6 min read

Analysis

Same Surgery, Different Price: Who Owns the ASC Predicts What the Payer Pays

Payerset priced three orthopedic procedures across Atlanta's independent, private equity, and system-owned surgery centers. Rates rose with the market power of the owner every time.

July 2026 · 6 min read

Policy

Updates to Hospital Price Transparency Requirements and the April 1st Enforcement Deadline

CMS replaced estimated allowed amounts with percentile-based remittance data in the hospital price transparency rule. Here's what changed before the April 1, 2026 enforcement deadline.

April 2026 · 11 min read

Guides ·Analysis

Part 2: A Practical Look at Reimbursement Benchmarking with Price Transparency Data

Part two of our series on benchmarking with price transparency data. A real-world example of how single-code comparisons can mislead, and what a comprehensive approach actually looks like.

March 2026 · 7 min read

Guides ·Analysis

Part 1: How to Analyze Price Transparency Data for Reimbursement Benchmarking

A framework for using price transparency data to benchmark reimbursement between hospitals, built from hundreds of customer interactions with managed care professionals.

March 2026 · 8 min read

Policy ·Analysis

Transparency in Coverage (TiC) Schema 2.0 Is Live - Updates

February 2nd, 2026 marked the first enforcement deadline for TiC Schema 2.0. Here's what we're seeing on the ground with payer compliance and the new data fields.

February 2026 · 3 min read

Policy

CMS Proposes Major Updates to Transparency in Coverage (TiC) Rules

CMS is proposing significant updates to TiC requirements including network-based file structures, annual utilization files, quarterly reporting, and enhanced out-of-network data.

February 2026 · 10 min read

What we cover

Analysis

Data-driven analysis of pricing patterns, market variation, and what the numbers reveal about payer-provider dynamics.

Policy & Regulation

CMS rulemaking, enforcement, No Surprises Act outcomes, and what's next for federal and state transparency mandates.

Field Guides

How to benchmark rates, read an MRF, prepare for negotiations, and use transparency data in daily operations.

Patient Equity

Price variation's human impact. Surprise billing, access gaps, and tools that put pricing power back in patients' hands.

Empowering Employers

Empowering employers with the data and tools to make smarter benefits decisions, negotiate better rates, and lower healthcare costs for their workforce.

Common Questions

Frequently Asked Questions

What is the Price Transparency Project?

The Price Transparency Project is a Payerset initiative that publishes data-driven analysis, policy explainers, and practical playbooks on U.S. healthcare price transparency. It helps hospital finance leaders, analysts, employers, and researchers turn payer and hospital machine-readable files into actionable insight for reimbursement benchmarking and contract negotiations.

What is healthcare price transparency?

Healthcare price transparency refers to federal rules that require health plans and hospitals to publicly post the rates they have negotiated for medical services. The Hospital Price Transparency rule (effective 2021) and the Transparency in Coverage rule (effective 2022) together make previously confidential negotiated rates available online as machine-readable files.

What is the Transparency in Coverage (TiC) rule?

Transparency in Coverage (TiC) is a federal rule that requires health insurers and group health plans to publish their in-network negotiated rates and out-of-network allowed amounts in machine-readable files (MRFs). The files are updated monthly and cover essentially every commercial plan, making them the most comprehensive public source of payer-negotiated rate data.

What is hospital price transparency?

Hospital price transparency is a federal rule, effective January 1, 2021, that requires every U.S. hospital to publish a machine-readable file of standard charges (including gross charges, discounted cash prices, and payer-specific negotiated rates) alongside a consumer-friendly display of shoppable services. CMS has progressively tightened the file format and enforcement requirements since.

What is a machine-readable file (MRF)?

A machine-readable file (MRF) is a structured data file, typically JSON or CSV, that payers and hospitals publish to satisfy price transparency rules. MRFs list negotiated rates by payer, provider, and billing code, but their large size, inconsistent schemas, and data-quality issues make them difficult to use without significant normalization and enrichment.

How is price transparency data used?

Organizations use price transparency data to benchmark reimbursement against competitors, prepare for managed care contract negotiations, model pricing strategy, evaluate market access, and build healthcare analytics products. Because the data reveals the rates payers and providers have actually agreed to, hospitals, employers, and health-tech teams can negotiate and plan from evidence rather than guesswork.

The market only works when prices are visible

Join the practitioners, policymakers, and advocates building a transparent healthcare system.