News & Updates

Payors are Using Transparency Data to Their Advantage: Providers, Are You?

Wed, 20 May 2026 16:54:12 GMT

The goals of price transparency under the Trump administration have been pretty straightforward. Ultimately, the aim is to help patients save money on healthcare.

But reality has fallen short of the intent for several reasons. For one thing, Providers and Payors have complied with transparency requirements inconsistently, and even when pricing data is released, it’s presented in massive, highly technical files that are impractical for most people to interpret. Additionally, it’s nearly impossible for consumers to get an apples-to-apples comparison of the costs of care across medical offices and the coverage options available. As a result, the financial relief envisioned for patients has not yet materialized.

In an ironic twist, reporting from KFF Health News suggests that the primary beneficiaries of price transparency have been Payors. KFF quotes Eric Hoag, an executive at Blue Cross Blue Shield of Minnesota, who acknowledged, “We use the transparency data to make sure that we are competitive, or, you know, more than competitive against other health plans.”

It seems that across the Payor industry, price transparency data has become a key tool for benchmarking and negotiation. Analysts at firms like McKinsey & Company and Forvis Mazars are tracking how Payors are using this data to compare reimbursement across markets, enabling them to improve contracts and reduce intelligence gaps. It’s been estimated that as many as 9 out of 10 Payors are leveraging transparency data today to gain an edge in negotiations. Meanwhile, a Dec. 30, 2025, MGMA Stat poll found that relatively few, as low as 18%, of medical groups use this data in negotiations. This contrast highlights a stark disconnect between the policy intent and how things are actually playing out in the market.

In other words, while consumers have faced challenges in using this data and most Providers have yet to engage with it, sophisticated Payors are using it to strengthen their market position. Which begs the question, why are Payors realizing the benefits sooner than Providers? As we’ve discovered, it’s in part thanks to the role third-party vendors are playing in shaping how this data is used across the market.

Playing Both Sides

Many vendors in the Price Transparency space sell access to portals with uncurated versions of this data to both Payors and Providers. While this could be perceived as a fair and neutral approach, the reality is that Payors are the ones who come out on top. This is not simply because Payors have been more willing to engage, but rather because, when vendors play both sides, Providers face an inherent disadvantage for a number of reasons.

Transparency Breakdown: The underlying intent of this legislation is transparency (it’s even in the bill's name). The aim was to empower patients and (indirectly) Providers to have more insight into the way healthcare is priced and paid for. Payors already had much of this information, but now they can access it in greater detail. By further empowering them with this intelligence, vendors weaponize this data in a way that goes against the spirit and intent of the law. Rather than creating balance, Payors stay a step ahead, continuing to set the terms of negotiation while Providers lag behind.
Conflicts of Interest: A vendor cannot fully advocate for a Provider while also advising Payors on how to optimize reimbursement strategies. At best, their incentives are split. At worst, they will help one side outmaneuver the other using the same intelligence. Providers need partners whose success is linked to their own, and who have only their best interests in mind.
Communication Leaks (Even Unintentional Ones): Even if there are strict rules of engagement about data sharing, it’s inevitable for insights to bleed across clients. Over time, vendors develop an understanding of how their clients think and behave under pressure. They gain an awareness of negotiation tactics. Inevitably, what a team learns about one client will seep into what it communicates to another.

Price Transparency was intended to level the playing field between Payors and Providers so they could engage in informed discussions about reimbursement, leading to more transparent and just pricing of healthcare services. When vendors play both sides, they only strengthen the Payor’s position, reinforcing, if not furthering, the advantage already at play.

Putting Transparency Data to Work for Providers

This is why After Transparency has chosen a different approach, and we’ve taken a firm stance against working with Payors. We see how this data is poised to either set Providers back further or put them on a path to financial stability, and we choose the side that empowers their financial stability.

For the first time, Providers can access a clear view of the pricing landscape that Payors have used for years to their advantage. Providers must seize this moment, in partnership with a vendor who’s on their side alone, so they can finally have a fair chance in negotiations.

As Blake Madden of Hospitalogy puts it, “Payor Price Transparency Data is very useful in helping your hospital understand what Payors know about YOUR organization.” He’s right. Payors already have so much market insight at their disposal. Price Transparency Data is a huge opportunity for Providers to level set in a way that has yet to be fully realized.

With After Transparency, Providers can access what they need to be successful in negotiations, new market analysis, and strategic planning evaluations. And they can trust they’re working with a partner free of any conflicts of interest. As Pete Brumm, Founder of After Transparency, explains, “We’re here to equip Providers with the necessary analytic support that enables strategic growth in a way that’s finally fair and equitable.”

We’re putting defensible analysis within reach of Providers and only Providers. If you’re a Provider interested in learning more, then let’s talk . We’re here to help you win.

Why Price Transparency Matters Now: How Providers Can Face Regulatory Pressure and Market Shifts with Confidence

Tue, 05 May 2026 17:37:19 GMT

Today’s Providers are navigating a whirlwind of challenges, with changes coming fast and on multiple fronts. Government policies, such as the Big Beautiful Bill, are reshaping how care will be delivered and paid for. At the same time, longer-term pressures, such as rising Medicare costs and an influx of aging Baby Boomers , are poised to reshape the future of healthcare, with effects still unfolding.

One critical capability at the center of these evolving conversations is Payor Price Transparency Data . Providers who dismiss it as a short-lived government sideshow risk overlooking a huge opportunity. Meanwhile, those who invest in understanding how to interpret and apply this data will be well-positioned to adapt and compete more effectively as the changes persist.

Across our client base, we’re seeing what’s possible when this data is leveraged with the right partner who can extract meaningful insights. One organization achieved a 240% increase in reimbursement from a key Payor over two years. Another was able to confidently invest in new technology, knowing stronger reimbursement and expanded service capability would follow. A large health system narrowed a reimbursement gap with a major competitor from 9% to 5%. These aren’t exceptional wins; they’re indicators of what’s possible when this data is effectively put into practice.

We’re seeing it play out time and again for our clients: Providers who take Payor Price Transparency Data seriously are putting themselves in a position to win. As financial pressures intensify from policy shifts, rising costs, and increased demand, the need to act will only grow.

In this post, we’ll discuss some of the forces driving this urgency and consider why now is the time for Providers to act , especially those who haven’t yet begun to use the insights from this data. The opportunity to take greater ownership of your financial future is here, but it won’t wait around forever.

Regulatory Changes and Rising Penalties

Federal enforcement of transparency rules has been spotty in the past. But that appears to be changing. Recent legislation, including the Lower Costs, More Transparency Act , signals a shift toward stricter implementation and higher penalties for noncompliance, in the ballpark of millions of dollars. At the same time, many states are imposing their own measures, with dozens of laws already taking shape to increase accountability for healthcare pricing. Check out the National Academy for State Health Policy tracker , which identifies laws enacted in real time, including 48 laws in 32 states related to transparency at the time of this post.

Additionally, the Big Beautiful Bill introduced funding cuts that will significantly impact hospitals' bottom lines, particularly those serving Medicaid patients. These safety net hospitals can expect to lose hundreds of millions in supplemental Medicaid funding and will need to prepare for a difficult reality. The unfortunate challenge is that state budgets are limited, and not all hospitals have enough privately insured patients or negotiating leverage to make up the difference on the commercial side (or so they think).

This is where Payor Price Transparency Data can offer a meaningful advantage. For the first time, Providers have access to clear market intelligence and insight into how their rates compare with others. This information can fundamentally strengthen a Provider's position at the negotiating table by showing where reimbursement is misaligned, calculating the gap, and helping to build the case for a credible rate increase. In an environment where margins are sure to tighten, that kind of visibility can be critical to long-term sustainability.

In practical terms, hospitals must be more strategic than ever in how they operate, partner, and advocate. The stakes are high for these organizations, many of which serve as a critical access point for healthcare in their communities.

The Shift to Medicare Advantage

Healthcare leaders are also preparing for a major demographic shift, often referred to as “peak Medicare.” According to the U.S. Census Bureau, by 2030, 1 in 5 Americans will be age 65 or older . This means that over the next 3–5 years, there will be a surge of patients aging out of employer-sponsored insurance and enrolling in Medicare, many of whom will likely choose Medicare Advantage plans.

This shift will inevitably create a financial challenge for hospitals. Since Medicare Advantage plans typically reimburse at lower rates than commercial insurance, the financial pressure will only build for hospitals already operating on thin margins. With this impending shift in mind, health systems must begin (or already have begun) reassessing their Payor mix and making difficult decisions about participation in certain plans.

This again is where Payor Price Transparency Data can help at the negotiating table. Historically, Payors have pushed Providers to negotiate in silos, separating commercial plans from Medicare Advantage rates. But hospitals expecting to lose money on Medicare Advantage patients will likely need to secure higher reimbursement rates on the commercial side to make ends meet.

Payor Price Transparency Data gives Providers clear visibility into how their reimbursement compares across their market. Instead of negotiating in the dark, Providers can identify where rate adjustments are most critical and approach negotiations with data-backed confidence.

Just as importantly, it exposes the limitations of today’s fragmented negotiation model. Past ways of operating may be forced to change, with a pivot toward holistic, enterprise-level conversations that reflect the total value and sustainability of the Provider-Payor relationship. Only time will tell. But the entrance of Payor Price Transparency Data into the equation will be a powerful lever for Providers ready to use it.

The Need for Speed and Smarter Infrastructure

All of this is happening at once: regulatory pressure, reimbursement compression, and demographic changes. The Providers who navigate this moment successfully will be those who plan proactively and adapt in real time. That will require more than access to data. It’ll also require the ability to use it effectively.

It’s easy to see how a growing divide could emerge in healthcare. On one side will be the organizations investing early in partners and infrastructure to leverage Payor Price Transparency Data, both now and in the future. On the other side are those who still view this data as a regulatory burden rather than a strategic asset. Abraham Gage , SVP and Chief Strategy Officer at UofL Health , speculates that Payor Price Transparency Data may soon become “as ubiquitous as AI,” with early adopters seeing measurable advantages.

As After Transparency co-founder Jon Bruser notes: “The challenge we most often see is with adoption—most organizations don’t have the time, capabilities, or internal alignment to integrate and use this data fully. That’s where the real opportunity—and the real risk—lies.” Even Providers that recognize the value of this data often struggle with execution. The data is complex. The files are massive. And the insights are not always obvious to the untrained eye.

That’s what makes this moment important and why the stakes are higher than they may seem. As the pressures outlined in this post continue to build, the question will no longer be whether Payor Price Transparency Data matters, but whether it’s being used effectively enough to keep pace. The Providers that answer that question decisively will be the ones shaping their financial future, rather than reacting to it.

That’s also why the right partner in this endeavor is critical. After Transparency helps Providers move beyond raw data to real strategy, equipping hospitals to strengthen negotiations, evaluate market opportunities, and plan with confidence, even in an increasingly complex environment. Keep in mind that not all vendors offer a truly valuable partnership, so if past experiences with data vendors have fallen short, it’s worth taking a second look at what can be accomplished when this data is fully activated.

If you’re ready to get started or simply want an informed perspective on where to begin, connect with our team today. Discover the After Transparency difference. Reach out to us here .

Note: After Transparency is honored to be a part of Hospitalogy's "10 Healthcare Consulting Reports Worth Reading.” Blake Madden originally shared aspects of this post, “After Transparency: Unleashing the Black Box,” in August 2025, in his Hospitalogy newsletter, which you can subscribe to here .

How Large Health Systems Are Using Payor Price Transparency to Inform Strategy, Negotiations, and Expansion

Mon, 30 Mar 2026 17:24:42 GMT

Payor Price Transparency data has quickly become one of the most powerful (and to date, underutilized) strategic assets available to health systems. While the value of this data is often discussed in terms of contract negotiations, the potential extends far beyond that.

To better understand how forward-thinking health systems are putting this information to work, we sat down with Abraham (Abe) Gage , SVP, Chief Strategy Officer at UofL Health in Kentucky. In partnership with After Transparency, Abe and his team have begun leveraging payor transparency data to strengthen negotiations, evaluate market expansion opportunities, and support strategic investment decisions.

The takeaways from this conversation highlight how organizations can start using transparency data to drive meaningful financial and operational impact.

As Blake Madden, healthcare strategist and founder of Hospitalogy, notes: “Given the scale and level of volumes in all kinds of specialties and service lines, hospitals and health systems hold the biggest opportunity in leveraging Payor Price Transparency data. Rate negotiation is really just the beginning. Over time, as systems move from siloed thinking toward an enterprise-wide mindset, we’re going to see strategy, finance, and even marketing teams infuse transparency data over a broad range of use cases.”

Our conversation with Abe confirmed exactly that. Below are several high-impact areas where health systems like UofL are already unlocking value.

1. Strengthening Contract Negotiations

For many Providers, the most immediate opportunity lies in Payor contract negotiations . Historically, negotiations have been shaped by a Provider's limited visibility into market rates, forcing them to rely heavily on Payor assertions about network pricing.

Transparency data changes that dynamic. As Abe explains: “Payor Price Transparency data is the most valuable and transformative source of competitive intelligence available to health systems today—and a critical asset as hospitals work to stabilize financial performance and plan for the years ahead.”

With access to After Transparency’s data and services and the strategic insight and analytical support of our team, UofL can now benchmark its reimbursement rates against competitors and validate Payor claims during negotiations. UofL can finally have truthful, meaningful conversations with its Payors based on facts .

For example, one Payor repeatedly told UofL it was already receiving the highest reimbursement rates within its Kentucky network. But after an investigation and review by Abe and After Transparency, this assertion was debunked.

Armed with actual market data, including specific reimbursement figures for nearby hospitals, UofL was able to challenge the claim and reframe the negotiation around verified facts. The result was a more productive line of conversation and measurable progress toward a fair reimbursement.

With After Transparency’s help, UofL Health has reduced a reimbursement gap with a key competitor from 9% to 5% .

2. Evaluating New Market Opportunities

Payor Price Transparency data is also proving valuable for health systems considering expanding services or entering new markets . Opening a new clinic or service line requires significant upfront investment, and understanding reimbursement dynamics in advance can help determine whether the move is financially viable.

UofL has used After Transparency’s data to evaluate opportunities such as free-standing imaging centers in new locations. By analyzing reimbursement trends in a target market, Abe’s team can now determine:

What Payors are currently reimbursing for specific services
The specific rates in that geography
Whether proposed contracts will cover operational costs

This insight has allowed the UofL contracting team to approach Payors with clear expectations regarding the reimbursement rates required to sustain a new facility. Rather than accepting low initial proposals, the team can negotiate from a position of informed confidence.

As a not-for-profit health system, UofL Health isn’t seeking excessive margins; it simply needs reimbursement levels that allow it to sustainably deliver care. Payor Price Transparency data, when paired with the right analytics partner, like After Transparency, will ensure those financial assumptions are grounded in real market conditions.

3. Evaluating ROI for Expenditures and Investments

Another emerging use case involves strategic investments in quality programs and service-line development . This came into play for UofL Health as they weighed the pros and cons of participating in the BlueCross BlueShield Distinction Programs.

Through analysis conducted with After Transparency, UofL Health identified meaningful reimbursement differences between hospitals that participated in these programs and those that did not. These insights allowed them to begin evaluating whether participation would generate a meaningful return on investment for their hospital.

The team was able to model several critical variables:

Upfront and ongoing program participation costs
Expected patient volumes tied to Payor programs
Reimbursement deltas associated with distinction status

By simulating these scenarios, UofL Health can project the potential financial return of participating in quality programs before making significant operational commitments. Many times, once they run the numbers, it’s a no-brainer for them to move ahead with these initiatives.

Why This Matters Now

These types of insights are especially important in today’s financial environment. Large health systems, and particularly safety-net and not-for-profit organizations, must carefully allocate limited resources while continuing to expand access to care.

Better intelligence about reimbursement markets allows leadership teams to make those decisions with greater confidence. Instead of relying on assumptions or incomplete information, organizations can now model financial outcomes using real market data.

The After Transparency Approach

At After Transparency, we’ve seen firsthand how many health systems are approached with solutions promising operational improvements or revenue gains, often requiring large commitments before any value is proven. Our approach is different.

Our strategy is to start small, show value, and scale over time. Rather than asking organizations to overhaul their strategy overnight, we start with a focused, high-impact use case. This might involve a single Payor, service line, geography, or contract negotiation.

By concentrating on one measurable opportunity, health systems can quickly see tangible results. On average, organizations working with After Transparency experience greater than 10x ROI from their initial use case . From there, the data foundation can expand.

As After Transparency co-founder Jon Bruser explains: “The end goal is a system-wide approach to optimizing Payor reimbursement data, which will result in cost savings, streamlined operations, and improved care quality. As the value you see from After Transparency grows, so will our partnership.”

Using this initial analysis as a baseline, After Transparency will:

Establish a robust Payor reimbursement dataset that covers more of your business
Advise you on how to utilize this data to drive better decision-making and financial outcomes
Expand data applications across other markets and business units

And as Blake Madden of Hospitalogy puts it: “Over time, we will see countless use cases emerge for transparency data as provider organizations move from siloed to enterprise-wide strategic thinking. Don’t get left behind.”

If you’re ready to explore what’s truly possible or simply want an informed conversation about the possibilities available to your organization, connect with our team today. Come discover the After Transparency difference. Reach out to us here .

Note: After Transparency is honored to be included in one of Hospitalogy's "10 Healthcare Consulting Reports Worth Reading.” Blake Madden originally shared aspects of this post in October 2025 in his Hospitalogy newsletter, which you can subscribe to here .

While you’re at it, join the thousands of healthcare professionals who already get expert analysis on healthcare M&A, strategy, finance, and markets. Subscribe to Hospitalogy, created by Blake Madden, at hospitalogy.com .

Welcome Page Thompson: A Champion for Providers Joins After Transparency as SVP of Sales

Mon, 23 Mar 2026 13:30:01 GMT

After Transparency is excited to welcome Page Thompson as our new Senior Vice President of Sales . Page joins the team with a long-standing passion for technology, startups, and the providers and caregivers who power our healthcare system.

Over the course of his career, Page has helped organizations leverage technology to streamline operations and reduce administrative burdens, giving healthcare professionals more time to focus on patient care. Page now brings his experience to After Transparency, focused on helping providers leverage Payor Price Transparency data to strengthen their financial position and continue delivering essential care.

Seeing Healthcare from Every Angle

Early in his career, Page’s passion for technology startups brought him to Nashville, TN, to join a young technology company, where he spent eight years helping the business grow and learning from an incredible group of colleagues and mentors.

Living in Nashville eventually led him to the healthcare industry, one of the city’s defining sectors. Through a series of connections, Page joined another early-stage company, Change Healthcare, where he became employee number three and stepped into the role of Vice President of Sales. His time with Change reinforced an idea that has guided his career ever since, which is, technology can play a powerful role in improving healthcare .

Over the years, Page continued working at the intersection of healthcare and technology, holding leadership roles across sales, strategy, and operations. At UL Workplace Health & Safety, he helped healthcare organizations adopt clinical practice management and EMR solutions. After that, he worked with Infinite Leap to equip health systems with technologies designed to improve patient flow, asset management, and staff security. But one chapter of his career, in particular, fundamentally reshaped his perspective on healthcare. It was formative not only because of the role itself, but because it placed him in a unique position during a season of extraordinary challenges in the healthcare world.

A Defining Chapter: Supporting Caregivers

In 2017, Page joined Premise Health, one of the country’s leading providers of employer-based healthcare services. For Page, the role was a shift. Instead of selling solutions into healthcare organizations, he moved into operations, overseeing clinical teams and managing healthcare services delivered directly to employees.

Then came 2020 and the COVID-19 pandemic, which reshaped healthcare delivery worldwide. Page found himself in the midst of a defining moment, supporting clinicians and caregivers as they navigated brand-new, unthinkable challenges.

“I had always worked closely with providers, but this experience gave me a completely different perspective,” Page says. “The clinicians and caregivers I worked with during that time were selfless. They showed up every day to take care of people. They truly were angels on earth.”

When the dust settled, Page took time to reflect on what he’d learned. A key takeaway was how the healthcare system asks a tremendous amount of providers and too often gives them little support in return. This insight weighed heavily on him and changed how he approached work going forward.

Why After Transparency

For decades, healthcare providers have negotiated contracts with Payors without clear insight into how reimbursement rates compare across markets. They’ve had to establish essential reimbursement agreements without knowing the landscape of what they should or could expect. Not to mention making long-term strategic decisions around expanding lines of service, green-lighting joint venture initiatives, or brokering M&A plans with indeterminate financial terms. They’ve had to set all these plans in motion with only approximate budgetary figures.

To Page, this lack of transparency is just another example of how Providers are continually being asked to make important decisions without essential information, just as he observed during the pandemic. We have a system that expects providers to deliver exceptional care without providing the required resources they need to operate sustainably.

“They might receive a contract increase,” Page explains. “But they don’t know if it’s fair. They don’t know how their rates compare to others in the market. It’s impossible to make the best decision without the right information.”

Recognizing this disconnect (and wanting to be part of the solution) is a big part of what drew him to After Transparency. For the first time , thanks to Payor Price Transparency data and organizations like After Transparency, providers can access insights that reveal how reimbursement rates vary across markets and organizations. They can make plans based on accurate “to the penny” pricing data, not estimations. They can operate a more sustainable, profitable business while continuing to provide essential community care.

“When I learned about what Pete Brumm and the After Transparency team were building, it immediately resonated,” he says. “They don’t just give access to the data, as others do; they extract meaningful insights and truths that are hidden deep within the data and deliver it to the very people who need it most. This is information providers have needed for a long time, and I am proud to be a part of a team that is helping realize the vision of Payor Price Transparency to radically change the system for the better.”

A Perfect Fit

At its core, Page believes the mission of After Transparency is simple: empower providers with the knowledge they need to make better decisions. “As Schoolhouse Rock famously said, knowledge is power,” Page says with a smile. And in healthcare, that knowledge can have enormous implications.

Even helping a single hospital achieve better reimbursement would be meaningful. But Page sees the bigger vision. “What excites me most is the scale of the impact,” he says. “The intelligence generated through our transparency data and insights can help providers across the country make better decisions for their organizations and ultimately better serve the patients who depend on them.”

For Pete Brumm, founder of After Transparency, bringing Page onto the leadership team was a natural fit. “Page brings a rare combination of a startup mindset, deep healthcare experience, and a genuine passion for supporting providers,” Brumm says. “He understands the challenges caregivers face because he’s spent years working with them. We’re thrilled to have him join the team and help expand the impact of what we’re building.”

As Senior Vice President of Sales, Page will lead After Transparency’s efforts to partner with healthcare organizations nationwide, helping them unlock insights hidden in transparency data and strengthen their negotiating position with Payors.

For Page, the opportunity is deeply meaningful. “Caregivers dedicate their lives to helping others,” Page says. “We should be doing everything we can to make sure they’re paid fairly for the life-giving services they provide.” When providers succeed, the entire healthcare system is stronger. For Page and the team at After Transparency, that’s a goal worth building toward.

If you’re a provider interested in exploring how Payor Price Transparency data can have a meaningful impact on your organization, connect with Page and the After Transparency team today. Reach out to us here .

The End of Blind Negotiations: Why Providers Finally Have Proof and Power

Tue, 10 Mar 2026 21:47:55 GMT

Payor-provider negotiations have historically followed a predictable pattern. Providers have come armed with anecdotes, internal spreadsheets, and gut instincts, ready to push for the better rates they felt strongly were owed. Payors arrived with a smug disposition and proprietary market data the Provider couldn’t see. The scales of power were so obviously uneven. Payors had all the leverage, and they knew it.

When a Payor said, “This is a competitive offer,” Providers had little ability to challenge that assertion. Without comparative rate data, they were left to choose between accepting the terms or risking network disruption, patient loss, and financial instability.

Veteran negotiator Kelly Drosihn shared with Blake Madden of Hospitalogy how insurers have been known to stretch negotiations to the breaking point, with Payor executives only returning calls at 5:00 p.m. on the eve of Thanksgiving or Christmas, hoping to catch hospital leaders distracted or desperate to close the deal. Negotiations have often been treated like a game, with Payors having better information, more time, and less urgency to close.

One After Transparency client, the Family Practice Associates of Lexington (FPA), located in Central Kentucky, had to navigate this game for years and nearly lost everything in the process. Despite maintaining a full patient panel, they faced flat revenue and rising costs. The primary culprit for the disparity between patient volume and income was the low reimbursements they were receiving from their primary Payor, a large national insurance company.

Compared to the large health systems in their market, FPA was being drastically underpaid for the same procedures. And while they had long suspected this, they didn’t have the data to back it up. Every time they raised concerns, the Payor responded with the same refrain: You’re being reimbursed fairly. You’re in line with the market. FPA couldn’t prove otherwise, and the Payor seemed to be counting on that.

After years of stonewalling, FPA began considering the unthinkable: terminating the contract. Walking away from a major Payor meant sending patients elsewhere and risking more financial strain. But staying the course felt just as unsustainable.

Then FPA partnered with After Transparency, who helped them verify trends in their data that supported the extent to which they were being underpaid. They finally had access to clean, actionable reimbursement data that showed exactly how far below market their rates were. With that proof in hand, FPA was able to renegotiate its contract without a costly legal battle and ultimately secured a double-digit increase over two years on codes that were impactful to the practice. More importantly, they walked away empowered, with proof that even small providers can level the playing field when armed with the right data.

Payor Price Transparency Data is Changing the Game

FPA’s story is one that Payors don’t want Providers to hear, but it’s a new reality that Providers can’t afford to miss or ignore. Thanks to regulations enacted in 2023 and reinforced in 2025 , negotiated rates are now public, and Providers no longer have to be in the dark. For the first time, Providers can see what Payors are paying their competitors. They can negotiate with proof of their position.

But access to this data in its raw form is not where the advantage lies. These machine-readable files are massive and often messy. They have been known to exclude payments, fees, or other arrangements. Many are missing physician group identifiers. Others are formatted in ways that make meaningful analysis nearly impossible. This data is powerful, to be sure, but you still need to know how to use it correctly. That’s where having the right people and tools comes in.

As Hospitalogy summarized, “For the provider orgs working with the right people who know what they’re doing, they’re now realizing they’re sitting on a goldmine of dealmaking leverage for better rates with actionable data.”

Hospitalogy adds an important warning: “You NEED to incorporate payor price transparency data - and its future iterations - into your future strategy planning in order to future-proof your operations.”

Their urgency stems partly from the fact that Payors are already using this data in negotiations, and they’re counting on Providers not to. In a KFF Health News report, a Blue Cross Blue Shield executive openly acknowledged using transparency data to ensure their rates remain competitive with other health plans. And according to the Medical Group Management Association , “9 of 10 Payors use [this] data in negotiations with Providers.”

One surprising reality in this new world of data transparency is that many vendors positioning themselves as trusted advisors to Providers are also selling transparency data to Payors. They’re playing both sides, with no concern for how this alignment with Payors undercuts their Providers.

The After Transparency Difference

At After Transparency, we believe that who you align with matters. Our loyalty is to the organizations delivering care and to the financial sustainability that care requires. We will not support both sides of the same negotiation.

As Founder Pete Brumm has explained: “Every aspect of payor pricing data has historically been marked by secrecy, assumptions, and incomplete information. Providers have been kept in the dark and at a disadvantage. Our goal is to leave those black-box practices behind and replace them with transparent ones — where providers finally have reliable, defensible support.”

Since 2023, After Transparency has built its platform and client experience around disciplined data validation, pattern identification, and strategic application. Operating less like a data vendor and more like a managed care insights partner, we handle data complexity so Providers can negotiate with confidence, and finally win the reimbursement game.

Note: After Transparency is honored to be included in one of Hospitalogy's "10 Healthcare Consulting Reports Worth Reading.” Blake Madden originally shared aspects of this post in September 2025 in his Hospitalogy newsletter, which you can subscribe to here .

Leveraging Payor Price Transparency Data Is An Opportunity Providers Can’t Afford to Ignore

Thu, 26 Feb 2026 22:40:20 GMT

Following a CMS rule enacted in 2023 and reinforced in 2025 , Payors are now required to publish negotiated healthcare pricing data. Providers have a huge opportunity to utilize this data to strengthen their market position, but to do so, they need to be aligned with the right partner.

Blake Madden of Hospitalogy believes, “...effectively leveraging Payor Price Transparency Data may be the single highest-impact financial initiative a Provider organization can undertake.” His conviction stems from the reality that questions once impossible for Providers to answer are now within reach.

Do we have the highest (or lowest) ED rates in our state?
Is another hospital carving out inpatient procedures in our market?
A Payor is asking us to move to OPPS (APC) billing, but is that the right change for our practice?
Do my competitors discount HMO or ACA at the same percentage as I do?
Are carve-outs possible for this Payor in this state?

When used correctly, this data offers insight into competitive intel and real market rates, enables smarter decisions about service line expansion opportunities and risks, and more accurate rate setting. Providers of all sizes can now walk into a Payor contract renegotiation with unprecedented confidence (and data) to back their request for a more equitable reimbursement for services.

And yet, for most Providers, these opportunities remain largely untapped. At a baseline, many are still unaware that this data is accessible to them. Others who’ve heard of it haven’t attempted to pull any value from it. And for those Providers who have attempted to leverage this data, the experience has frequently fallen short of the promise, with lots of frustration and little payoff. Let’s consider why this has been the case and how After Transparency is working to address these issues:

Data integrity concerns : Problems and discrepancies still exist within Payor datasets. After Transparency consistently flags inconsistencies to oversight bodies. Providers understandably question whether they can trust what they’re seeing.
Overwhelming dataset sizes : We’re talking hundreds of trillions of data points, refreshed monthly. Downloading and unzipping a Payor file is one thing. Processing it has turned out to be another.

As highlighted by Hospitalogy , Abraham (Abe) Gage at UofL Health in Kentucky downloaded a transparency file from Anthem, unzipped it, queued up Python, and promptly crashed his computer. As it turns out, Abe’s story is not unusual. The infrastructure required to process these datasets is significant. Large systems may eventually adapt or acquire the data, but most independent hospitals and Provider groups cannot realistically invest the internal resources to then curate, rationalize, and interpret the ensuing data. It wasn’t until Abe partnered with After Transparency that his team was able to fully realize the potential of this data and see a positive impact for his organization.
Unreliable or conflicted vendors : Some data vendors oversell their capabilities, while others deliver incomplete or poorly normalized datasets. In some cases, Providers have spent hundreds of thousands of dollars investing in the promise of Payor Price Transparency Data without actionable results. Possibly more concerning, many vendors work both sides of the table. They’re enabling Payors in negotiations while marketing themselves as Provider advocates.

At After Transparency, we’ve taken a firm stance. We do not work with Payors. Our loyalty is to Providers and the patients they serve. We will not support both sides of the same negotiation.
The persistence of old negotiation tactics : Despite the new transparency push, many Payors still attempt to maintain the upper hand and act as if they’re the only side with all the intel. If Providers lack full confidence in their data—either due to an untrustworthy data vendor or poor in-house data capabilities—Payors can smell blood in the water, and often pounce at the opportunity to dominate. In response, many Providers revert to old patterns and concede under pressure, taking whatever the Payor will give them. After Transparency equips clients to enter negotiations with clarity and the assurance of a strong position.

With so many issues, the hesitation to persevere and make use of Price Transparency Data is natural. That’s why After Transparency was founded, and it’s why we take a different approach in supporting Providers.

The After Transparency Difference

We’ve invested the time, infrastructure, and expertise to solve these data challenges, so Providers don’t have to. Our efforts support both large health care organizations as well as smaller, independent practices (because we know they have more leverage than they think).

Hospitalogy asserts: “Payor Price Transparency isn’t just a regulatory requirement—it’s a massive opportunity. With trustworthy, actionable data and experts like After Transparency in your corner, Providers can finally level the playing field in negotiations and enterprise decision-making.”

As Pete Brumm , Founder of After Transparency, has highlighted, “we believe this data holds great value to identify market opportunities and reimbursement disparities. We’re here to equip Providers with data that is traceable, verified, and compliant, and the necessary analytic support that enables Payor negotiations that are finally fair and equitable.”

After Transparency delivers transparent and up-to-date contracted rate intelligence. We put defensible analysis within reach of Providers, large and small.

If you’ve been burned before, your hesitation is fair. But writing off Payor Price Transparency Data will be a costly mistake.

Note: After Transparency is honored to be included in one of Hospitalogy's "10 Healthcare Consulting Reports Worth Reading.” Blake Madden originally shared aspects of this post in August 2025 in his Hospitalogy newsletter, which you can subscribe to here .

I’m Coming Out of Retirement for a Fight Worth Taking On

Thu, 05 Feb 2026 19:42:24 GMT

For all of my career, Provider contract negotiations with insurance companies (Payors) have felt like a rigged poker game.

Payors, who play this game thousands of times a year, come to the table with a stacked deck and are able to see everyone’s cards. Meanwhile, Providers aren’t allowed to look at their own hand or see what cards others are holding. They’re expected to play blind. They can’t see how competitors are paid, and they can’t validate whether their rates are fair. Even when they attempt to improve their chances by purchasing data insights, they’re told the data is too sensitive to be shared, or worse, Payors swat aside their math as “wrong.”

This wildly lopsided imbalance isn’t accidental, and even in today’s data-rich environment, it persists. That’s why I’m thrilled to announce I’m joining After Transparency as Chief Strategy & Development Officer , because I believe they can finally give Provider leadership teams competitive market clarity, necessary comparative precision, and the edge they need in their contract negotiations.

The Monster We’ve All Been Fighting

Recent price transparency regulations have cracked wide open what was once the industry’s biggest secret: negotiated rates between Providers and Payors. Unfortunately, what followed these federal mandates has been chaos, rather than clarity.

A multitude of opportunistic tech and data vendors rushed to publish inadequate portals filled with averages, quartiles, and disconnected data points that lacked necessary context and curation.  

These vendors raised the hopes of earnest Providers, then left them to do the hard work themselves—filtering, validating, and defending numbers they didn’t fully trust and couldn’t confidently present in negotiations. It’s been a mediocre experience at best.

Without trust in their data, Providers lack the confidence to negotiate effectively. And uncertainty at the table is the fastest way to lose leverage with a Payor. On top of that, most transparency data vendors sell to Payors—enabling Payors to use this data during negotiations, putting Providers at an even greater disadvantage.

After Transparency is a Different Kind of Company, Which is Why I’m Fired Up

While other vendors were offering inadequate solutions, crashing their IT systems trying to download transparency files, or bragging about how much money they invested in parsing the Payor’s datasets, After Transparency had already built enterprise-grade infrastructure to ingest, analyze, and curate negotiated-rate data at extraordinary scale—we’re talking thousands of trillions of longitudinally connected pricing datapoints, refreshed monthly. And no, that’s not a typo.

That data is transformed into precise, apples-to-apples, market-specific intelligence, down to the penny, that Providers of all types can actually use. Providers don’t have to invest or scale a team of analysts to ingest and interpret Payor datasets. After Transparency delivers clear, defensible insights that can improve negotiations, optimize revenue, support strategic service-line decisions, and reveal how a Provider truly compares in their market.

Critically, After Transparency aligns exclusively with Providers. There’s no selling insights out the back door. No “leveling the playing field” by quietly empowering Payors. This tool is equipped with views even Payors don’t have access to, and After Transparency has no intention of undercutting Provider trust by sharing this important, proprietary intelligence with Payors.

Results That Change the Game

Simply having transparency data rarely moves the needle in reimbursement negotiations. What Providers need is trusted, curated intelligence with context. This information can then be shared, defended, and confidently used in negotiations.

Since 2023, After Transparency has built a company and customer experience that stands apart. Operating less like a data vendor and more like a managed care insights partner, they handle data complexity with discipline and care so Provider executives can focus on strategy, not analysis. Each data delivery is curated with the Provider's unique market-specific nuances in mind. It’s this customer engagement philosophy, aligned with a simplified delivery approach, that engenders Provider trust.

With access to this kind of intelligence, Providers are seeing remarkable results. Most have achieved significant results like the following:

45%–147% rate increases with major commercial Payors 
Immediate lifts starting at 4% , scaling to nearly 50% on strategic DRGs 
A 125% reimbursement increase in year one

Why This Matters

For decades, confidentiality clauses and black-box analyses protected the status quo. Providers went into negotiations with outdated claims data, anonymized benchmarks, or reports that couldn’t be shared without being dismissed outright.

Meanwhile, Payors could make claims that were nearly impossible to refute.

That imbalance has real human consequences.

When my mother was hospitalized near the end of her life, she was overwhelmed, not just by her health, but by uncertainty. She didn’t know if what she owed was fair, and she didn’t know how to find out. Worst of all, she felt powerless in a system that should have been clearer, fairer, and more humane.

Ironically, while my mom’s story is from the perspective of a patient, Providers feel a similar powerlessness as they face Payors at contract renewal time. And here’s the thing: if insurers were truly good stewards, the data would show it.

It would show that the best outcomes are rewarded,
Academic medical centers would be paid for the burden they carry,
Third party negotiators wouldn’t be locked out of negotiations, and
Contracts would be understandable and terminable.

But that’s not the world we’re operating in. Or at least, it hasn’t been. Thanks to new regulations, and After Transparency , things have the potential to change. Providers can identify where they’re leaving money on the table and walk into a negotiation with real data, not just guesswork, a hope, and a prayer.

An Underdog Worth Fighting For

I’ve always loved an underdog story. And the Provider–Payor power imbalance may be the biggest one in the U.S. economy.

Hospitals are blamed for rising costs, yet the real question is: Are Payors fairly reimbursing Providers and are these tactics spurring consolidation as a result?

After Transparency exists to answer questions like that with facts, not rhetoric. And we’re working to answer these questions for Provider groups of all shapes and sizes.

Transparency regulations aren’t going away. Enforcement is increasing, and After Transparency is leading the way in identifying when Payors are not compliant in their data submissions. Providers who act now can gain a meaningful advantage. Those who wait will be negotiating from behind–against both competitors and Payors who already understand the terrain.

I’m proud to join After Transparency and help Providers finally fight and win on equal footing. If you’re on the Provider side and want to talk about what transparency can look like when it’s done right, as well as the real impact it have in support of your organization -- I’d love to connect.