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:

1. 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.
   
   
2. 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.
   
   
3. 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.
   
   
4. 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.

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. 

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.  

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.