Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships. At the same time, unprecedented volumes of pricing data are becoming available, offering health systems a new source of insight — and leverage.
During a June 9 webinar hosted by Becker’s Payer Issue in collaboration with PurpleLab, leaders from Payerset, PurpleLab and Forvis Mazars outlined how health systems can use price transparency data to improve contract negotiations, support market expansion strategies and prepare for upcoming changes in drug pricing rules.
Here are four key takeaways:
Note: Quotes have been edited for length and clarity.
- Price transparency data as a strategic tool
While many health systems initially saw price transparency mandates as a compliance burden, the data now holds strategic value.
“We’re bringing together the most comprehensive price transparency data and all-payer claims data so that we can triangulate contract data with real-world claims,” said Jacob Little, Chief Customer Officer and Co-founder of Payerset. “This is the first solution of this scale.”
- Proactive benchmarking beats reactive negotiations
Heather Parker, Director of healthcare strategy and finance at Forvis Mazars, emphasized the importance of benchmarking rates before payers force the issue. She shared a case in which a hospital was surprised by a payer request for a 6% reimbursement decrease.
“We used claims utilization data to look at the full spectrum of their contract,” Parker said. “Yes, in that certain service line, that payer was disadvantaged. But when you looked at the contract in aggregate, that was not entirely true.”
With better data and support, the health system reversed course and ultimately secured a modest rate increase.
- Data is only as good as your understanding of it
Having access to data is one thing — knowing how to use it is another. Many health systems are overwhelmed by the volume and complexity of payer-posted pricing files.
Through partnerships with companies like Payerset and PurpleLab, Parker’s team leverages utilization data and contract logic to strip out irrelevant “ghost rates” and focus on actual paid rates for real services. This makes the data actionable for decision-making, not just informational.
Amy Crowe, Vice President of go-to-market at PurpleLab, said, “We’re looking at enhancing [health system performance] with the combination of claims data and price transparency.”
- Clarity on the ‘black box’
The next major wave in transparency will involve drug pricing. A new schema for drug price data is expected in October 2025, with enforcement starting in early 2026.
Parker added that her clients are eager for clarity in this space, especially as they struggle with mismatches between acquisition costs and reimbursement. “It’s the black box area,” she said. “Our clients are very excited for this [drug pricing] data.”
Bottom line for health system leaders
As pricing data becomes more accessible and accurate, payers are already using it to shape reimbursement discussions. To avoid being caught flat-footed, health system executives must prepare now.
Leaders who invest in data readiness today will be better positioned for fair contracts tomorrow.
