Healthcare costs traditionally have been a source of major stress for businesses and employees alike, and we’re seeing that pressure increase. With healthcare costs expected to rise by nearly 8% in 2025, employers are grappling to balance costs with fulfilling obligations to employees. Instead of one-size-fits-all solutions, they’re looking for insights to make smarter decisions about healthcare spending. For healthcare brokers, this shift presents a real opportunity to stand out.
At Claritev, we’re seeing a growing focus on compliance, fiduciary responsibility and analytics. Price transparency data is going to be a particularly important area for brokers next year, with a focus on understanding how data analytics and price transparency converge.
But price transparency isn’t just about checking a compliance box—it’s a game-changer for brokers who want to stay ahead. By helping employers make sense of complex data, brokers can uncover opportunities to help their clients identify cost-effective providers, negotiate better direct contracts and optimize their networks.
The Roadblocks to Price Transparency
While at first glance price transparency might seem simple enough—just gather the numbers from machine-readable files (MRFs) and share them—brokers know how complicated it actually is. MRF data includes details like provider names, procedure codes, negotiated rates, allowed amounts for out-of-network services, and plan details.
With MRFs, this information becomes publicly available in a more usable and actionable format, revolutionizing how businesses evaluate pricing strategies, drive reimbursement rates, and gain a competitive edge. But brokers can’t be expected to sift through billions of machine-readable files (MRFs) and validate these rates on their own. The high volume of data, the variety of sources, the complexity of pricing structures, the need for real-time updates, data privacy concerns, and other issues, collectively turn Transparency in Coverage into a significantly big data challenge.
Third-party tools will play a crucial role in providing solutions as MRF guidelines evolve. While it’s true your organization can access these files, it is incredibly difficult to turn the available data into actionable insights. You must acquire, clean, and complement the data to make it ready for in-depth analytics.
The reality is that employers need brokers who can bridge the gaps and simplify the complexity. Without the right tools, brokers are left piecing together answers from incomplete and inconsistent data, an approach that doesn’t meet modern employers’ needs.
Turning Data Chaos into Actionable Insights
For brokers, tackling the challenges of price transparency means leveraging the latest tools that enable actionable insights, like Claritev’s PlanOptix. Integrating big data techniques into healthcare transparency efforts can yield valuable insights for improving patient care, optimizing healthcare processes, and driving informed decision-making.
PlanOptix is designed to compare networks, contract rates and health payors to allow clients to select ideal health plans and networks.
• Identifies cost-effective providers, allowing you to create targeted cost-containment programs
• Tools to benchmark and better understand market position to differentiate
• Provides insights empowering clients to negotiate better direct contracts and customize deals to win and retain business
As Business Group on Health notes, “Access to information about the price and quality of health care items, services and providers can help payers build better provider networks, plan designs, and derive more value for their health care spend…Employers and other payers have worked in earnest to comply with these requirements, but the results are extremely large data sets and often not suitable for plan sponsor or consumer-facing direct comparison without substantial third-party analysis and have a number of other shortcomings.”
So, while this has traditionally helped payers, this is where tools like PlanOptix now provide real value to brokers. PlanOptix offers brokers a comprehensive look at network performance, highlighting areas where costs can be reduced and benefits improved. It simplifies identifying inefficiencies and helping plans align with client goals.
Rethinking the Broker’s Role in the Age of Transparency
More than ever, price transparency and smarter use of data are reshaping what it means to be a broker. We often see brokers asking, “What can we do differently for next year?” That’s when they begin to look at plan performance, review data, analyze trends, and consider options like evaluating new plan designs and implementing point solutions to address employer needs. But employers have moved beyond the once-a-year check-in during open enrollment. They’re looking for year-round partners—advisors who can use price transparency solutions to help them stay ahead.
The message is clear: brokers who adopt tools that provide actionable insights can give their clients the edge they’re looking for. While both price transparency data and claims data are used in healthcare to understand costs, price transparency data focuses on the listed, negotiated prices for medical services from payors and providers, while claims data reflects the actual costs billed and paid for services rendered to patients, including information on diagnoses, procedures, and payor details based on submitted insurance claims; essentially, price transparency data shows what a service “should” cost, while claims data shows what it “did” cost in a specific patient encounter. Price transparency data has perpetual applications. You can use this data for market research, negotiation positioning, market expansion, pricing new items and services, surfacing it alongside other data, and more. It is detailed down to the payor and provider level, making it a useful tool.
Becoming the Innovative Partner Employers Rely On
The future of healthcare brokerage isn’t just about crunching numbers or meeting regulatory requirements. Employers are under immense pressure from rising costs, tighter regulations, and growing employee expectations. They need brokers who proactively identify trends, uncover unseen inefficiencies, and don’t just understand the data but can transform it into strategies that solve problems and deliver results.
This is the critical role brokers play in driving change and innovation. The time to act is now. Brokers who rise to the occasion will strengthen their relationships, grow their business, and shape the future of healthcare—one client at a time.
