By Christine Cooper

Healthcare professionals face increasing pressure on both clinical and administrative fronts, as employers and self-insured plans continue to confront rising healthcare costs. Historically, providers gained tactical and strategic advantages through network negotiations that included fragmented pricing and opaque fee structures. In that and other ways, the combination of very broad networks which include most providers, and the No Surprises Act in-network requirements have contributed to growing financial strain - leaving plan sponsors with limited control over costs.

The Healthcare Price Transparency Executive Order signals a decisive shift. It forces providers and insurers to disclose actual negotiated prices, offering a level of visibility previously unavailable. For healthcare professionals involved in hospital administration, contracting or benefits design, this policy change represents more than compliance—it reshapes the healthcare pricing ecosystem. And, interestingly, the main beneficiaries of transparency could be providers whose charges are consistently below the median of all providers for the same services.

Addressing persistent transparency challenges
Previous price transparency efforts repeatedly fell short of their goals. Many hospitals complied only partially, disclosing fragmented pricing data obscured by convoluted contracts and rate variability. Without a standardized, enforceable framework, this patchwork approach added to existing inefficiencies.

Employers had no reliable way to benchmark costs or question rates. Self-insured plans lacked the clarity needed to structure cost-effective benefits. Patients, meanwhile, faced opaque billing processes, undermining trust in providers and claims payors alike.

The new Executive Order addresses these shortcomings head-on. It mandates clear, itemized price disclosures in a standardized format and backs this requirement with meaningful penalties for noncompliance. By establishing firm reporting standards, it offers precise, actionable data. The goal is a more transparent, accountable and efficient healthcare marketplace.

Implications for healthcare professionals
The Executive Order introduces immediate and significant changes. One of the clearest shifts will occur in contracting and negotiations. Hospitals and health systems, long accustomed to confidential rate-setting, now face an environment where pricing information is fully public.

Transparency may compel some healthcare providers to critically assess how their pricing holds up under public and competitive scrutiny especially where their charges are far in excess of the median for the same services in the same location. Transparency may also enable other health care providers to identify an opportunity to increase their prices where their charges are less than the median. A study by Turquoise Health showed convergence of prices where providers who have the highest prices reduced rates and those with the lowest prices increased rates – so that prices for the same service are becoming more similar across providers. That study observed that trend across 82.8% of the markets studied.

Similarly, a study by FAIR Health suggests that, after the No Surprises Act, an ever larger percentage of claims are “in-network” – with perhaps the exception of providers of mental health and substance use disorder services - increasing the percentage of medical expenses subject to the lower PPO point of purchase cost sharing. In-network providers will likely use this increased utilization in their bargaining over future fees.

Employers, particularly those managing self-insured plans, will use this transparency to benchmark fees, flag excessive markups and pursue reference-based pricing strategies. Healthcare professionals leading payer negotiations must be ready to justify cost variations and engage with more informed, data-driven employer partners.

Additionally, the order may reshape employer-provider relationships by increasing demands for value-based care arrangements. Transparent pricing makes it easier for employers to spot cost discrepancies between different care settings—such as hospitals versus ambulatory surgery centers—and question whether higher costs align with measurable clinical value.

As a result, providers may be required to reassess site-of-care pricing, defend higher-cost settings based on quality outcomes or collaborate with employers to develop shared savings models. Healthcare professionals should anticipate closer scrutiny of referral patterns, particularly in vertically integrated systems where financial and care delivery interests intersect.

Opportunities to strengthen care delivery and cost management
Healthcare professionals are well-positioned to turn price transparency mandates into actionable strategies that improve both care delivery and financial management. Operational leaders can use newly disclosed pricing data to analyze internal cost structures, pinpoint inefficiencies and maintain competitive pricing.

Physicians and clinical teams must also push for the integration of meaningful quality metrics alongside price data, ensuring that care isn’t reduced to a commodity. Meanwhile, where these transparency tools are deployed, employees may be empowered to make informed care choices, particularly within high-deductible health plans. Together, these efforts bridge regulatory compliance with practical cost control and quality improvement.

Overcoming industry challenges
Implementing the Executive Order’s requirements will present some operational hurdles. Compliance teams have new administrative tasks, including the need for detailed documentation and standardized price reporting. Some providers may hesitate to fully disclose negotiated rates, amid growing concerns about losing market leverage or triggering downward price pressures.

One effective strategy is to align with experienced third-party administrators and benefits consultants. These partners can help interpret complex pricing data, support renegotiation efforts with providers and integrate transparency initiatives into broader benefits strategies—ensuring cost control is balanced with employee engagement and plan sustainability.

Turning compliance into competitive advantage
A defining feature of the Executive Order is its strong enforcement framework. Compliance is no longer optional or symbolic—regulators will actively identify non-compliant hospitals, issuing financial penalties and tightening oversight.

By demonstrating value, optimizing price competitiveness and integrating clear quality metrics, healthcare organizations can move beyond defensive cost control toward proactive, value-based collaboration. Forward-thinking professionals can leverage transparency to build strategic partnerships with employers and insurers.

In today’s environment, price visibility is non-negotiable. Those who adapt quickly—embracing transparency as a strategic tool rather than a regulatory hurdle—position themselves to not only meet new requirements but to also thrive in a more competitive, accountable healthcare market.

About the author: Christine Cooper, founder and CEO of aequum LLC, is a transformative leader in the healthcare industry who is recognized for her pioneering spirit, dedication to positively move the needle for constituents in the self-insured community and assist and defend plans and patients. Cooper continues to bring technological advancements to the market space and has assembled a tech-driven team that effectively partners with TPAs, insurers, medical cost management companies and stop-loss carriers throughout the country.