Combining Price Transparency and Claims Data Helps Employers Save on Health Care Costs

ORLANDO, FL, UNITED STATES, November 6, 2026 /CourierPR/ -- Employers seeking to make informed decisions about health care spending can benefit significantly from combining publicly available price transparency data with medical claims data, according to a new article published in Health Affairs Forefront. The article, co-authored by David Muhlestein and Elvira Makk Frid of Simple Healthcare, highlights the complementary nature of these two sources in understanding health care prices and identifying opportunities to reduce costs.

Medical claims data provides a detailed account of the care patients received and the amounts their health plans allowed. However, when considering a change in insurers or shifting care to a different site, employers need additional information that claims data alone cannot provide. Specifically, they require insight into what another insurer would have paid for the same care. This is where publicly available price transparency data comes into play.

Price transparency files reveal contracted rates for providers and services, including rates that may never appear in an employer’s claims history. By combining claims data with this public price information, employers can gain a more complete picture of health care spending. This combination helps them identify spending drivers, compare insurers’ negotiated rates, and evaluate alternative providers and sites of care.

While both sources offer valuable information, they also come with limitations. Public price data can contain implausible provider-service combinations, incomplete payment formulas, and gaps in the connections between hospital and physician charges. Claims data, on the other hand, captures actual care but is retrospective, can be delayed or incomplete, and often comes with access and licensing restrictions. Neither source alone provides a complete picture of health care prices and spending.

For employers, the authors recommend starting with their own medical and pharmacy claims to understand where members receive care and what drives spending. Public transparency data can then be used to add current contracted rates, comparisons across insurers, and information about providers and care settings outside the employer’s historical experience. These comparisons are particularly relevant when considering a change in insurers or networks.

The authors also call for continued improvements to public reporting. Their recommendations include more detailed service-volume information, clearer reporting of complex payment arrangements, and better connections between facility and professional rates. The long-term goal is to make public files reliable enough that employers, researchers, states, and journalists can answer price-related questions without purchasing proprietary claims data, while preserving the distinct information claims provide about utilization, patient mix, and historical spending.

Simple Healthcare, a company that helps employers, brokers, and other health care stakeholders understand health care prices and identify opportunities to lower costs, offers a public Search tool providing free access to health care prices. Its Roadmap combines employer claims analysis with network benchmarking to support purchasing decisions.

In conclusion, the integration of publicly available price transparency data with medical claims data offers a powerful tool for employers to make informed decisions about health care spending. By leveraging both sources, employers can better evaluate their options and identify opportunities to reduce costs.