These networks impact the pricing, administration, and quality of health insurance programs. They determine the basic competitiveness of healthcare markets, and their owners have become the defacto gatekeepers of innovation, flexibility and collaboration. Information is opaque, especially regarding the cost of service, and there are limited opportunities for users to make healthcare decisions based on cost. Compounding the problem: hundreds of isolated unique networks, maybe large for a market but lacking scale to the nation, all operating in their own silos, all with their own approach and protocols.