Neal Kaufman

March 6, 2025

On February 25, 2025, President Trump signed an Executive Order to "empower patients with clear, accurate, and actionable healthcare pricing information." This renewed focus on healthcare price transparency highlights a challenge the industry has grappled with for years: how to make transparent pricing truly accessible and meaningful. Our healthcare system requires more than just enforcing existing regulations and published price lists—it needs infrastructure to make transparent prices truly actionable.

The Current State of Healthcare "Transparency"

Despite regulatory efforts, healthcare pricing remains frustratingly opaque for several critical reasons:

First, compliance with existing transparency requirements is inconsistent. The recent executive order specifically directs federal departments to strengthen implementation of regulations created in 2020 — a clear indication that mandates alone haven't created the desired transparency.

Second, even when facilities publish prices, the information is often incomplete or inconsistent. Machine-readable files (MRFs) might include a base procedure price but omit crucial details about what's included. Does the price cover anesthesia? What about specific implants or post-procedure physical therapy? Are there any other carve outs and exclusions? Without these details, a procedure with a specific listed price could result in a substantially larger, unexpected bill.

Third, publishing prices without addressing the underlying infrastructure fails to solve the core problem. The healthcare system frequently creates situations where parties agree on a price, then dispute the business terms, resulting in confusion about what was actually "agreed upon." The claims process itself—from submission through editing, repricing, clinical review, cost-share application, to remittance and payment—relies on outdated technology and infrastructure that stifles transparency and innovation.

The result? Both providers and purchasers operate in an information vacuum. Providers cannot easily see true market prices for their services, and employers cannot effectively evaluate purchasing options up-front or understand why claims cost significantly more than expected.

What's missing is a system that makes transparent pricing actionable by connecting the entire healthcare transaction process.

Building the Infrastructure for Transparent Healthcare

OpenNetworks is developing technology from the ground up to create infrastructure that manages key processes in today's healthcare system: from providers setting rates and terms upfront, to purchasers selecting rates with full visibility into key business terms, to tracking claims from submission through payment.

The difference lies in OpenNetworks' approach:

1. We enable transparent insight into the entire transaction flow. A provider uses their existing processes to submit a claim, OpenNetworks retrieves the claim, reprices it according to agreed-upon rates, passes it to the employer or TPA for clinical evaluation, and tracks the final resolution and remittance. This process ensures that the agreed upon business terms and rates are adhered to, and purchasers and providers gain visibility into every step of this process.
2. We eliminate contractual barriers. Traditional healthcare networks often incorporate exclusivity clauses, gag orders, and opaque fee structures. Our platform is open to all providers, with no exclusivity requirements or hidden fees.
3. We align incentives through our business model. We charge a simple per-employee-per-month fee, as opposed to taking a percentage of savings or earning revenue based on the volume of claims. This positions us as a neutral actor with no incentive to inflate or deflate service delivery or prices.
4. We provide meaningful data analysis. Beyond simply republishing MRF data, we analyze claims to provide de-identified, aggregated market intelligence that helps providers understand their competitive position and enables purchasers to make informed decisions to support their employees and members.

The Future of Healthcare Transparency

True transparency will reduce provider abrasion and purchaser confusion, lowering costs throughout the entire healthcare system. It creates an environment where providers can differentiate based on the quality and value of their services rather than competing in a race to the bottom on price. Purchasers will be able to make informed decisions about their healthcare spend and to plan accordingly, reducing uncertainty and financial risk.

I invite you to reach out to our team to see how OpenNetworks can help you navigate this new era of healthcare transparency with technology specifically built to align the interests of providers, purchasers, and patients.

The future of healthcare is transparent, connected, and efficient. Let's build it together.

Neal Kaufman is CFO/COO of OpenNetworks, a healthcare platform bringing together purchasers seeking transparently priced healthcare services and providers willing to deliver those services based on clearly defined terms.