Joe Nelson

August 4, 2025

America's healthcare system operates on a fundamentally broken model. The dominant network structure relies on layers of intermediaries, hidden costs, and opaque contracts that have made it difficult for employers and providers to understand, let alone manage, the economics of the care. For decades, this system has delivered spiraling costs, crushing administrative burdens, and completely misaligned incentives.

OpenNetworks offers a radically different approach: a fully transparent, employer-and provider-led infrastructure built to serve as a complete primary network replacement. This isn't just another layer on top of an antiquated system. It's a reinvention of how healthcare relationships and transactions should work in a modern, value-aligned ecosystem.

The Blind Spot: Paying Without Power

Even though employers foot the bill for most healthcare spending in the U.S., they remain in the dark about how their healthcare dollars are spent. Despite federal price transparency mandates, negotiated rates remain hidden, pharmacy benefit manager (PBM) pricing is completely black-boxed, and claims data often lacks clarity or usability. Employers are writing massive checks while having virtually no control over the underlying costs. They’re expected to manage rising costs while having minimal visibility or control.

The numbers speak volumes telling the story of a system in crisis. According to the Centers for Medicare & Medicaid Services National Health Expenditure Fact Sheet, updated in June 2025, total U.S. healthcare spending reached approximately $4.9 trillion in 2023 - a staggering 7.5% increase from 2022, representing the fastest and sharpest rise in two decades. This spending now accounts for 17.6% of GDP, or roughly $14,570 per person.

Complexity by Design: When the System Itself Is the Problem

The legacy network model doesn't just tolerate complexity. It thrives on it. Claims systems are deliberately built to deny first and approve reluctantly. Contracts are intentionally riddled with clauses that obscure actual pricing. Employers are deliberately kept on the sidelines, while providers struggle with outdated reimbursement processes and delayed payments that often have little to do with the quality of care.

This administrative burden isn't an unfortunate byproduct of the system. It's the core feature that enables the entire structure to extract value without delivering proportional benefits. The complexity protects the intermediaries by allowing them to profit from inefficiency, not the people delivering or purchasing care.

Shifting the Power Dynamic Through Direct Healthcare Networks

OpenNetworks breaks that cycle by introducing a network model that empowers those who fund and deliver care. Rather than attempting to retrofit digital tools onto a fundamentally flawed system, it provides a modern, transparent network built on a disruptively practical technology platform. That gives employers and providers the tools to contract directly or build comprehensive networks, maintaining control over healthcare transactions, pricing, and relationships.

The platform provides employers with extensive network capabilities including full provider coverage, transparent pricing, direct provider relationships, and detailed insights into their healthcare spending. No longer are employers confined to the limited options and opaque pricing structures of traditional carrier networks. With OpenNetworks, they can build and manage their own healthcare networks and proactively manage costs of care, gaining full visibility into every aspect.

For healthcare providers, OpenNetworks offers a genuine alternative to the status quo. where they can establish their own rates based on transparent business terms and build direct, sustainable relationships with local employers.

This innovative, transparent model returns control to the people who actually deliver and purchase care. This approach aligns incentives, reduces overhead, and creates sustainable, transparent relationships between employers and providers.

The old model works against the very people it’s meant to serve. It urgently needs a new foundation - an infrastructure built for transparency, accountability, and value creation. OpenNetworks delivers precisely that. This new approach fundamentally realigns incentives, replacing the legacy system with one built for shared clarity, flexibility, and accountability among all parties dedicated to delivering quality care at sustainable costs.