OAKLAND, Calif., Oct. 14, 2025 (GLOBE NEWSWIRE) — The Purchaser Business Group on Health (PBGH), a nonprofit coalition representing dozens of the largest private and public employers in the U.S., today released the results of its groundbreaking Health Care Data Demonstration Project. The initiative, launched amid the biggest increase in health care costs for employers in more than a decade, marks the first time employers have had access to the data needed to compare what they actually paid for health care services against what they should have paid, allowing them to pinpoint overpayments, challenge hidden fees, and demand accountability from health plans and providers.
The demonstration, conducted with five major employers, including Boeing, Qualcomm, and the City and County of Denver, combines Hospital Price Transparency (HPT) and Transparency in Coverage (TiC) data with claims, quality, and safety information. The result is a powerful set of tools that reveal what constitutes a fair price—aligned with the fiduciary standard under federal law—and in some cases exposes the failure of third-party administrators (TPAs) and carriers to deliver value. Direct contracts, in contrast, demonstrated the best pricing and highest value.
“For decades, the health care industry has fought to keep pricing hidden because opacity enabled them to overcharge employers and employees,” said Elizabeth Mitchell, president and CEO of PBGH. “This project finally puts the truth in employers’ hands. It shows them not just what they paid, but what they should have paid—and that discrepancy is where hidden fees and profiteering live. It is transformative because it enables employers to fulfill their fiduciary duties, hold vendors accountable, and drive down costs for their workforce.”
Unlike All-Payer Claims Databases (APCDs) and other limited initiatives that simply show what was paid—without context, quality measures, or the ability to identify specific plans or providers—PBGH’s model delivers actionable, employer-specific insights. For the first time, employers can see how their payments compare to national commercial benchmarks, identify high-value providers, and target the areas where they are being overcharged.
“The findings from this project have already enabled us to ask questions of our carriers and uncover pricing inconsistencies,” said Sabina Mahoney, senior benefits manager with Qualcomm. “No other source currently provides this level of actionable, comparable information.”
The year-long project was made possible with support from strategic partners including Milliman, Embold Health, The Leapfrog Group, EY, and with funding and thought partnership from the Peterson Center on Healthcare. Together, the partners aggregated and analyzed claims, transparency, and quality data, overcoming major inconsistencies and barriers that have long stymied employers’ ability to act.
“This project has demonstrated the real potential of transparency data to transform the market,” said Caroline Pearson, Executive Director at the Peterson Center on Healthcare.
“The only stakeholders who can meaningfully create downward pressure on prices right now are employers in their role as plan sponsors and health care purchasers.”
“This is the first time claims have been directly compared against transparent pricing and quality data in a way that employers can use,” added Erica Reijula, principal and consulting actuary with Milliman. “It provides a clearer line of sight on areas needing improvement, and additional clarity they’ve never had before.”
With employers facing the steepest increase in health care costs in more than a decade, and under heightened fiduciary obligations enforced by the Consolidated Appropriations Act, the demonstration provides a roadmap for how jumbo employers nationwide can finally drive affordability, hold vendors accountable, design smarter benefits, and push back against a system that has thrived on opaque business practices.
“As a nonprofit that only represents employers and their employees, we are not beholden to the industry players,” added Mitchell. “The reality is that people are struggling to afford care, and employees have lost decades of wage growth to health costs. This project proves that when employers can see the truth, they can act, and the industry knows it, which is why they are still fighting transparency despite the law.”
PBGH will expand this service in the coming months, scaling it to more large employers eager to leverage data to control costs, improve quality, and create a more competitive health care marketplace.
Employers or other stakeholders interested in learning more are encouraged view the full report here: https://www.pbgh.org/initiative/pbgh-health-care-data-demonstration-project/, or reach out to [email protected].
About Purchaser Business Group on Health
PBGH is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $350 billion annually purchasing health care services for more than 21 million Americans and their families. In partnership with its members, PBGH initiatives are designed to test innovative operational programs and scale successful approaches that lower health care costs and increase quality across the U.S.
SUPPORTIVE QUOTES:
- City and County of Denver
- “For the City and County of Denver, we definitely need to figure out a way to continue to analyze this data,” said Heather Britton, Director of Benefits and Wellness at City and County of Denver.
- Embold Health
- “This collaboration demonstrates how transparency data can be transformed into actionable insights,” said Al Codalbu, Senior Vice President of Employer Business at Embold Health. “By integrating our provider performance analytics with cost transparency data and employer claims, we illuminated where value and efficiency is being delivered and where it isn’t. When employers can clearly see the link between cost, quality, and outcomes, they’re empowered to demand accountability, reward high-performing care, and effect real strategic change in their benefits strategy.”
- The Leapfrog Group
- “We are excited to see this groundbreaking data project take shape and pleased to contribute our ratings on quality and safety to the work. With leadership from PBGH, Milliman, Embold and Leapfrog, employers will have exceptional new opportunities to drive a market for better care for their employees.” Leah Binder, President and CEO, The Leapfrog Group
- Peterson Center on Healthcare
- “By combining their own claims data with the price transparency data and quality and safety information, we’ve been able to equip employers with actionable insights—things they can concretely do to reduce health care costs and drive higher quality,” said Caroline Pearson, Executive Director at the Peterson Center on Healthcare.
- Purchaser Business Group on Health | Leveraging Health Care Price Transparency