Health Care Price Transparency and Claims Data Work Best Together, new Health Affairs Forefront article explains

Simple Healthcare authors explain in Health Affairs Forefront how publicly available price data can help employers evaluate options beyond their past spending.

ORLANDO, FL, UNITED STATES, November 6, 2026 /EINPresswire.com/ — Employers use medical claims to understand their health care spending. But when considering a different insurer or site of care shift, they need information their claims cannot provide: what that insurer has negotiated to pay for the same care.

A new article published today in Health Affairs Forefront explains how combining claims with publicly available price transparency data can help employers answer that question. Written by Simple Healthcare’s David Muhlestein and Elvira Makk Frid, “Claims and Transparency Files are Complements in Understanding Health Care Prices” outlines how these sources work together to support more informed purchasing decisions.

Claims show the care patients received and the amounts their plans allowed, while price transparency files reveal contracted prices, including rates for providers and services that may never appear in an employer’s claims history. Together, these sources can help employers identify spending drivers, compare insurers’ negotiated rates, and evaluate alternative providers and sites of care.

“Claims can tell an employer what its plan paid for care last year, but they cannot show what another insurer would have paid for that same care,” said David Muhlestein, CEO of Simple Healthcare and coauthor of the commentary. “Combining claims with public price data gives employers a stronger basis for evaluating their options and identifying opportunities to lower costs.”

The commentary describes limitations in each source. Public files can contain implausible provider-service combinations, incomplete payment formulas, and gaps in the connections between hospital and physician charges. Claims capture actual care but are retrospective, can be delayed or incomplete, and often come with access and licensing restrictions. Neither source alone provides a complete picture of health care prices and spending.

For employers, the authors recommend beginning with their own medical and pharmacy claims to understand where members receive care and what drives spending. Public transparency data can then 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.

Support for this work was provided by the Peterson Center on Healthcare.

About Simple Healthcare
Simple Healthcare helps employers, brokers, and other health care stakeholders understand health care prices and identify opportunities to lower costs. Its public Search tool provides free access to health care prices, while Roadmap combines employer claims analysis with network benchmarking to support purchasing decisions. Learn more at www.simplehc.com.

Nancie Steinberg
Simple Healthcare
nbsteinb@gmail.com

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