Transparency is foundational to a healthily functioning market, which is why state and federal officials have been working to ensure healthcare markets are transparent in pricing, contracting, and claims data. But if compliance with these laws is lacking, or companies look for loopholes to hide data, transparency can’t help bring about the market corrections needed to reduce prices.
New survey data from the National Alliance of Health Purchaser Coalitions indicates employers with full claim-level access were more likely to be taking action on strategies to address high-cost claims. But too many companies are still being refused access to their data, leaving them unable to make informed decisions that could help lower healthcare expenses.
“Despite widespread reporting of data rights, access and audit capabilities remain inconsistent. Approximately one-third of employers said they lack complete claim-level access, and only about 3 in 5 said they are confident they could audit their complete files. Among respondents, 75% store their claims data with a health plan or third-party administrator, the arrangement associated with the lowest rate of complete access (59.2%), whereas about 1 in 4 who use an independent data warehouse reported the highest access rates.”
In 2025, Texas lawmakers made a critical move towards improving claims data transparency by fully-funding the Texas All-Payor Claims Database. As lawmakers prepare to convene for the next state Legislature in January, they will have an opportunity to build on this effort by taking up measures that require middle men to provide health benefit payors with all of the data associated with their plans.
Employers are eager to take up strategies to control healthcare expenses—the data proves it. But they can only explore and adopt these strategies if they have access to the data necessary to evaluate and adjust their plans accordingly. When it comes to transparency, employers need data—not lip service.