The Price of Healthcare Podcast

Payerset
  • 5.0 (4)
  • Medicine

The brightest minds in healthcare finance discuss what drives costs, where leverage lives, and how better data can change the system.

Episodes

  1. 3d ago

    How Montana's State Health Plan Climbed From Near-Insolvency to $112 Million in Reserves with Marilyn Bartlett

    Marilyn Bartlett, CPA, is a senior policy advisor at the National Academy for State Health Policy (NASHP), where she works on the organization's Hospital Cost Tool. Before NASHP, she ran the Montana State Employee Health Plan, moving its projected reserves from minus $9 million to a positive $112 million in under three years while improving benefits, after earlier roles as a controller for a Blue Cross Blue Shield plan and CFO of a regional third-party administrator. Self-funded employers pay the full cost of their employees' care, yet many don't get the detailed claims data that shows where their money went. This conversation follows those dollars from the plan, through carriers and middlemen, to the hospital. Bartlett explains how Montana moved its hospitals to Medicare-based reference pricing and how Medicare cost reports show what a hospital spends to deliver care. Listeners come away knowing which contract clauses to question and what claims data to demand from a TPA. In this episode Taking over a Montana plan of 30,000 lives that was projected to lose $28 million in one yearWorking with Allegiance Benefit Plan Management to reprice the 11 acute care hospitals that made up 87% of Montana hospital spend, starting from one paid an average of 611% of Medicare for outpatient careCross-plan offsetting and a California court case where an employer paid $4 million and the provider received $875,000Bringing state employees and union leaders on board, and the last hospital holdout that cited a most favored nation agreement with Blue Cross Blue ShieldHow NASHP's Hospital Cost Tool uses Medicare cost reports, including a hospital's claimed 40% Medicaid loss that its cost report put at 18%Senate Bill 2355, the Patients Deserve Price Tags Act, and its requirement that employer plans receive their full transaction dataHospital price transparency compliance and the updated Transparency in Coverage rulesWhere a benefits director should start, from contract clauses to cutting wellness vendors for $5.5 million in savingsHow the HIPAA need-to-know standard keeps claims details away from the employerFigures cited in this episode Bartlett puts hospital price transparency compliance at about 20% before a rule change let hospitals post pricing algorithms, and in the 40% range now. PatientRightsAdvocate.org's reviews of 2,000 hospitals match both numbers. Its seventh compliance report found 421 hospitals (21.1%) in full compliance, and its eighth report, released in September 2026, found 49.4%, the highest rate it has recorded. Sources: PatientRightsAdvocate.org, seventh compliance report and eighth compliance report, September 2026. The Price of Healthcare Podcast is produced by the team at Payerset. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data.➡️ https://payerset.com/pricetransparencyproject/  📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays➡️ https://payerset.com/employer-rate-intelligence/ 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️ https://www.linkedin.com/company/payerset

    How Montana's State Health Plan Climbed From Near-Insolvency to $112 Million in Reserves with Marilyn Bartlett

  2. Oct 6

    How employers are taking control of healthcare costs in the modern benefits market with Jeff Hogan of the Judi Group

    This episode of The Price of Healthcare Podcast features Jeff Hogan, Managing Director and co-founder of the Judi Group, who draws on four decades of industry experience to discuss the challenges and opportunities facing purchasers of employer-sponsored healthcare. Topics include: The historical lack of a true healthcare marketplace and the resulting “conditioning” of CFOs and HR executives to accept status quo costs.The impact of the Consolidated Appropriations Act (CAA) of 2021 on employer fiduciary duty and the move towards contract transparency.Emancipating and warehousing claims data to drive better purchasing decisions and compliance.The critical role of governance, fiduciary committees, and actionable analytics in transforming benefits decision-making.Practical steps employers of all sizes can take, starting with contract review, disclosure management, and point solution evaluation.The episode also covers trends in direct contracting, advancements in technology-driven procurement, and the emergence of supply-side health systems eager to compete for employer business. For those committed to reshaping healthcare purchasing, actionable strategies and new standards of fiduciary responsibility are discussed throughout. Listen for a roadmap to drive change, create accountability, and leverage new market dynamics for more transparent, sustainable employer health benefits. The Price of Healthcare Podcast is produced by the team at Payerset. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data.➡️ https://payerset.com/pricetransparencyproject/  📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays➡️ https://payerset.com/employer-rate-intelligence/ 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️ https://www.linkedin.com/company/payerset

    How employers are taking control of healthcare costs in the modern benefits market with Jeff Hogan of the Judi Group

  3. Sep 22

    Unpacking the mechanics and award sizes of the IDR process with Dr. Tia Goss Sawhney

    Join Andrew Gordon as he interviews Tia Goss Sawhney, a healthcare data and policy expert, to break down the real-world impact and current issues surrounding the No Surprises Act. Get a direct look into the independent dispute resolution process and its effects on employers, providers, and patients. In this episode… Why Tia believes commercial pricing only changes when self-funded employers demand it, and what the Consolidated Appropriations Act opened upWhere the No Surprises Act is working for patients, and the one gap left for reference-based pricing plansWhy the qualifying payment amount starts too low: 2019 rates, CPI trending, and ghost ratesProviders winning more than 85% of determinations, and why no one but the arbitrator sees the justificationHow elective surgeries at in-network facilities land in IDR, from assistant surgeons to neuromonitoringThe August amendments and the Fifth Circuit’s QPA decision, and what neither one changesWhere challenges could come from: EmblemHealth’s suit against Dr. Norman Rowe, and False Claims Acts for public employersHow to find probable IDR claims in your own claims data, and how the cost reaches employees The Price of Healthcare Podcast is produced by the team at Payerset. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data.➡️ https://payerset.com/pricetransparencyproject/  📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays➡️ https://payerset.com/employer-rate-intelligence/ 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️ https://www.linkedin.com/company/payerset

    Unpacking the mechanics and award sizes of the IDR process with Dr. Tia Goss Sawhney

  4. Sep 5

    Inside the Origins of Healthcare Price Transparency with Randy Pate

    In this episode of The Price of Healthcare Podcast, host Andrew Gordon sits down with Randy Pate to explore how healthcare price transparency moved from a policy concept to a federal requirement with the potential to reshape the market. Randy is the founder of Randolph Pate Advisors and a former Deputy Administrator at CMS and Director of the Center for Consumer Information and Insurance Oversight. Drawing on more than two decades of public- and private-sector healthcare policy experience, he offers a firsthand account of the early thinking behind Transparency in Coverage and the process of turning an executive order into a complex federal rule. Andrew and Randy discuss why accessible pricing is a necessary foundation for informed consumer choice, how employers helped build momentum for the regulation, and why Randy’s own perspective shifted as CMS gathered input from stakeholders across the healthcare system. They also examine the regulation’s early technical challenges, the evolution of machine-readable files, the role of GitHub in developing the data schema, and the ongoing gap between a published negotiated rate and the amount ultimately paid on a claim. The conversation closes with a look at enforcement, stakeholder engagement, and Randy’s vision for a future in which patients and purchasers can compare price and quality before receiving care. The Price of Healthcare Podcast is produced by the team at Payerset. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data.➡️ https://payerset.com/pricetransparencyproject/  📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays➡️ https://payerset.com/employer-rate-intelligence/ 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️ https://www.linkedin.com/company/payerset

    Inside the Origins of Healthcare Price Transparency with Randy Pate

  5. Season 1 Trailer

    Welcome to The Price of Healthcare Podcast

    In this introductory episode of The Price of Healthcare Podcast, Payerset co-founders Jacob Little and Jerry DiMaso explain why they launched the Price Transparency Project and what listeners can expect from the conversations ahead. They reflect on how healthcare price transparency has evolved since the Transparency in Coverage data first became available in 2022, from early confusion and technical challenges to a rapidly maturing source of insight for the entire healthcare ecosystem. They also explore the continued need for education, advocacy, and open dialogue across groups that too often operate in separate echo chambers. The conversation covers upcoming policy developments, including the anticipated Transparency in Coverage Schema 3.0, the important differences between hospital and insurer transparency requirements, and the potential for better data to make healthcare pricing more understandable, predictable, and actionable. Above all, this episode introduces the podcast’s central mission: bringing together care delivery organizations, employers, insurers, policymakers, patients, and other healthcare leaders to share perspectives, challenge assumptions, and build a more functional healthcare market. The Price of Healthcare Podcast is produced by the team at Payerset. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data.➡️ https://payerset.com/pricetransparencyproject/  📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays➡️ https://payerset.com/employer-rate-intelligence/ 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️ https://www.linkedin.com/company/payerset

    Welcome to The Price of Healthcare Podcast
  • 1 Trailer
    4 Episodes

Trailer

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The brightest minds in healthcare finance discuss what drives costs, where leverage lives, and how better data can change the system.

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