TL/DR –
Healthcare analytics firm, Trilliant Health, has released a report highlighting significant variations in commercial healthcare prices across the United States, based on data from over 2,600 hospitals and 3,400 ambulatory surgery centres. The report reveals that negotiated rates for six inpatient procedures varied by an average ratio of 9.1 across the country, and found no correlation between cost and quality of care. Despite spending more on healthcare per person than any other country, the U.S. has worse health outcomes, partly due to a lack of information needed by employers to make informed purchasing decisions.
Key Insights from Trilliant Health’s Report:
Healthcare analytics firm Trilliant Health has unveiled a new report. This report exposes substantial variations in commercial healthcare prices across the US, leveraging data from the Transparency in Coverage (TiC) final rule. The data analyzed includes 2,659 hospitals and 3,491 ambulatory surgery centers, revealing a “startling spread in prices” for identical procedures.
Information Asymmetry
Although the U.S. healthcare system spends more per person than any other country, it has poorer health outcomes. Employers, who provide private health insurance for over half of the American population, have historically lacked necessary information to make informed purchasing decisions.
Trilliant’s report emphasizes that healthcare spending is a result of utilization and price. Americans end up paying more for the services they receive, a problem obscured by federal antitrust laws and contractual gag clauses.
According to Allison Oakes, Ph.D., Chief Research Officer at Trilliant, this information asymmetry has inhibited competition between providers and insurers. However, the problem was intended to be tackled by the 2020 TiC final rule, requiring health plans to publish negotiated rates data monthly.
Extreme Price Variation Trends
The analysis reveals several key findings:
- National and State-Level Price Variation: Average ratio of 9.1 across the country for the negotiated rates of six inpatient procedures.
- Payer-Specific Pricing at the Same Hospital: Different payers negotiate different prices for the same procedure at the same hospital.
- No Correlation Between Cost and Quality: There’s no observable correlation between cost and quality within a sample of 10 “best hospitals”.
- Outpatient Savings in Ambulatory Surgery Centers: The national median rate for five outpatient surgeries was consistently lower at an ambulatory surgery center (ASC) than at a hospital outpatient department.
The report identifies the extreme variation in prices for the same service as a form of waste. With the availability of granular, facility-level data, employers can now fulfill their fiduciary duty to make informed healthcare benefits decisions. “The report reveals a startling spread in prices that begs for explanation,” says Oakes. “Employers now have the information they need to understand the value of the healthcare services they purchase.” For more details on the report, visit https://www.trillianthealth.com/market-research/reports/2025-price-transparency
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