Key Themes and Takeaways

December 11, 2025
Austin, Texas

PBGH’s Annual Summit brought together more than 125 employers, public purchasers, and business leaders for focused conversations about where health care needs to go next.

This year’s Summit carried quiet but noticeable shift in tone. No one needed convincing that the system is broken. That case has been made. Participants spent less time debating what should happen “someday” and more time talking about what they’re already doing., where progress is happening, where it’s falling, and what has to change to keep the work going.

Employers are doing the work. They’re drawing clearer lines, tightening their expectations, and building the infrastructure required to act, and they’re seeing results.

1. The Shift from Learning to Leading

Employers aren’t new to this work anymore. They understand how overpayment happens. They see low-quality care hiding behind discounts and familiar network logos. They know the data exists. And their tolerance for inaction grows smaller by the day.

Several employers described the same realization: the biggest barriers aren’t technical or market-based. They’re contractual. Decisions made years ago, often with limited visibility, now define what’s possible today.

Once that becomes clear, inaction stops feeling neutral. Knowing better raises the standard, not just morally, but operationally.

What employers are doing now: questioning long-held assumptions about what cannot be changed, treating delay as a decision with real cost, and asking vendors to explain constraints instead of accepting them.

What this unlocks: more honest internal conversations about why change is required, and less patience for incremental fixes that avoid deeper problems.

2. Your Constraints Aren’t Always the Market. Check Your Contract.

Contracts came up again and again as the place where strategy either lives or dies.

Employers described discovering that limits on data access, network design, and alternative contracting were not imposed by the market. They were written into agreements and left unexamined. Years were spent debating strategy while the real constraint sat quietly in the contract.

There’s a shift happening. Understanding what the contract allows is now the starting point of any serious conversation.

One employer shared a telling example: when carriers said direct contracting wasn’t possible because “provider contracts trump yours,” the employer pushed back. They required full disclosure of every contract conflict upfront.

Carriers initially resisted, then produced multi-page disclosures showing restrictive clauses, conflicting rate structures, and inconsistent terms across carriers. The information existed. It simply had not been required before.

As one employer put it plainly:

“We spend $1.6 billion on health care. It’s our dollars, and we should know exactly what we’re getting. We are the customer. You are the vendor. We want to partner, but that power dynamic matters.”

What this changes: leverage shows up earlier, when it matters most, with fewer surprises late in negotiations and real pathways to direct contracting and alternative models.

3. Access to Transparency Data Is Non-Negotiable

Transparency data exists, and employers are increasingly insisting on access in a form they can actually use.

For years, claims data, quality metrics, and pricing benchmarks arrived from separate places. They were rarely aligned, if not outright missing. That fragmentation and opacity made negotiations and comparison difficult and lack of accountability has continued for so long.

As one participant said:

“The data you’ve had is useless. The data you need is multiple layers together, price, quality, utilization, so you can actually make decisions.”

What’s changed is visibility. Programs like the PBGH’s Data Transparency Project are giving employers insight into price, quality, and utilization in a package they can understand and take action on. That full picture is  where behavior shifts.

One employer described receiving hospital data that initially seemed implausible and was set aside. When that same data was later viewed alongside quality ratings and market pricing, the issue became clear. Members were using a hospital with a D safety rating. The data wasn’t wrong. The realization was uncomfortable, and clarifying.

When the full picture is visible, overpayment becomes harder to justify. Variation stops being abstract and discounts lose their persuasive power.

What this changes: faster, evidence-based decisions, more grounded conversations with carriers and vendors, less reliance on vendor-controlled narratives, and greater confidence explaining decisions to leadership.

4. Fiduciary Responsibility Has Become Practice

Fiduciary duty is no longer theoretical. It’s showing up as a day-to-day filter for decision-making.

Employers are asking things like “can we explain this decision clearly? What tradeoffs are we accepting? Where are we relying on assumptions instead of evidence?” Expectations have shifted, and the definition of “reasonable” has shifted with them.

New federal transparency requirements came up, not as compliance hurdles but as a signal of where the bar now sits. Fiduciary responsibility is less about avoiding risk and more about showing intent.

What this supports: greater confidence in procurement and contracting, and stronger alignment with boards and senior leadership.

5. Consistency Is the Competitive Advantage

Focus came up repeatedly. Employers talked about narrowing efforts, simplifying the employee experience, and sticking with changes long enough to see results. The work was not flashy. It was disciplined.

Design for how people actually live, then stay with it long enough to make it better.

One employer described designing benefits for a largely frontline workforce:

“When someone is making $22 an hour, working in a rural area, and English may not be their first language, that’s the population I have to focus on.”

They do not need dozens of provider options. They need experiences that work, supported by real people, not just tools that assume digital fluency.

As another employer put it:

“People don’t need 40 choices. They need maybe five on the first page, and to them, that’s choice.”

This kind of consistency builds trust. It also leads to more sustainable outcomes.

Where the Work Gets Personal

This year’s keynote speaker, Dr. Will Flanary, known widely as Dr. Glaucomflecken to his millions of social media followers, brought humor to the Summit while bringing the people behind the data into sharp focus.

Through satire and storytelling, Flanary highlights the everyday absurdities of navigating the health care system. The handoffs that never happen. The rules that make sense only on paper. The quiet ways complexity gets pushed onto patients and families. The laughter in the room was familiar. It was recognition.

As both a physician and a patient who survived cancer and cardiac arrest, Flanary described what happens after a medical crisis:

“When you have something like this, you’re trying to put the pieces of your life back together, and then we drop the healthcare system on their head and say, ‘Here, deal with this. Figure it out.’ It’s one of the worst things that we do to people.”

Flanary’s keynote reinforced a key theme from the Summit: when systems are unclear, poorly aligned, or locked in by old decisions, the burden doesn’t disappear. Instead, it moves downstream to patients, families, and clinicians.

The choices employers make about data access, networks, and accountability aren’t abstract. They shape whether the system supports people when they are most vulnerable, or quietly asks them to hold it together themselves.

The Work In Action

The Summit closed with the presentation of the 2025 PBGH Moonshot Awards, PBGH’s annual recognition of employers and purchasers moving the needle on health care affordability, quality, access, and equity.

This year’s recipients, Amazon, NextEra Energy, Microsoft, and CSAA Insurance Group, were recognized for accomplishments across four moonshots: advanced primary care, health care affordability and accountability, maternal health and birth equity, and inclusive health and well-being.

After a day of discussion, the awards offered a tangible view of what this work looks like in practice and the significant impact it’s having on employees and their families.

What Comes Next

The Summit made clear that this work is moving out of theory and into practice. Employers are gaining a clearer view of where the system breaks down, what the data can show, and how contracts shape what’s possible.

The question now is not whether change is needed, but how steadily it can be pursued in the face of real constraints. The conversations in Austin reflected a growing willingness to stay with the work, test assumptions, and act with more clarity into the future.

This momentum will shape what comes next.