Transform Health Care Purchasing with Data Intelligence

Deliver the highest-value care for workers and families and hold vendors accountable

Until now, it’s been impossible to know if you’re paying fair prices for the best health care, because true pricing data has been all but impossible to get — especially in a usable form. PBGH, which spearheaded the drive for price transparency legislation on behalf of all purchasers, has now created a breakthrough health care data framework, so you can:

1. Aggregate and standardize transparency data from hospitals and health plans to show market prices negotiated by all payers in your market —not just yours.
2. Integrate your claims data with price transparency data to reveal what you actually paid for specific services versus what others paid — revealing savings opportunities.
3. Incorporate quality and safety ratings to find the highest-value providers — not just cheapest or costliest — and unlock new ways to optimize your health benefit design.

Download the Full Report

Breaking Healthcare’s Black Box: PBGH’s Price Transparency Service Now Available to Help Jumbo Employers Optimize Benefits and Diminish Fiduciary Risk

Download Report

Also included:

PBGH’s expert advisory services, offering you strategic guidance so you can deliver the best care possible. In a recent pilot, Boeing, Qualcomm, the City and County of Denver and others gained unprecedented insights into their benefits. Some were paying above-market prices for below-average quality and outcomes. Others were paying an unjustifiably wide range of prices for identical services. Some discovered and addressed fiduciary vulnerabilities. Each found ways to improve benefit design, by optimizing care-delivery networks, holding vendors accountable, or more effectively negotiating with plans and providers.

Our pilot project offered a blueprint for profit-driven vendors to launch similar services, but only PBGH is unmotivated by profit, unencumbered by conflicts of interest, and unyielding in its dedication to delivering results for jumbo purchasers — as it has for 35 years.  The PBGH Data Transparency product set includes:

1. Data Audit and Assessment: Verify published prices and fees paid to providers.

2. Value Optimization: Network performance assessments, RFIs and RFPs, contracting and vendor management, and strategies for building Centers of Excellence.

3. Strategic Design: De novo benefit design, direct contracting strategies, and strategies for steering employees to the optimal sites of care while protecting network access.

Transparency & Affordability

Transparency Initiative: Leading the Way to Affordable, High Quality Health Care

PBGH has a longstanding strategic imperative to transform the way health care is purchased and managed and to advocate for competitive health care policy reforms – all to support affordable, quality care for employers and public purchasers and the millions of American workers and their families who receive employer-sponsored health insurance. Through a coordinated effort, we have developed innovative, market shaping programs and resources for employers, successfully influenced legislation, and meaningfully contributed to the ongoing dialogue on health care affordability and strategies to improve health care.

Over the past year we have focused on driving health care value and provider accountability through data-driven insights as part of our Transparency Initiative. As a trusted industry leader and policy advocate, we developed the PBGH Health Care Data Demonstration Project to fill a critical gap and show employers how they can use data to achieve meaningful insights in health care costs and value. The project uses transparency in coverage (TiC) and hospital transparency data to empower employer fiduciaries in making informed health care decisions. It has also been used to inform policy work to make transparency data usable and support refinement and enforcement of transparency regulations. Read more about the PBGH Health Care Data Demonstration Project.

Advocating for Impactful Health Care Policies

PBGH’s policy positions are rooted in evidence, a deep understanding of the complexities and challenges of the health care system, and the impact on affordability. In our policy advocacy we emphasize the importance of transparent pricing, employer access to data, industry consolidation, PBM reform, limiting anticompetitive business practices and access to care – all critical components for sustainable, high-quality, affordable health care.

Our pioneering policy advocacy created transparency requirements, and we remain committed to supporting its evolution. Key learnings from the PBGH Health Care Data Demonstration Project have informed discussions with policymakers on our experience with transparency data, the depth of actuarial and analytical infrastructure required to aggregate the data and improve its usability to achieve its intended potential.

Here is our body of work on policies to enable affordability through transparency:

• Issue Brief: Purchaser Innovation and Policy Engagement Against a Backdrop of Unaffordability and Fiduciary Risk
• Congressional Resource: Achieve Fiduciary Excellence and Hold Vendors Accountable to Quality Care at a Fair Price
• Letter to Tri-Agencies on Gag Clause Prohibition Attestation and Purchaser Data Access (October 31, 2023)
• RFI Response to House Education & Workforce Committee’s RFI on ERISA (March 15, 2024)
• Letter to the Senate on Purchaser Policy Priorities (September 24, 2024)
• Senate Briefing on Health Care Price Transparency with the Public Interest Research Group (“PIRG”) (November 19, 2024)
• Letter to the Trump Administration on Price Transparency Improvements (March 26, 2025)
• RFI Response to CMS TiC Implement of Prescription Drug MRFs (July 2, 2025)
• RFI Response to CMS Hospital Price Transparency Enforcement RFI (July 21, 2025)
• Statement for the Record on Senate HELP Hearing on Health Care Affordability (July 31, 2025)
• Comment Letter on CMS’s CY 2026 OPPS Proposed Rule (September 15, 2025)

Engaging Education on Effective Purchasing and Strategies for Success

Our annual events, webinars and roundtable discussions serve as vital platforms for dialogue, knowledge sharing and strategy development among the most passionate, dedicated and innovative benefits leaders. These events have spotlighted learnings and insights throughout the PBGH Health Care Data Demonstration Project and the strategies employer participants are using for effective purchasing and accelerating meaningful change.

UPCOMING EVENT:  Register to attend our virtual event, Are We There Yet? Making Transparency Work for Purchasers and Patients, September 24, 9:30 a.m. – 12:00 p.m. PT, for insights from the PBGH Health Care Data Demonstration Project. The project has achieved an industry-first: pushing the boundaries of data access and analytics to create a coherent view of transparency data, comparative commercial health data, employer data, and quality and safety data to strengthen employers’ fiduciary compliance. Register Today!

Contributing to Dialogue on Health Care Affordability

PBGH consistently advocates for transparency as a cornerstone of health care reform. Our leadership team, including CEO Elizabeth Mitchell, are frequently called upon to share their knowledge and insights. Our leaders emphasize the critical role of transparency data and data access in empowering employers to be prudent fiduciaries.

Here are some of our recent engagements:

• NAM Commission on Investment Imperatives for a Healthy Nation Commissioner Meeting 
• Why it’s hard for corporate America to buy the best health care for employees
• Want to Lower the Price of Eggs? Start With Health Care Costs.
• Employers are frustrated by rising healthcare costs, and they’re demanding changes
• Hospitals face more pressure for transparency in prices, and lower prices

Transparency is not just a dataset. It Is a catalyst for accountability and health system reform.

Our stewardship in sharing our methodology, outcomes from the PBGH Health Care Data Demonstration Project, key learnings and comparative commercial benchmark data is to develop and share practical tools so employer fiduciaries can make strategic and informed decisions about their health care spend to ultimately benefit millions of American workers and their families. Together, employers can leverage their purchasing power and collective action to compel positive change in health care.

Achieve Fiduciary Excellence: Contact PBGH Advisory Services

The PBGH Health Care Data Demonstration Project was led by PBGH Advisory Services, an independent, unconflicted expert advisor that has earned employer trust in managing the complexities of fiduciary risk, and evaluating and negotiating high-quality, cost-effective health care benefits for employees.

PBGH Advisory is scaling tools used in its PBGH Health Care Data Demonstration Project to help employers and public purchasers across the country achieve fiduciary excellence. To get started, contact Aurora Chen, Vice President, PBGH Advisory Services.

PBGH Health Care Data Demonstration Project

Strengthen your fiduciary governance and optimize your purchasing strategies with unprecedented insights into the real cost and value of commercial health care. The groundbreaking PBGH Health Care Data Project takes a deep dive into the black box of health care pricing by leveraging newly available Transparency in Coverage (TiC) and Hospital Price Transparency files, combined with quality and safety data and employer and purchaser claims, in a first-of-its-kind analysis.

Generously funded by Peterson Center on Healthcare, the pilot project included five large, self-insured employers and public purchasers, covering 10 regional markets across the U.S.

The highly anticipated report highlighting the results of this project is now available!

Download the Full Report

Access the groundbreaking findings and insights from the PBGH Health Care Data Demonstration Project.

Download Report

Download a copy of the report to access useful insights, including:

• Never-before-seen commercial pricing and quality benchmarks for select common procedures and services
• The utility and limitations of price transparency data and opportunities to address these gaps
• How employers and public purchasers can leverage data insights to hold their service providers accountable and to inform strategic health care purchasing decisions to improve affordability and quality.

For more details on the underlying methodology for this data analysis, please view the recently published white paper “Creating a Data Framework by Combining Health Care Cost Transparency and Quality Data for Purchasers”

If you have additional questions about this work or are interested in opportunities to participate in future project phases, please contact Aurora Chen, Vice President, Advisory Services.

Inclusive Health Workgroup

PBGH’s Inclusive Health Workgroup, launched in fall 2024 and co-chaired by Jonathan Liu, MD, FACP and Taylor Priestley, MPH, MSW, Covered California, aligns employers and public purchasers on purchasing priorities and standards for achieving high-quality and equitable care, experiences and services across all populations.

The Inclusive Health Workgroup, in partnership with external stakeholders and subject-matter experts, has developed a suite of Inclusive Health tools and resources including:

• Inclusive Health Attributes that define purchaser expectations for the care employees and their families receive in all health care settings
• Inclusive Health Purchasing Principles that can be used to guide the procurement of inclusive care and services
• Inclusive Health Vendor Assessment and Member-Only Scoring Grid that can be used to assess and identify carriers and vendor partners that demonstrate their ability to provide fair outcomes, experiences and high-quality health care services
• Inclusive Health Issue Brief that outlines the role of purchasers in improving inclusive health outcomes and examples of successful purchaser strategies

For questions regarding PBGH’s Inclusive Health work or opportunities to partner, please contact Lauren Remspecher (lremspecher@pbgh.org).

Intensive Outpatient Care Program (2012-2015)

The Intensive Outpatient Care Program (IOCP) was a three-year initiative led by the California Quality Collaborative from 2012 to 2015 through a CMS Innovation Center grant. The program supported 23 participating provider organizations serving over 15,000 Medicare beneficiaries across Arizona, California, Idaho, Nevada, and Washington in adopting a patient-centered, team-based care model to manage high-risk, medically complex patients. IOCP focused on improving clinical outcomes, enhancing patient experience, and reducing the utilization of high-cost care services such as emergency department visits and hospitalizations. The program enrolled over 9,500 patients, particularly targeting those whose outcomes could be significantly improved through enhanced care coordination.

Program Overview

IOCP provided a comprehensive framework for integrating intensive outpatient care into participating healthcare organizations’ existing services. Key elements of the program included:

• Multidisciplinary Team-Based Approach. Central to the IOCP model was a care coordinator who served as the primary link between patients and their care teams, including primary care, specialty services and community resources.
• Comprehensive Care Coordination. The program emphasized coordination of medical, behavioral and psychosocial care tailored to the needs of patients with chronic illnesses and multiple comorbidities.
• Patient-Centered Care Planning. Care coordinators worked with patients to develop individualized care plans that aligned with their personal health goals and needs.
• Support for Self-Management. Patients were provided with tools and resources to manage their conditions effectively, reducing dependency on emergency and inpatient services.

Participant Support 

IOCP participants received:

• Funding and Grants. Financial support to implement and sustain the intensive outpatient care model.
• Training and Curriculum. Access to a comprehensive training curriculum focusing on patient-centered care, care coordination and self-management strategies.
• Peer Learning Opportunities. Regular learning sessions and workshops to share insights, strategies and best practices among peers.
• Technical Assistance. Ongoing support from CQC and its partners, including expertise in care model design, data analytics and quality improvement.

Program Outcomes

IOCP achieved significant improvements in both patient outcomes and health care utilization:

• Reduction in Depression Symptoms. The program reported a 33% improvement in average PHQ-9 scores among participants, indicating better management of depression.
• Reduction in Cost of Care. 21% reduction in cost of care for high-risk patients enrolled for at least nine months.
• Increased Patient Activation. 3.6% patient engagement increase of patients advancing to a higher level of activation.
• Health Status Improvement. Participants showed a 3.4% increase in mental health composite scores and a 4.1% increase in physical health composite scores, according to the Health Status Survey (VR-12) results.

Funding

IOCP was made possible by the generous support of the Centers for Medicare & Medicaid Services.

Cal-IN Peer Group (2024)

In partnership with the Collaborative Family Healthcare Association, the California Quality Collaborative (CQC) is hosting quarterly virtual peer group meetings for individuals working to integrate behavioral health care into the primary care setting in California.

Participant Benefits

Participants of the Cal-In Peer Group will have the opportunity to:

• Connect with peers within California’s behavioral health integration space
• Share behavioral health integration experience, including challenges and successes
• Brainstorm and commit to potential future collaborations

Meeting Dates

The Cal-In Peer Group 2024 virtual meeting dates are:

• Saturday, March 30 | 12 – 1 p.m. PT
• Wednesday, June 26 | 12 – 1 p.m. PT
• Wednesday, September 18 | 12 – 1 p.m. PT
• Wednesday, December 4 | 12 – 1 p.m. PT

How to Join

Those interested in participating should complete this interest form and CQC will follow up with you soon.

California Medicare Collaborative

California’s over-65 population is diversifying and growing faster than any other age group. By 2030, it will represent a quarter of the population, which means addressing their unique health and long-term care needs will become critical, requiring creative solutioning for the delivery ecosystem. Medicare beneficiaries tend to have chronic conditions, need a variety of providers and services and may experience daily living challenges, leading to difficulty navigating a complex system of medical and nonmedical services when seeking to live a healthy, safe life at home. Medicare-only individuals are often forgotten in their struggles to finance and access the services and support they need across the health care, behavioral health, and long term services and supports delivery systems.

To address this need, the California Quality Collaborative (CQC), The SCAN Foundation, Archstone Foundation, Gary and Mary West Foundation and Department of Health Care Services Office of Medicare Innovation and Integration, will launch the California Medicare Collaborative, a one-year stakeholder alignment effort beginning in March 2024, dedicated to improving care across the spectrum of Medicare enrollees, including duals, non-duals and those in traditional Medicare and Medicare Advantage programs.

Goals and Areas of Focus

The collaborative will focus on the following four areas:

• Cognitive and behavioral health
• Chronic illness management and care coordination
• Support consumer choice in a confusing market
• Access, equity and disparities in care

CQC’s goal is to gain consensus within each focus area by the end of 2024 on opportunities for action that can be achieved through alignment and partnerships among California delivery system stakeholders and to secure commitment from these stakeholders to support implementation of those action steps following the close of the collaborative.

Participants

CQC, along with the Department of Health Care Services’ Office of Medicare Innovation and Integration (OMII) and our funders, is seeking to involve a wide range of stakeholders. This diverse representation will ensure that a range of organizational perspectives influencing Medicare care delivery in California are considered. Participants will have the opportunity to forge valuable connections with peers and actively contribute to shaping the future direction and strategy of California’s Medicare system.

Support

This program is made possible thanks to the support of The SCAN Foundation, the Archstone Foundation and the Gary and Mary West Foundation, in collaboration with the Department of Health Care Services Office of Medicare Innovation and Integration.

Comprehensive Maternity Care Workgroup

The United States has the highest rate of maternal mortality among wealthy nations. Moreover, women of color are more likely than white women to die from complications of childbirth, and access to maternity care is decreasing as maternity care deserts – counties with limited or no maternity care – become increasingly common. Employers pay for more than half of the births in the U.S. and can play a significant role in impacting maternal and infant health outcomes on behalf of workers and their family members.

PBGH’s Comprehensive Maternity Care Workgroup, launched in summer 2022 and co-chaired by Qualcomm Incorporated and Walmart, brings together employers and public purchasers to achieve high-quality, affordable and equitable health care for mothers and babies.

The workgroup, in partnership with other stakeholders and subject-matter experts, has developed tools to advance that goal, including a shared standard to define Comprehensive Maternity Care, a purchaser Priority Maternity Measure Set to ensure accountability and transparency and the PBGH Comprehensive Maternity Care Common Purchasing Agreement, which provides benefit design and purchasing recommendations for employers and public purchasers, health plans and providers. These tools are intended to help ensure public and private purchasers are purchasing accessible, high quality and equitable maternal care for their workers and family members.

For questions regarding PBGH’s maternal health and birth equity work or opportunities to partner, please contact Lauren Remspecher (lremspecher@pbgh.org).