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. 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 (March 2025)
• Congressional Resource: Achieve Fiduciary Excellence and Hold Vendors Accountable to Quality Care at a Fair Price (March 2025)
• 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.

Inclusive Health

Employers and public purchasers have made it a priority to ensure that the care they purchase on behalf of employees and their families is inclusive and leads to high-quality, fair health outcomes across all populations served.

That’s why PBGH created the Inclusive Health workgroup to align public and private purchasers on purchasing priorities and standards for achieving high quality and equitable care, experiences, and services for all employees and families.

PBGH Sponsorship Opportunities

The Purchaser Business Group on Health (PBGH) is pleased to collaborate with innovative organizations to drive more affordable, high-quality, and equitable health care for employees and their family members.

Interested in partnering? Learn more about opportunities to connect with the country’s largest employers and public purchasers through our highly anticipated events, including:

• Health Policy Summit (March – Washington D.C.)
• Member Retreat (June – California)
• Annual Summit (December – TBD) Limited remaining for 2025!
• Innovation Series (Virtual)

View 2026 Prospectus

Tiers are expected to sell out quickly, so early commitment is encouraged. To confirm your selection, please return the sponsor agreement form on the last page of the prospectus.

For questions, please contact Lauren Remspecher.

Moonshot Awards

PBGH members have established ambitious goals centered on advancing quality, driving affordability and fostering equity in health care. Through this annual award process, we recognize innovative employers and public purchasers that are reimagining the status quo to achieve their health care and benefits moonshots.

We have four award categories:

1. Advanced Primary Care
2. Health Care Affordability and Accountability
3. Maternal Health and Birth Equity
4. Well-being and Health Equity

Eligibility

PBGH member organizations are eligible to apply for recognition on an annual basis. To learn how to become a member, contact Lauren Remspecher.

PBGH Advisory Services

As the market dynamics shift and new regulations emerge, PBGH ensures your organization is poised to navigate the complexities of the Consolidated Appropriations Act (CAA). With ERISA’s “prudent expert” standard now applied to health plan fiduciaries, our suite of services is tailored to ensure your organization remains compliant. We help you leverage innovative cost-saving strategies and proactively monitor your programs for optimal performance.

4 Reasons Why PBGH is Your Trusted Partner for Achieving Fiduciary Success and CAA Innovation and Compliance:

1. Unconflicted Advisor: PBGH is a mission-based organization working solely in the interest of employers and purchasers. We are an unconflicted partner dedicated to your success. We do not accept industry commissions.
2. Unparalleled Expertise: Our team, renowned for bringing health care innovations like Employer Center of Excellence Network (ECEN) and advanced primary care (APC) to market, demonstrates a proven track record in the industry. PBGH excels in bringing together public and private sectors for collective impact, fostering collaborative solutions. Our engagement in shaping health policy sets us apart, as we leverage our expertise for broader systemic change.
3. Tailored Solution: Each project is carefully customized to meet your unique requirements and objectives.
4. Clear and Fair Pricing: Our pricing is transparent and based on the scope of your project. We bill strictly time and materials, guaranteeing that you receive true value for your investment. Due to our cost structure and mission orientation, our rates are lower than typical for-profit consultants.

Fair Health Costs Initiative

The Fair Health Costs Initiative is an Arnold Ventures-backed effort by the Purchaser Business Group on Health and National Alliance of Healthcare Purchaser Coalitions (National Alliance) to mobilize employer purchasers, educate policymakers and advocate for public policies to reduce health care prices.

Resources

These resources can be used by business coalitions, employers and allies to raise awareness of critical issues affecting the cost of health care. Join the conversation.

• Communications Toolkit: A collection of resources, including fact sheets, talking points and social media posts and graphics.
• The Real Cost of Health Care: A blog series exploring the outsized role of hospital pricing in rising health care costs, and the market and legislative fixes necessary to reduce unsustainable cost increases for American businesses and families.

The Problem

The cost of health care in the U.S. is unaffordable for families and employers, and health outcomes are poor. High health benefit costs come at the expense of core business investments and hold down wages, dampen business growth and squeeze family budgets.

Increasingly high health care costs for private purchasers in the U.S. are driven primarily by high prices in the commercial sector. Hospital prices in commercial plans across the U.S. in 2018 averaged 247% of Medicare payments and the gap has been increasing. This trend is largely the result of industry consolidation and use of anti-competitive contracting practices and pricing strategies by hospitals, health systems and provider groups to gain market power. In the wake of the COVID-19 the pandemic, many providers are pursuing further consolidation and acquisitions.

The Opportunity

Although the problem of high prices in the commercial sector has been apparent for at least a decade, there is growing recognition among policymakers and purchasers that this problem must be addressed. Voters consistently name high health care costs as their top issue and government leaders feel strong pressure to respond.

We have to get at the root of the problem – the lack of functional markets in the private U.S. health care system. Effective markets require healthy competition among providers, health plans, drug manufacturers and suppliers; transparent information on quality, patient experience, health equity and prices; and meaningful choices for consumers. Unfortunately, these conditions are not met in all markets, and entrenched interests – particularly large, consolidated, health care systems – feed off of these market failures and use their political muscle to keep the broken status quo in place. This requires direct intervention.

• Regulatory and Legislative Actions to Strengthen Competition: In some market segments and geographic areas, the potential for healthy competition exists, but has been thwarted by dominant industry players. In these situations, government needs to strengthen antitrust enforcement and explicitly prohibit anti-competitive practices that have been the driver of high prices.
• Direct Government Intervention in Pricing: In other areas, the market is fundamentally broken, and it is nearly impossible to address costs through competition.  In these situations, government needs to step in to limit prices.

Past Programs

Reducing Pharmacy Costs

Businesses and employees are spending far too much on prescription drugs; high drug costs remain one of Americans’ greatest concerns. To reduce your health care costs and improve access to higher quality care, PBGH helps purchasers disrupt the complicated and opaque pharmaceutical supply chain and hold vendors accountable. The result is transformative benefit design and access to better and more transparent drug pricing for employers and their employees.

Patient Assessment Survey Program

Good patient experience with the health care delivery system is an important indicator of quality. It has been linked to multiple benefits for patients, including improved disease management, adherence to medication regimens, quality of life and health outcomes.

For more than 20 years, PBGH has been a thought leader in patient experience measurement and ran the nation’s largest program to gather patient feedback and produce annual provider organization ratings. Annually, patient opinions and experiences regarding 176 provider organizations were collected from more than 40,000 commercially insured patients.

Two core products were offered:

• Provider Organization Survey:
  • Commercial Health Maintenance Organization (HMO) and Point-of- Service (POS) patients (Adult or Pediatric)
  • Medi-Cal patients (Adult)
• Provider Survey:
  • Quarterly fielding: Commercial HMO, POS, Medicare or Medi-Cal patients (Adult or Pediatric providers)

Survey results included clinical, patient experience and cost-of-care ratings, and are made available to consumers through the California Department of Managed Health Care’s Office of the Patient Advocate Health Care Quality Report Cards website. Through 2024, performance on the Patient Assessment Survey (PAS) Group-Level Survey accounted for 30% of the bonus of the Integrated Healthcare Association’s (IHA) Value-Based Align. Measure. Perform. (AMP) program. AMP is a nationally recognized incentive program designed to drive meaningful changes that reduce costs and improve care quality and outcomes in California and nationwide. PBGH’s Patient Assessment Survey was the source of patient experience data used in the AMP program.

In June 2024, the Integrated Healthcare Association (IHA) decided to remove patient experience results from its AMP incentive payment program  in 2025. Without incentive payments to participate, there is no longer a business case for providers to collect and report the data. Given this change PBGH has determined that these changes will make the PAS program unsustainable. As such, it will sunset the program effective July 31, 2024. Current program participants have been informed of this decision and next steps.