A Collective, Stronger Approach for Employers to Secure Transparency & Accountability

Why Employers Lose Leverage Before Contracts Are Final 

Traditional health plan procurement leaves employers reviewing contract terms after vendors are selected—when leverage is already gone. By the time contract language is available, limitations often become clear—making it expensive and time-consuming to walk away. The result is familiar:

• Limited rights or access to your own claims data
• Opaque fees and incentives
• Inflexibility to innovate or contract directly with top providers to improve affordability and care quality

Employers deserve better. And federal law gives them the right to it.

A Collective Approach for Better Outcomes

Rather than accepting the status quo, five leading employers—representing nearly 200,000 covered lives—partnered with PBGH to rewrite the process and set contract expectations upfront to find partners who will meet their priorities.

This effort is not collective purchasing—each employer maintains full independence in individual decisions—but a collective effort to define baseline expectations for fairness, transparency, accountability and data access in contracting from the start. Acting together strengthened employer leverage and underscored the urgency for change, while preserving full flexibility for individual decisions.

Setting Expectations Early = Real Market Power

By signaling non-negotiables at the outset of the procurement process, employers can eliminate unaligned partners early. By proactively defining core principles and ensuring their inclusion, employers can hold vendors accountable to:

• Full access to their own claims data
• Transparency into all fees, revenue sources, and conflicts
• Flexibility to innovate and contract with high‑quality providers
• Modern contract protections that enable accountability and reflect emerging best practices

What the Market Responses Revealed

Nearly 50 carriers and administrators were invited to respond to the RFI. Vendor responses—and non-responses—revealed clear, consistent market signals:

• Resistance to change without legal pressure persists
• Transparency in compensation and conflicts of interest remains a dividing line
• Data access varies dramatically; some provide full access while others create unnecessary barriers
• Fair contracts? “Only if you are big enough” mentality still holds true with some large carriers
• Independent TPAs may struggle in areas they don’t control, yet demonstrate creativity
• Fiduciary promises undermined by network supremacy

Across the market, voluntary adoption of accountability standards remains rare—underscoring that employer leadership and policy advocacy are critical to drive lasting change.

The good news? There are a growing number of flexible and responsive TPAs and administrative partners indicating clear readiness to meet employer needs. The market is evolving with differentiated options.

A Better Path to Fiduciary Oversight and Employee Value

This approach—setting clear contract expectations early—gives employers:

• Clear insight into which vendors align with their needs
• Stronger negotiating position
• Fewer late-stage costly surprises
• Reduce time and potential wasteful administrative spend
• Plans that support better access, quality, and affordability

Employer Resources

• Vendor response and scorecards
• Implementation guidance
• Model contract lanuage

Both PBGH members and non-members can access the RFI results and supporting documents, with PBGH members enjoying complimentary access to the model contract language and de-identified RFI result summary via member portal, as well as discounted fees for additional advisory services.

For more information or if you are interested in accessing the results and/or additional PBGH Advisory Services, please contact Aurora Chen, Vice President of Advisory Services, at achen@pbgh.org