Hidden behind the ever-rising costs of American healthcare lies a significant leading factor: the shocking extent to which procedure pricing can vary based on facility and provider.
A 2025 report reveals that among national insurers, prices for common procedures can vary by 50% to more than 200%, with a minimal link between price and quality. In fact, hospitals with the highest price markups for elective surgeries have been found to deliver worse outcomes for patients.
Unfortunately, many plan members are unaware of these trends. Left on their own to make their care decisions in an information vacuum, many eventually find themselves facing astronomical expenses and poor-quality service — without any knowledge of the alternatives available to them.
To combat these challenges, innovative players in the healthcare sector have pivoted to a member-driven approach that provides patients the information they need to make smarter care decisions.
In this guide, we’ll explain why pricing transparency is a key solution to advancing high-value healthcare in the U.S. today, how this strategy benefits both plan members and the payers who sponsor them, and how Vālenz Health® is leading the way with our comprehensive, data-driven cost and quality transparency navigation tool, Valenz Bluebook.
Cost transparency has been a concept in the healthcare market for more than 20 years, with insurers and health plans implementing piecemeal solutions over time to varying success.
That all changed with the Transparency in Coverage (TiC) legislation.
To empower consumers and promote competition within the healthcare industry, the TiC regulations require all healthcare plans and issuers to disclose price and cost-sharing information to plan participants, beneficiaries, and enrollees. Specifically, the ruling demands real-time, personalized access to this information through digital, internet-based self-service tools.
For healthcare leaders like Valenz that had already implemented transparency tools, the TiC rulings were a long time coming and helped to standardize the concept of “transparency” across the industry. Now, all health plan members have access to detailed information about how much providers charge for certain procedures, how that cost may vary based on facility, and how much they as patients could expect to pay out-of-pocket — removing the disconnect that had previously left consumers at the mercy of providers and insurers.
Learn more about Valenz Bluebook Comply helps plans meet TiC requirements.
Price transparency is about more than just leveling the playing field for members, however. It’s a necessity for any organization that wants to improve the experience of the entire healthcare chain, from patients to payers to providers to plans.
The more information that is available to members at the start, the more informed choices they can make — a foundation that is necessary for the advancement of a value-based care system that emphasizes patient outcomes over profits.
With price transparency tools in their belt, today’s members are more empowered to make smarter, better decisions about their care — in turn, minimizing costs for themselves and plan payers in part due to the improved care outcomes made possible by better healthcare literacy and enhanced healthcare equity.
Before the TiC regulations and implementation of price transparency tools, plan members often faced uncertainty when scheduling care. The opacity of the insurance and claims process meant the exact amount of money owned after service was never 100% clear.
The pricing transparency required by the TiC rulings — combined with the balance billing protection provided by the No Surprises Act — helps reduce that uncertainty to inform members of potential estimates before scheduling care.
The results: Plan members can now actively select lower-cost providers and facilities to significantly minimize their healthcare costs.
According to a 2023 analysis, the implementation of price transparency tools was estimated to save as much as $80 billion in overall healthcare costs in 2025. Consumers choosing lower-cost options is only part of the reason; other studies reveal that top-tier service rates have fallen about 6% since legislation was enacted, although lower-tier prices have increased by 3% during the same period.
At Valenz, we see the same effect for our clients. On average, clients that implement our cost transparency solution achieve $1,500 in savings each time an employee uses the platform.
By giving health plan members transparent, easy-to-navigate pricing information upfront, today’s consumers are empowered to make informed comparisons when shopping for care, leading to smarter decisions that minimize both out-of-pocket charges and plan costs for employers.
The cost transparency tools required by the TiC rulings do more than just provide consumers with valuable pricing information. They also encourage better healthcare literacy as a whole.
By providing transparency tools to members (and encouraging their use through ongoing education and rewards programs), health plans can play a crucial role in improving members’ understanding of their care options, benefits packages, and overall healthcare journeys.
Analysis of digital literacy intervention methods shows that these initiatives can deliver measurable improvements in people’s ability to find, understand, and act on health information — all of which play a key role in their care experience.
More importantly, healthcare literacy is a significant factor in overall care outcomes, with higher health literacy linked to better adherence to treatment plans. In other words, the more educated a member is about their choices, the more engaged they can be with their healthcare journeys — and transparency tools make that much easier.
By reflecting estimated costs before care is scheduled, price transparency tools remove a key barrier to accessing care and, in turn, make it easier for members to seek out preventive care that’s key to long-term health outcomes.
Consider a 2024 study, which analyzed the relationship between medical debt and participant wellness to find that debt is associated with worse health status, more premature deaths, and higher mortality rates at the county level in the U.S.
By increasing access to affordable healthcare (i.e. incorporating pricing transparency tools into health plans), that medical debt can be alleviated and care outcomes can be improved. Instead of delaying care due to financial concerns, members with access to pricing data are more likely to get the regular, preventive screenings needed to avoid chronic health conditions that cost them (and plan payers) hundreds of thousands of dollars over time.
While pricing transparency tools are now required by law, their true power to transform health outcomes is untapped when they are combined with other key data: care quality data.
Low-cost care is of no value unless it’s also high-quality. That’s why transparency platforms such as Valenz Bluebook incorporate cost and quality data into one system for a more comprehensive view of provider options.
By encouraging members to weigh both cost and quality information in their decision-making process, platforms like Valenz Bluebook encourage a value-based approach to healthcare — delivering affordable care options without sacrificing care quality.
Learn more about how Valenz Bluebook identifies Fair Price™ providers and facilities below.
Finally, price transparency tools provide an important benefit for underserved, vulnerable populations: improved healthcare equity.
Underserved populations — such as those who live in rural areas, experience poverty, or have language or cultural barriers to accessing care — often have trouble navigating the complex U.S. healthcare system. In many cases, they don’t have equal access to high-quality providers that other populations do, a factor that contributes to lower life expectancy and higher rates of chronic conditions like diabetes.
Price transparency tools can help bridge this gap by providing important cost and quality data that highlights those discrepancies and encourages members to choose higher-value care options within their communities. And, when combined with navigation services that personally guide members through their healthcare journeys, these digital tools can significantly improve accessibility for underserved populations in a way that traditional health services cannot.
According to one study by AKASA, 64% of Americans have never sought out pricing for healthcare services — but not for a lack of interest.
While 58% of Americans said they were willing to “shop” for healthcare if pricing information was disclosed prior to services being rendered, a lack of awareness and understanding about price transparency programs have hindered many members from using these tools to make informed care choices.
For programs that invest in member education and engagement, however, the response is impressive.
Take, for example, the case of one employer in the Southeast who implemented the Valenz Bluebook cost and quality transparency tool in 2016. Facing ever-rising healthcare costs (and a lack of tool utilization by employees), the employer realized it needed a stronger communication strategy to encourage member use of high-quality, low-cost care options as listed in the Valenz Bluebook tool.
By implementing a comprehensive rewards and communication strategy that directed members to use the price transparency tool whenever they needed care, the employer increased average utilization rates to 30.4% — an improvement that ultimately delivered $239,000 in savings and a 7:1 return on investment.
When plan members are given both the tools and education they need to evaluate their care options based on price and quality, the uptake is significant. Not only do these tools empower members to choose higher-quality, lower-cost care options, but they also build trust between employers and employees. Giving members the power to take charge of their own healthcare journeys creates a new sense of engagement, which, in turn, improves overall care outcomes (and reduces overall costs for every party involved).
To meet members’ growing demand for pricing transparency tools (and to adhere to the legal requirements of the TiC legislation), many health plans have hastily implemented their own platforms over the last few years, to varying levels of success.
As a long-time leader in this space, Valenz goes above and beyond with our Valenz Bluebook solution, offering both cost and quality transparency to inform smarter, better member choices.
With price and quality data for more than 4,000 hospitals and 500,000 physicians — plus quality rankings for more than 200 procedures and Appropriateness of Care metrics for 20 provider specialties — Valenz Bluebook provides the most comprehensive transparency tool in the market. Our color-coded, “red-yellow-green" ranking system makes it easy for members to find high-quality care at a Fair Price, with estimates based on real claims data from thousands of shoppable procedures that are risk- and volume-adjusted for accuracy.
Unlike other pricing transparency tools, the Valenz Bluebook platform is fed entirely by unbiased data sources, empowering members to make informed decisions without the obligations set by certain carrier networks. And, by including care outcomes data as part of our ranking system, we ensure members aren’t just directed to low-cost options but high-quality ones, as well.
The result: True transparency that directs members to the absolute best option for their needs, regardless of carrier or network affiliations.
When health plan members understand their options for care (including how factors like price and quality play into those options), they make better choices. And, when employers and payers enable those choices through pricing transparency tools, the entire system moves one step closer to a value-based care system — one that emphasizes patient outcomes over dollar signs for a more equitable, member-focused approach.
For today’s health plans and health plan payers, pricing transparency is no longer optional. As required by TiC regulations, members must be provided clear, accessible data that helps them make informed decisions about their care, which is where the comprehensive suite of transparency and compliance solutions from Valenz comes into play.
With our industry-leading transparency tools and TiC compliance offerings, Valenz helps make member-centered healthcare a reality, delivering better care outcomes, lower plan costs, and higher engagement among plan members.
Learn more about how our comprehensive approach can improve your benefits strategy by contacting one of our team members below.