A Foreword from Clarify Health’s President & Co-Founder, Todd Gottula: 

The White House’s call for greater price transparency underscores the broader shift from standalone analytics tools toward integrated solutions and AI-driven partnerships. By embedding accurate, real-time pricing data into clinical and financial workflows, healthcare organizations can evolve beyond compliance and begin delivering truly outcome-based, patient-centric services. This approach requires not only advanced analytics and interoperability, but also the kind of consolidated expertise that’s emerging through M&A and collaborative ventures—ensuring that actionable cost insights are woven into every aspect of care delivery.

The future of healthcare price transparency: challenges and opportunities

On February 25, 2025, the White House issued an executive order titled “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This policy directive reinforces and expands previous efforts to improve price transparency in healthcare, aiming to equip patients with the necessary information to make informed decisions about their care. While this represents a significant step toward a more competitive and consumer-friendly healthcare system, longstanding challenges must be addressed to ensure its success. Addressing these challenges will require advanced data analytics and the integration of pricing insights into payer-provider workflows to enhance accessibility and usability.

A renewed focus on transparency

The executive order makes it clear that price transparency is essential for consumer empowerment and market-driven competition. As stated in the order, “It is the policy of the United States to put patients first and ensure they have the information they need to make well-informed healthcare decisions.” By mandating that hospitals and health plans disclose actual prices rather than estimates, the policy seeks to eliminate the opacity that has historically made it difficult for patients and employers to compare costs.

However, implementing and enforcing these mandates effectively is a challenge. While previous transparency regulations laid the groundwork, audits of compliance have shown mixed results. The order acknowledges this, stating that “The Federal

Government will continue to promote universal access to clear and accurate healthcare prices and will take all necessary steps to improve existing price transparency requirements.” But achieving meaningful transparency requires more than just regulatory oversight; it demands a concerted effort to standardize data reporting, ensure accuracy, and make the information digestible for stakeholders across the healthcare ecosystem.

Challenges in making price transparency work

Despite the clear intent of the executive order, price transparency efforts have historically faced a number of roadblocks:

1. Data Inconsistencies and Accuracy Issues – Recent analyses of price transparency data have revealed significant inconsistencies. The Peterson-KFF Health System Tracker found that some providers report rates for services they do not offer, while others display identical rates across multiple services—both of which raise questions about data reliability. Additionally, hospitals and insurers use different rate structures and reporting methods, making cross-comparisons difficult.
2. Lack of Standardization – Even when price data is available, the way it is structured varies widely between health plans, hospitals, and other entities. Without a uniform format, patients and healthcare organizations struggle to make meaningful comparisons.
3. Complexity of Healthcare Pricing – Even with access to pricing information, patients may still find it difficult to interpret what the costs mean in practice. Factors such as out-of-pocket expenses, variations in negotiated rates, allowed amounts and coverage limitations make it hard to determine the actual financial impact of a medical service.
4. Enforcement and Compliance Gaps – A key component of the executive order is its renewed emphasis on enforcement. The order calls for more robust audits and regulatory actions to hold organizations accountable for non-compliance. While this is a necessary step, enforcement alone may not resolve underlying issues related to data quality and usability.

How the Industry Can Adapt

To make price transparency effective, healthcare stakeholders—including providers, insurers, and technology firms—must take proactive steps to improve how pricing information is collected, shared, and utilized.

• Enhancing Data Accuracy – Organizations should invest in systems that validate and standardize price data, ensuring that patients and employers receive meaningful, accurate information.
• Leveraging Advanced Analytics – Artificial intelligence and machine learning can help identify pricing anomalies, flag inconsistencies, and provide more accurate cost estimates tailored to individual patients’ insurance plans.
• Improving Integration with Healthcare Systems – Embedding price transparency data into electronic health records (EHRs) and provider workflows can help ensure that cost information is available at the point of care.
• Empowering Employers and Consumers – Employers, as major purchasers of healthcare, can play a pivotal role by advocating for clearer, standardized pricing and leveraging price transparency tools to negotiate better rates for employees.

Looking Ahead

While the executive order lays out an ambitious vision for healthcare price transparency, its success will depend on collaboration across the healthcare industry. Standardization, enforcement, and technological advancements will all be critical to transforming raw price data into actionable insights that benefit patients, providers, and payers alike.

The healthcare industry is at a pivotal moment where leveraging intelligent data platforms, automated compliance monitoring, and real-time pricing insights can bridge the gap between policy and practical implementation. By investing in solutions that streamline data collection, improve accuracy, and integrate transparency into provider workflows, healthcare leaders can help build a system that is not only compliant with regulatory mandates but also truly benefits patients and organizations navigating the complexities of healthcare costs.