Price transparency tools are table stakes in today’s healthcare economy. But despite rising demand, performance is falling short. While 63% of employers say these tools are very important, only 47% rate their current tools as excellent. That 15-point gap is a clear call to action—and a major opportunity for payers and TPAs to lead.
New research from Zelis and Datos Insights breaks down what’s working, what’s missing and how stakeholders can close the gap to deliver real value for members, employers and stakeholders.
TL;DR
- Payers and TPAs face a critical opportunity to close the gap between transparency expectations and current tool performance.
- Embedding transparency into natural workflows reduces friction and boosts member engagement.
- Real-time, personalized data is essential for building trust and guiding high-value care decisions.
- Employer collaboration is becoming a key differentiator for demonstrating ROI and value.
Why Rising Healthcare Costs Make Price Transparency Essential
When done well, transparency tools empower members to choose the right care and avoid unnecessary spending. For payers and TPAs, delivering these capabilities shows value, drives competitive differentiation and supports client retention.
Sixty-eight percent of healthcare members say their healthcare costs have increased over the past two to three years. Nearly half of those report increases of five percent or more.
As budgets tighten, both employers and members are actively seeking ways to better understand and manage their healthcare expenses.
That’s where healthcare price transparency tools come in — or at least, where they should come in.
Four Proven Ways to Improve Price Transparency Tools for Payers and TPAs
Whether you’re supporting employers or guiding members, transparency tools must work seamlessly across every interaction. These four improvements help you get there.
1. Embed Transparency into Natural Workflows
Integrate transparency into existing tools—provider search, appointment scheduling, pre-authorization and care navigation—so members don’t have to hunt for cost information.
2. Design with Generational Diversity in Mind
Younger members expect mobile-first design; multi-generational users rely on clarity, simplicity and accessible human support. A seamless experience serves everyone.
3. Ensure Complete, Personalized, Real-Time Data
Transparency tools must unify every critical data point—especially as upcoming TiC EO updates push plans toward deeper pricing visibility and accuracy.
It should include:
- Negotiated network rates
- Actual and paid rate insights
- Physician and facility fees
- Real-time deductible and out-of-pocket data
- Quality ratings and value indicators
When members see real numbers—negotiated, billed and paid—confidence rises. Incomplete or outdated data erodes trust, but full, accurate insight empowers smarter decisions.
4. Partner with Employers on Strategy and Results
Use employer insights to refine tools, identify savings opportunities and share ROI reporting that demonstrates real impact on member decisions.
When transparency feels embedded, contextual and personalized, it stops being a research project and becomes part of everyday care decisions.
The Future of Transparency: Three Must-Have Capabilities
Transparency is evolving beyond static estimates into real-time, personalized guidance. These three capabilities define the future.
1. End-to-End Guidance
Move members from estimate → decision → financial planning in one continuous experience.
2. Integrated, Real-Time Data
Use modern API integrations to unify claims, benefits, quality and financial data—and make it accessible across every channel, from IVR to customer service to digital touchpoints.
A single real-time source of truth keeps answers consistent and builds trust.
3. Personalization Powered by Analytics
Pair price transparency data with engagement tools, navigation support and predictive insights to drive smarter decisions.
When transparency tools evolve in this way, everyone benefits. Members make informed choices. Employers see lower costs and higher satisfaction. And payers and TPAs build stronger, more trusted relationships.
The next wave of transparency is not just about showing prices — it’s about guiding people to better choices, with confidence.
How Payers and TPAs Can Lead the Next Era of Price Transparency
With costs rising and demand for clarity growing, TPAs and national payers are positioned to lead—not just by meeting regulatory requirements, but by delivering intuitive, trustworthy tools that guide members to better decisions.
To get there, they can focus on three high-impact areas:
1. Smarter, Connected Data
Break down data silos and unify what members actually need:
- Real-time claims and benefit accumulators
- Provider quality, cost and network status
- Deductible, HSA/FSA and plan-specific financial information
- Historical claims, episodes of care and treatment pathways
When this data flows together, members finally see the full picture—not numbers in isolation.
Integrated data and rate-based insights help members compare provider vs. facility costs, understand episodes and bundles and make more confident decisions.
2. Design That Reduces Cognitive Load
Too many transparency tools feel like research projects. Instead, prioritize:
- Clear comparisons instead of long lists
- Personalized recommendations based on coverage and past utilization
- Proactive nudges that highlight optimal care choices
- Mobile-first experiences that meet consumer expectations
- Plain-language explanations of costs, coverage and next steps
A well-designed tool turns a stressful search into a confident choice.
3. Deeper Employer Collaboration
Employers expect more support than ever. Payers can strengthen partnerships by:
- White-labeling tools for a unified employee experience
- Sharing insights on utilization trends and savings opportunities
- Helping HR teams define and communicate “what good transparency looks like”
- Co-creating wellness, navigation and cost-education campaigns
When employers feel supported, they become champions of the experience—and that builds long-term relationships.
Turn Compliance into Competitive Advantage
By investing in better design, smarter data integration and tighter employer collaboration, transparency can shift from a checkbox to a strategic differentiator.
Ready to turn transparency into measurable ROI? Zelis can help you get there.
Source: Proprietary research commissioned by Zelis and led by Datos Insights, 2025.
