Does Price Transparency Make Healthcare Value Calculable?

The claim

Trilliant Health’s 2026 report describes the U.S. health economy as a tragedy of the commons: individual stakeholders respond rationally to their own incentives while the system produces rising costs, uneven access and disappointing health outcomes.

The proposition that matters for purchasers comes later. Trilliant argues that price transparency has, for the first time, made healthcare “value for money” calculable. Stakeholders can use price and quality information to create accountability around value. If they do not, Trilliant expects government to continue imposing enclosure through rate setting, price caps, bundled payments, drug-price negotiation and similar controls.

What is established

The report makes a strong case that commercial healthcare prices are now considerably more observable and that they often vary substantially for the same or similar services.

Trilliant shows negotiated rates varying by geography, payer and even within the same hospital. For one joint-replacement DRG, Aetna rates in its data range from $13,290 to $117,081. The report also finds substantial differences between hospital outpatient departments and ambulatory surgery centers for the same procedures. These types of differences have been reported repeatedly from Transparency in Coverage files since their release.

Higher prices are not consistently associated with better performance on the quality measures the report examines. For four common medical conditions in Los Angeles, correlations between negotiated rates and hospital mortality or readmission measures are weak. Those measures do not explain the price spread. They also do not establish that the spread is unjustified.

What the measures cannot settle

Observing the spread does not explain it. Trilliant’s next claim is that price plus existing quality measures now make value calculable. Those measures are insufficient by themselves to establish prospective provider value.

Negotiated rates can now be stated in dollars. The quality measures paired with them do not, by themselves, support a reliable prospective ranking. A hospital that was cheaper and had lower measured mortality in a past cohort is not thereby shown to be the better choice for the next patient.

Trilliant notes that only 27% of more than 800 active CMS quality measures are outcome measures and argues that quality reporting emphasizes process, structure and patient experience. Greater reliance on outcomes does not remove the underlying measurement problem. Patients arrive with different risks. Risk adjustment improves comparisons, but observed outcomes still reflect patient characteristics, treatment, care environment, unmeasured differences and random variation.

There is a separate prospective purchasing problem. An employer may be able to estimate how many NICU admissions, joint replacements or cancer cases its population will generate in aggregate and still have much less certainty about where those cases will occur, which providers will be clinically available and how much of the utilization can realistically be influenced. As the analysis becomes more specific by service, geography and provider, expected volume fragments and randomness increases.

What transparency can support

A purchaser can use the files without a provider ranking. Transparency can identify unusual prices, site-of-care differences, network outliers and service lines that warrant additional clinical and economic review.

A purchaser does not need to establish that two providers are clinically equivalent to ask why one is paid materially more than another for a reasonably comparable service. The question at that stage is whether the price difference has an explanation that matters to the purchaser.

The evidentiary requirement is higher when the conclusion moves from “this price requires explanation” to “this provider offers better value and future utilization should be directed there.”

Trilliant itself shows that the data have not yet translated into widespread purchaser use: only 18% of large employers had conducted or received an analysis using price-transparency data as of 2025.

Enclosure around value or cost?

Trilliant presents a choice between voluntary enclosure around value and government enclosure around cost. That distinction is incomplete.

Rate caps primarily constrain unit prices and can leave fee-for-service volume incentives in place, as Trilliant notes. Other public payment models combine spending constraints with episode, utilization or quality accountability. Private purchasers can also emphasize price, quality, access or some combination of them.

The relevant issue is whether the mechanism can distinguish prices required to support appropriate care and capacity from prices attributable to market power or other unexplained factors.

Trilliant shows that substantial commercial price variation exists and that the quality measures it examines do not explain it. It does not determine how much of the remaining difference reflects necessary capacity, patient or service complexity, other unmeasured factors, or payment above what those considerations would require.

Evidentiary Ceiling

Price transparency has made commercial rates observable as negotiated dollar amounts. It has not made prospective value observable in the same way.

A past cohort in which one hospital was cheaper and had lower measured mortality does not establish where the next case should go.

The strongest supported use is narrower. Transparency can identify prices that warrant explanation and service lines that merit further underwriting. It does not by itself identify the provider to whom future utilization should be directed, nor does it distinguish needed capacity and unmeasured differences from payment above what either would require.