We’ve seen in talking with our customers and mingling with the greater industry at large at conferences: the endless frustrations regarding payer negotiations.
Providers sit across the table from payers who have near-complete visibility into market rates, utilization patterns, and contract performance. Providers, historically, have not had the same advantage. Transparency in Coverage was supposed to change that. Whether it actually has is a different question.
We decided to find out.
The survey
In collaboration with the Healthcare Financial Management Association (HFMA), Trek Health administered a survey across provider organizations ranging in size, type, and market to assess how the industry is operationalizing TiC data, where the gaps are, and what the downstream financial consequences look like when payer intelligence is incomplete.
We organized our questions around four domains:
- Negotiation Readiness and TiC Adoption: Are organizations actually using TiC data? How confident are they in their market benchmarks heading into negotiations? What barriers are getting in the way?
- Financial Exposure from Incomplete Payer Intelligence: Where is revenue being left on the table? How are organizations forecasting reimbursement shifts driven by payer policy changes, and where are they falling short?
- Revenue Leakage Risks: What risks are organizations carrying into negotiations, and how are they thinking about payer non-compliance, inconsistent payment practices, and opaque reimbursement methodologies?
- Strategic Growth and Market Expansion: When organizations are evaluating new markets or service-line investments, how data-ready are they? Are they modeling ROI with actual rate intelligence, or working from assumptions?
What the data is already telling us
The data confirmed what we suspected: nearly two-thirds of respondents say forecasting reimbursement shifts driven by payer rate changes and policy updates is often or always challenging. Almost a quarter don't know how their organization uses TiC data at all. The single greatest revenue leakage risk was determined to be payer policy changes that aren't reflected in current contracts, with 68% of respondents citing it as their largest revenue risk. Meanwhile, the dominant approach to understanding competitive position in the market is still consultant-led benchmarking studies. The full picture is more nuanced, and more actionable, than any of that alone.
Why it matters
The barriers organizations cited, including time constraints, resource limitations, and data quality concerns, are legitimate. They are also solvable, and the financial exposure from not addressing them accumulates over time. Every contract cycle where an organization enters without accurate market benchmarks is an opportunity for rate concessions that did not need to happen.
TiC data exists. The challenge the industry is still working through is how to operationalize it, moving from raw machine-readable files to actionable intelligence that shifts outcomes at the negotiating table. That is the question this survey was designed to pressure-test.
The full report drops later this week.
