Why Visibility Into Payer Rates Is a Strategic Imperative for 2025
According to Deloitte, 65% of healthcare leaders say growth is their #1 priority for 2025.
The healthcare industry is under mounting pressure to scale revenue, optimize operations, and expand access, all while navigating labor shortages, inflation, and regulatory change. In this climate, it's no surprise that leaders are zeroing in on growth as the primary objective.
But here's the reality: growth doesn’t happen without clarity. And when it comes to negotiating payer contracts, clarity is still a major gap for most health systems.
The Problem: Limited Visibility in a High-Stakes Arena
Many health systems are still negotiating payer contracts based solely on internal data or outdated benchmarks. Without insight into how their rates compare to competitors in their region or market, they’re left to negotiate blindly.
This lack of visibility results in:
- Underpaid service lines that go unnoticed for years
- Missed opportunities for high-value payer negotiations
- Difficulty justifying rate increases with hard data
In an environment where payers are investing in advanced analytics and AI to optimize reimbursements, health systems relying on outdated strategies are starting from a position of weakness.
A New Era of Transparency
The introduction of the Transparency in Coverage Rule has changed the game. Payers are now required to publicly post their negotiated rates for all covered items and services. This has created an unprecedented data opportunity, but also a significant challenge in digesting, interpreting, and applying that information.
That’s where Trek Health comes in.
Trek transforms terabytes of raw payer data into clear, actionable insights. We provide:
- Real-time benchmarking of reimbursement rates by CPT/DRG code
- Granular visibility into payer plan types, negotiation history, and geography
- Heat maps that spotlight service lines underperforming against market standards
- Executive dashboards that guide negotiation priorities and strategy
Turning Transparency Into Leverage
Visibility is not just about awareness. It’s about action.
When you can see that your reimbursement for DRG 470 (hip & knee replacement) is $17,000 while your peer down the street is getting $14,000, it changes the entire conversation.
You now have:
- The data to challenge payer resistance
- The insight to prioritize renegotiations by value
- The strategy to optimize across all facilities and payers
This is how growth goals become growth outcomes.
For Health Systems Ready to Compete
Growth doesn’t just come from cutting costs or opening new service lines. It comes from getting paid what you’re worth.
Trek Health empowers health systems to:
- Reclaim lost revenue hidden in outdated contracts
- Negotiate smarter and faster
- Align reimbursement with care quality and outcomes
If growth is the goal, data is the strategy.
Final Thought
You wouldn't shop at a grocery store that didn’t list prices. So why would you negotiate multi-million dollar payer contracts without knowing what the market is paying?
Let’s put the price tags back on the shelf.
Let’s grow with data.
White Paper
From Transparency to Prediction: Quantifying the Drivers of Physician Reimbursement Variation
This analysis uses Transparency in Coverage data to model how payers behave, not just what they pay. By linking reimbursement rates to physician characteristics, we uncover the patterns behind payment variation and transform transparency data into predictive intelligence. The result: a predictive view of rate dynamics that helps stakeholders anticipate trends and negotiate with data-driven confidence.
White Paper
Reimbursement and Reality: The Economics of Breast Cancer Treatment
While breast cancer awareness efforts often focus on screening and treatment, one critical factor remains overlooked: how care is reimbursed. Payment structures shape far more than provider margins; they influence access, equity, and patient outcomes.
In this analysis of payer rates, Trek Health uses its Transparency Platform to analyze how reimbursement for breast cancer care varies across geography, commercial payer behavior, and public policy. The findings reveal a system that rewards disease burden rather than prevention which creates inequities that ripple through the entire care process.
Inside you’ll learn:
- How reimbursement rates differ dramatically by state and payer
- Why higher disease burden correlates with higher payment, but prevention does not
- What these trends mean for provider strategy, patient access, and equity
Download the full analysis to see how transparency data can help reshape breast cancer care—turning financial insight into fairer outcomes.
White Paper
The Private Practice Playbook: Rate Negotiation Index Rankings for Specialty-Specific M&A Strategy
Physician economics are shifting as private equity and independent platforms redefine the workforce landscape. Trek Health’s Rate Negotiation Index Report quantifies the return on physician labor across states and specialties in a new lens: combining commercial reimbursement, physician salary, malpractice risk, and provider density into a single metric. This data driven foundation for smarter M&A strategy identifies the most economically sustainable opportunities across the U.S. for physician recruitment and network expansion.
According to Deloitte, 65% of healthcare leaders say growth is their #1 priority for 2025.
The healthcare industry is under mounting pressure to scale revenue, optimize operations, and expand access, all while navigating labor shortages, inflation, and regulatory change. In this climate, it's no surprise that leaders are zeroing in on growth as the primary objective.
But here's the reality: growth doesn’t happen without clarity. And when it comes to negotiating payer contracts, clarity is still a major gap for most health systems.
The Problem: Limited Visibility in a High-Stakes Arena
Many health systems are still negotiating payer contracts based solely on internal data or outdated benchmarks. Without insight into how their rates compare to competitors in their region or market, they’re left to negotiate blindly.
This lack of visibility results in:
- Underpaid service lines that go unnoticed for years
- Missed opportunities for high-value payer negotiations
- Difficulty justifying rate increases with hard data
In an environment where payers are investing in advanced analytics and AI to optimize reimbursements, health systems relying on outdated strategies are starting from a position of weakness.
A New Era of Transparency
The introduction of the Transparency in Coverage Rule has changed the game. Payers are now required to publicly post their negotiated rates for all covered items and services. This has created an unprecedented data opportunity, but also a significant challenge in digesting, interpreting, and applying that information.
That’s where Trek Health comes in.
Trek transforms terabytes of raw payer data into clear, actionable insights. We provide:
- Real-time benchmarking of reimbursement rates by CPT/DRG code
- Granular visibility into payer plan types, negotiation history, and geography
- Heat maps that spotlight service lines underperforming against market standards
- Executive dashboards that guide negotiation priorities and strategy
Turning Transparency Into Leverage
Visibility is not just about awareness. It’s about action.
When you can see that your reimbursement for DRG 470 (hip & knee replacement) is $17,000 while your peer down the street is getting $14,000, it changes the entire conversation.
You now have:
- The data to challenge payer resistance
- The insight to prioritize renegotiations by value
- The strategy to optimize across all facilities and payers
This is how growth goals become growth outcomes.
For Health Systems Ready to Compete
Growth doesn’t just come from cutting costs or opening new service lines. It comes from getting paid what you’re worth.
Trek Health empowers health systems to:
- Reclaim lost revenue hidden in outdated contracts
- Negotiate smarter and faster
- Align reimbursement with care quality and outcomes
If growth is the goal, data is the strategy.
Final Thought
You wouldn't shop at a grocery store that didn’t list prices. So why would you negotiate multi-million dollar payer contracts without knowing what the market is paying?
Let’s put the price tags back on the shelf.
Let’s grow with data.
