New Trilliant Health Report Exposes Widespread Price Variation in U.S. Healthcare

Trilliant Health, a healthcare analytics firm, has released a new report using data from the Transparency in Coverage (TiC) final rule to reveal significant variations in commercial healthcare prices across the United States. The analysis, which includes data from 2,659 hospitals and 3,491 ambulatory surgery centers, shows a “startling spread in prices” for the same procedures. The U.S. spends more per person on healthcare than any other country, reaching $4.9 trillion in 2023, yet outcomes remain worse than peer nations. While employers underwrite the majority of private health insurance for over half of Americans, they have historically lacked the information necessary to make informed purchasing decisions. 

According to the report, healthcare spending is driven by both utilization and price, and while U.S. utilization rates are not higher than in other countries, Americans pay more for the services they receive. This price problem has been obscured by federal antitrust laws and contractual gag clauses that prevented disclosure of negotiated commercial rates. Allison Oakes, Ph.D., Chief Research Officer at Trilliant Health, noted that this information asymmetry has “stifled meaningful competition between providers and insurers” and argued that a market with proprietary prices is “doomed to fail.”

The TiC final rule, issued by CMS in 2020, attempted to address this imbalance by requiring health plans to publish monthly data on negotiated rates. However, these terabyte-sized files are highly complex, limiting their usability for researchers, employers, and consumers. Trilliant’s report processes this data to uncover several key findings. At the national and state levels, price variation is extreme: for six inpatient procedures, negotiated rates varied by an average ratio of 9.1, with the cost of a coronary bypass without major complications (MS-DRG 236) ranging from $27,683 to $247,902 nationally. Even within a single state, such as Pennsylvania, UHC’s negotiated rate for a major small and large bowel procedure (MS-DRG 330) varied by a ratio of 4.8, representing a $69,391 difference at one facility. 

The report also shows payer-specific discrepancies, with Aetna and UnitedHealthcare prices for the same inpatient procedures differing by as much as 30% of the median cost. Importantly, there was no correlation between higher costs and higher quality, as shown in an analysis of 10 “best hospitals,” where more expensive providers did not consistently deliver better care. In the outpatient setting, ambulatory surgery centers (ASCs) were consistently less costly than hospital outpatient departments, with a diagnostic colonoscopy costing a median of $2,454 at an ASC—67.5% less than at a hospital outpatient department—representing potential savings of over $4.5 billion annually for that procedure alone.

The report identifies these extreme price variations as a form of systemic waste, highlighting the opportunity for employers to use newly available, granular facility-level data to fulfill their fiduciary duty under Delaware law and make more informed business decisions about healthcare benefits. “The report reveals a startling spread in prices that begs for explanation, not rationalization or justification,” said Oakes. “Employers finally have the information they need to understand the value of the healthcare services they purchase and that their employees receive, while hospitals and payers can be held accountable for value for money.”