After years of building data pipelines, directories and cost-estimation tools to meet federal price-transparency and No Surprises Act mandates, payers now face the difficult task of driving meaningful engagement. While baseline compliance is increasingly table stakes, member adoption lags — and the gap between what plans have built and what members actually use is becoming a competitive liability.
During a featured session sponsored by RevSpring at Becker’s 4th Annual Spring Payer Issues Roundtable in April, Brandon Spring, chief commercial officer and Kyruus general manager at RevSpring, walked through what he called the “now what” era — the moment when mandate-driven infrastructure either gets activated for the member experience or sits idle as a cost center.
Below are four takeaways from the discussion.
Note: Quotes have been edited for length and clarity.
1. The mandate work is largely done. Adoption is the new metric.
Health plans have routed substantial portions of their new digital budgets — in some cases up to 80% — into the data infrastructure required by federal transparency mandates. Yet member usage of cost-estimation tools sits at roughly 8% to 15%, according to research compiled by Mr. Spring.
“Think about building infrastructure with data and pipes but having no faucet to use it,” he said.
The compliance phase produced plumbing, not experience. The next phase, he argued, is making the data usable enough that members actually engage with it before they receive care.
2. Transparency failures are now showing up in membership churn.
Mr. Spring shared the case of a large Mid-Atlantic health plan that lost roughly 40,000 fully insured members in the prior year. This leakage wasn’t due to price or network adequacy, but over transparency. Members reported there was no clear way for them to understand what their plan covered or what care would cost.
When transparency tools don’t surface in the moments members actually need them, the cost of inaction shows up directly in retention numbers, not just in regulatory reports.
3. AI raises the stakes on data quality, rather than lowering them.
Mr. Spring said RevSpring has seen a 60% uptick in members and patients turning to consumer AI platforms — including ChatGPT and Claude — for healthcare questions. Without grounded, payer-curated data feeding those tools, generic models become a default source of truth.
The implication for plans: their data has to live wherever members are searching, with a grounding layer that prevents large language models from filling the gaps with bad estimates.
4. The provider directory problem is the foundation everyone keeps skipping.
Despite roughly 1.6 million provider records in the U.S., the industry has not solved a national directory, Mr. Spring said. Health system websites publish accurate provider data because their brand depends on it; the same systems then send health plans rosters with different information that gets attested to and published into payer directories.
“There is a universal truth on every single provider in this country,” he said, pointing to information such as schools attended, specialty and practice location. Fixing demographics first, before tackling more complex network tiering, is the practical opening.
Where payer leaders go from here
Members are now searching for care across four or five different sources — health system sites, payer portals, Google AI mode, ChatGPT, Claude — Mr. Spring said. Plans that keep their data inside their own four walls will lose the eyeballs that have already shifted elsewhere. The plans positioned to win the next phase, in his view, will be the ones that stop building and start putting curated data into the places members are already looking.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
