The Pulse of the Purchaser 2025 Survey results send a clear message: employers are fed up with hospitals abusing their pricing power—and they’re taking action to protect their businesses and working families. For the fifth year in a row, employers ranked drug and hospital prices and high-cost claims as their biggest affordability threats. Behind these sentiments is a story of eroding trust, rising frustration, and a growing demand for change.
The survey, conducted by the National Alliance of Healthcare Purchaser Coalitions, highlights three key themes that illustrate how employers are experiencing and responding to hospital pricing challenges:
- Employers overwhelmingly distrust hospital pricing practices.
Nearly all employers surveyed (99%) identified hospital prices as a leading driver of financial strain in their organization. Further, six in ten employers doubt hospital efficiency and see little evidence that consolidation has led to better value. One respondent remarked, “Hospitals should not be in business to make the money they do!”
These concerns are far broader than the high bills employers and working families are navigating and reflect an underlying systemic problem. Lack of transparency and unchecked consolidation allow hospitals to increase costs without demonstrating better outcomes, a cycle that erodes trust and inflates costs for both employers and employees.
- Employers are pushing back with data-driven strategies.
Employers are tired of band aid fixes and are looking for meaningful solutions to address their concerns. Survey results show an increased use of strategies designed to counter hospital pricing abuses in the past year, such as:
- Direct contracting with providers who offer higher value care at lower costs (44%, up from 15% in 2024).
- Centers of Excellence (COEs) that steer patients to specialized facilities with proven results (65%, up from 22% in 2024).
- Site-of-care redirection, shifting services toward lower-cost outpatient or ambulatory centers instead of hospital-based settings (48%, up from 28% in 2024).
Steady access to reliable data is critical to empower employers to make these changes. Survey findings show employers with full claims visibility are far more confident in their ability to safeguard against unfair billing and implement these strategies effectively. While large employers are leading the way, this year’s survey shows that mid-sized organizations, which comprise the majority of respondents (63%), are increasingly adopting similar measures.
- Employers recognize hospital pricing as a fiduciary and policy priority.
Employers increasingly view hospital pricing as a fiduciary responsibility. Yet, confidence in hospital billing safeguards remains low—only 40% of employers without full claims access say they are confident in fiduciary responsibilities, compared to 80% for employers with full access to claims data and transparent PBM contracts. That visibility empowers them to meet fiduciary duties and protect plan assets.
Simultaneously, employers are signaling to policymakers that market-based solutions aren’t enough. In fact, more than two in five (42%) are already engaging in state or federal health reform efforts and showing support for tougher enforcement of hospital price transparency laws.
The sentiment towards hospital pricing from this year’s survey is clear: hospital costs are unsustainable, and employers are no longer willing to accept opaque billing and inflated charges as a routine part of doing business. By leveraging direct contracting, centers of excellence, and stronger data rights, employers are reclaiming control—but support from policymakers is essential.
Hospital pricing abuse doesn’t just strain employer budgets, it drives up costs for all of us. The time to act is now.