For years, we’ve treated healthcare prices like the weather — something that simply happens to us. You get the renewal. You brace. You sign. But the prices were never random. They were just hidden. And the moment they stop being hidden, “we’ve always done it this way” stops being an answer.
That’s the premise behind Real Talk Season 2, Episode 1: Less Talk, More Action. I sat down with Marco Diaz, SVP and Global Head of Benefits at News Corp, and Shay Forbes, GM of Employer Solutions at Turquoise Health, to talk about what happens when employers stop guessing what care costs — and start acting on what they can finally see.
A $27,000 wake-up call
Shay didn’t set out to work in healthcare data. He set out to play in the NBA — until a torn ACL, and a $27,000 bill four weeks later, did what no career counselor could. The facility was out of network; the provider was in. He spent three years fighting it, and fell down the rabbit hole of how care actually gets priced.
“That kind of launched my career… and it ultimately led me to Turquoise, where what we’re trying to do is bring more transparency to how healthcare is paid.”
The tools to do that at scale finally exist. Machine-readable files — born from the No Surprises Act and price transparency rules — mean prices are now, in Shay’s words, “transparent, emphasis on the transparent, not on the easy.” Turquoise processes a petabyte of pricing data a month (yes, AWS called to ask what they were storing) and turns it into decisions employers can act on.
The logo in your pocket
Marco has spent 26 years in benefits, and he said the quiet part out loud: the insurance card in your wallet has convinced everyone it’s the main character in your health.
“90% of their relationship to healthcare during the year is just them and their doctor. You’re not going to go to every doctor in America. You’re going to go to 3. Maybe 5.”
We built the mythology that a big network equals better care. We marketed it. And now, Marco says, “it’s on us” to walk it back — because a broad network has never guaranteed a fair price. It just made the price impossible to see.
You don’t have to become a data scientist
So does every employer now need to learn SQL and query claims data at midnight? Shay’s answer was refreshingly honest:
“I will be the last person to add yet another thing to a benefits leader’s plate.”
You don’t need to be the expert. You need better questions — and partners who bring the answers. Often the highest-impact move isn’t ripping up your network; it’s a small site-of-care shift. Same doctor, different building, dramatically different price. And if your advisor isn’t putting that in front of you, Shay’s advice was blunt: ask them why. That is their job.
The age of transparency — and the 8 months that changed everything
The most electric stretch of the conversation was Marco on AI. He now sits in vendor pitch meetings running the deck against his own population in real time — generating ROI scenarios while the rep is still talking. Decisions once made on gut instinct are now made on evidence. A carrier repricing that used to take six to twelve weeks, Shay noted, now surfaces its core insights in a minute or two.
“I say AI is the age of transparency. This price arbitrage was allowed to exist because nobody knew it existed. And suddenly, here it is.”
Or, as I put it on the call: employers are finally bringing a gun to a knife fight.
What the data actually shows
Then Shay pulled up the tool, and the theory got real. Three payer networks — two national carriers and Centivo. Five New York health systems. One service line: maternity, priced as a percent of Medicare.
The spread was staggering. For the same maternity care, prices ran from 127% of Medicare to north of 300% — depending on nothing more than the logo on the insurance card. That’s not a utilization problem. That’s a price problem, hiding in plain sight.
“If employers could purchase maternity and cardiovascular services in the New York market at a top-15 national hospital at 150% of Medicare or below, we wouldn’t have a healthcare crisis.”
Quality and cost aren’t enemies — the data makes that undeniable. The “art of the possible” isn’t a sales pitch. It’s a spreadsheet.
Break up with the discount
Which brings us to the number the industry loves and shouldn’t: the discount.
“We’ve become addicted… and everybody, when they say it, also understands it’s a flawed method.”
A discount off a price nobody can see tells you nothing. Unit cost — what you actually pay — tells you everything. Marco likened unwinding decades of discount-based modeling to a game of Jenga, and he’s right that it takes care. But “table stakes” is how one national broker’s head of actuarial now describes bringing this data to clients. The market is moving. The advisors who lead with evidence — and the nerve to make a client a little uncomfortable — are the ones who’ll matter.
So where should the money go?
We ended where every Real Talk should: with what’s actually at stake. If you recovered the dollars lost to inefficient sites of care, where would they go?
Shay would reinvest in people — richer, genuinely health-oriented benefits, because “$200 toward a gym membership might go a lot further than $200 toward another doctor’s visit.” Marco would route more of every dollar to the people actually delivering care, and free up total rewards for a workforce that healthcare spend too often crowds out. He called healthcare “the elephant in the room” that “sucks the wind out of” everything else employers could offer.
Either way, the point is the same. The data is here. The tools are here. The excuses are running out.
Less talk. More action.
Watch the full conversation with Marco Diaz and Shay Forbes here.
– Ashok Subramanian
