Perspectives

Oxbridge Health: Turning Price Transparency Into Predictability

Based on the 2025 Health Plan Price Transparency Report by Trilliant Health

Executive Summary

In 2023, U.S. healthcare spending reached $4.9 trillion, or $14,570 per person. Employers—through their sponsored insurance programs—funded more than $1.4 trillion of that total. Yet, despite this extraordinary spend, American health outcomes remain worse than those of peer OECD nations: shorter life expectancy, higher chronic disease burden, and higher maternal and infant mortality.

The 2025 Health Plan Price Transparency Report by Trilliant Health confirms the underlying driver: price variation, not utilization. Americans don’t consume more care—they pay vastly more for the same services.

This white paper reviews Trilliant Health’s findings and demonstrates how Oxbridge Health’s Episode Benefit Plans and Episode Advantage program uniquely translate transparency into predictability. By winsorizing costs on the front end, engaging consumers through functional transparency, and deploying four controllable levers, Oxbridge offers employers and brokers the first plan design that reliably eliminates unjustified variation and restores fiduciary accountability.

1. America’s Price Problem

• Spending: $4.9T in 2023; $1.4T borne by employers.
• Per capita cost: $14,570.
• Outcomes: Worse than OECD peers despite higher spend.
• Core driver: Not utilization, but unit price variation.

The U.S. does not use significantly more care than its peers—it simply pays much more for identical services.

2. Transparency in Coverage: A New Lens

The CMS Transparency in Coverage (TiC) rule (2022) mandated that commercial insurers publish monthly machine-readable files of their negotiated provider rates.

• Historic barriers removed: Antitrust concerns, gag clauses, and opacity of contracts are no longer a shield.
• Data challenge: Terabytes of raw files, often duplicative and messy, require significant processing to yield insights.
• Trilliant Health’s role: The 2025 report processes this data at scale, turning noise into a clear picture of price variation.

3. Findings from the 2025 Trilliant Report

Inpatient Services

• Coronary bypass (MS-DRG 236): Median price $68,194, but ranging from $27,683 → $247,902.
• Variation factor: Across six inpatient procedures, average national variation is 9.1x.
• Within-state variation: Even within the same state and payer, ratios of 3.2–3.4x between hospitals.
• Same hospital, different payer: Aetna vs. UHC prices differed by ~30% at Tufts Medical Center for the same bypass.
• Quality correlation: None. Higher reimbursement does not equate to higher quality outcomes.

Outpatient Services

• Colonoscopy (CPT 45378): ASC median $1,179 vs. HOPD $3,633—a 67.5% difference.
• Savings potential: $4.5B annually if colonoscopies alone were shifted to ASCs.
• Intra-market variation: Even within a single metro area, facility-level differences are significant.

4. Implications for Employers

• Fiduciary duty: Under ERISA and Delaware law, employers must act prudently with plan dollars.
• Transparency = accountability: Employers can no longer claim ignorance of pricing inefficiency.
• Waste is systemic: Extreme variation without quality justification represents measurable waste.
• Legal and financial exposure: Inaction exposes employers to both rising costs and fiduciary scrutiny.

5. Oxbridge Health’s Solution

A. Front-End Winsorization of Costs

Every plan aims to contain runaway costs. Most rely on blunt after-the-fact measures: reference-based pricing, narrow networks, or shifting risk to employees.

Oxbridge is different. By anchoring benefits around episodes with guaranteed prices, Oxbridge winsorizes cost variation before the claim ever enters the system. The “wild tail” of the top 30% of claims is cut off in advance.

B. Functional Transparency That Engages Consumers

Transparency only matters if it changes behavior. Raw data files do not.

Oxbridge turns transparency into functional transparency: consumers see guaranteed prices at the point of decision, shop like true consumers, and share in the savings. Every smart choice made by an employee directly reduces employer costs.

C. Episode Advantage: Four Predictability Levers

Oxbridge equips employers with dials—not blunt instruments. The Episode Advantage program provides four levers that can be calibrated annually to manage trend and volatility:

1. PPO Pathway – Baseline access for member familiarity.
2. Episode Allowance – Guaranteed bundled pricing anchor.
3. Non-Covered Corridor – Discourages outlier costs.
4. Shared Savings – Rewards members for shopping below allowance.

Together, these create a flexible, predictable platform for cost control.

Conclusion

The Trilliant Health 2025 Transparency Report made the problem undeniable: vast, unjustified price variation, with no quality benefit, drives U.S. healthcare’s cost crisis.

Oxbridge Health is the first plan to translate that transparency into predictability.

• Front-end winsorization eliminates waste.
• Functional transparency engages consumers.
• Episode Advantage levers put employers in active control.

The result: employers meet fiduciary duty, employees gain agency, and healthcare finally begins to make sense.

Oxbridge Health: Transparency transformed into predictability.