Why Transparency Didn’t Restore Trust in Employer Healthcare

Over the last several years, transparency has been positioned as the solution.

• More data.

• More disclosure.

• More access to pricing, fees, and contracts.

And to be fair, transparency was necessary. Employers deserved visibility into how their healthcare dollars were being spent.

But something interesting happened along the way.

Visibility increased.

Trust did not.

If anything, for many employers, the gap became more obvious.

Transparency Shows You the Surface

Transparency answers an important question:

What happened?

It can show a price.

It can show a fee.

It can show variation between providers or arrangements.

But trust depends on a different set of questions:

• Why was this decision made?

• How are incentives aligned?

• Who is accountable when outcomes don’t match expectations?

You can see the numbers and still feel uneasy.

Because transparency reveals the outcome.

It doesn’t explain the structure that produced it.

Trust Is Built Through Behavior, Not Data

One of the most thoughtful comments I heard this week framed trust this way:

Trust is built through consistency, competence, and character.

That framing is hard to argue with.

Consistency means decisions make sense month after month, not just at renewal.

Competence means someone can explain the mechanics behind the outcome, not just present the result.

Character means doing the harder, more honest thing when incentives pull in another direction.

Those qualities are observable. They show up in behavior over time.

Transparency, by contrast, is informational. It tells you something exists. It doesn’t guarantee how it will be handled.

In employer healthcare, that distinction matters.

Why This Moment Feels Different

Employers are being pulled closer to decisions they used to comfortably delegate.

• Pharmacy economics.

• Care navigation models.

• Contracting arrangements.

• Value-based initiatives.

The more visible these structures become, the more employers realize that trust can’t be outsourced.

It has to be built — deliberately — within the relationships that shape their plans.

That’s changing what “good partnership” looks like across the ecosystem.

Brokers can no longer rely solely on positioning.

TPAs can’t rely only on processing accuracy.

Health plans can’t rely solely on network size.

Providers can’t rely only on clinical excellence.

All of those matter. But they aren’t enough on their own.

Trust now requires explainability, alignment, and a willingness to sit in uncomfortable conversations about incentives.

Transparency Was the Starting Line, Not the Finish Line

Transparency was an important milestone. It exposed information that should have been visible all along.

But it also exposed something deeper:

How complex and fragmented the system really is.

And complexity, when left unmanaged, doesn’t produce trust. It produces caution.

If the goal is durable confidence from employers and their partners, the work now shifts from disclosure to design:

• Clarifying roles and responsibilities

• Making incentives visible before contracts are signed

• Aligning economic structures with stated outcomes

• Demonstrating consistency over time

That’s slower work. It doesn’t fit neatly into a dashboard.

But it’s the work that builds something durable.

Moving From Transparency to Trust

Trust doesn’t emerge because information is available.

It emerges when people experience consistency.

When explanations make sense.

When actions match stated principles.

In employer healthcare, the next phase isn’t about uncovering more data.

It’s about strengthening the relationships and structures that sit underneath it.

Transparency showed us what was happening.

Now the question is whether we’re willing to build systems that make what happens worthy of trust.

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Herb On Health exists to help people across the healthcare ecosystem think more clearly about healthcare strategy, incentives, accountability, and stewardship.