For years, behavioral health reimbursement has operated as a black box. Providers had little visibility into how their rates compared to peers, negotiations happened every three years (or more), and conversations with payers were often contentious at best.
That’s changing – and rapidly.
In a recent conversation with Rafiq Ahmed, CEO of Serif Health, our SVP of Operations Brett Reed sat down to discuss how Prosperity Behavioral Health is using price transparency data to fundamentally transform how behavioral health providers approach payer relationships.
From Out-of-Network to Strategic Partnership
The behavioral health landscape has shifted dramatically in recent years. When Prosperity was founded in 2017 by former investment bankers who saw firsthand the financial opacity plaguing addiction treatment facilities, most providers operated out-of-network. Payers weren’t paying close attention to the space, and providers weren’t thinking strategically about contracting.
“In 2019, most of our customers were out-of-network providers,” Brett explains. “They didn’t even think about being in-network with payers as a strategy. That’s completely changed.”
The shift mirrors broader behavioral health market dynamics. During COVID, the focus was entirely on access – getting people connected to mental health and substance use disorder treatment when they needed it. Now, payers feel confident about access and are laser-focused on quality.
“Payers are saying, ‘How do we make sure our in-network providers are the best ones possible for our patient population?'” Brett notes. “It’s about being in-network AND demonstrating quality.”
The Problem: Negotiating Blind
This transition created an urgent challenge for Prosperity. The company had outsourced all contracting work to third parties – a purely transactional approach where contracts were renegotiated every three years with no data-driven strategy.
“Providers would say, ‘Last time I was at $100 per unit. Now I want $110 because three years passed,'” Brett recalls. “We were negotiating blindly.”
Even with Prosperity’s substantial customer base, internal data had gaps. Without comprehensive market benchmarks, the team couldn’t confidently advise providers on their competitive position. Customer anecdotes – “my buddy down the street gets this rate” – couldn’t be validated or refuted.
The situation became untenable. “We couldn’t conceivably build this business in a scalable way without a solution to support that,” Brett says.
The Solution: Making the Invisible Visible
Enter price transparency data.
Following federal regulations requiring payers to publish their negotiated rates, companies like Serif Health began transforming massive, unwieldy datasets into actionable intelligence. For Prosperity, this represented an opportunity to completely reimagine their contracting approach.
The team conducted extensive diligence, evaluating multiple price transparency vendors. Serif Health stood out for three reasons:
1. Responsiveness and Partnership Approach – “Anytime you’re entering a partnership, you want to work with genuine folks willing to understand your problem set deeply and be honest about gaps and abilities,” Brett explains.
2. Flexible Product Integration – Prosperity had a “crawl, walk, run” strategy: initially using data internally, then as a reporting service, eventually integrating it into their product suite, and long-term building new products on top of it. Serif’s willingness to support this vision was critical.
3. Collaborative Problem-Solving – “We’re thought partners sitting on the same side of the table,” Brett says. “They’re taking notes on our use cases to apply more broadly, and we’re learning from their experience.”
From Black Box to Benchmark: Early Wins
The impact of having reliable price transparency data has been immediate and multifaceted.
Managing Customer Expectations
Behavioral health providers are passionate about their work – many come from the recovery community themselves. When reimbursement pressure mounts, emotions run high. Price transparency data brings objectivity.
“Step one has been managing expectations around where providers are today and where they can get in the next couple years,” Brett explains. “In some cases, they’re already market leaders setting the benchmark. In others, they’re slightly under market but we can get them there. That’s been a huge win – it’s taken the adversarial edge off.”
Transforming Payer Conversations
Perhaps most significantly, transparency data has fundamentally changed the dynamic with payers.
Brett shares a memorable early example: a Florida provider who hadn’t seen a rate increase in five years and was certain they were being underpaid. Armed with benchmark data, Prosperity approached the payer with a clear, fact-based case.
“The payer agreed that the benchmark data was accurate – that validation was critical,” Brett recalls. “It focused the conversation less on whether we were right or wrong about rates and more on how we get this provider to the right spot together.”
The payer thanked Brett for the thoughtful approach, noting frustration with others who “shoot from the hip” or use the data aggressively. “They don’t want to underpay folks relative to everyone else, but they’re also figuring out what transparency data means for their business. They need good partners in that process.”
Positioning as an Extension of Provider Relations
Prosperity has taken an innovative approach: positioning themselves as an outsourced provider relations arm for payers.
“Any one of our customers individually probably isn’t hitting the mark on payer radar,” Brett explains. “But in aggregate, we represent strong interests. Provider relations is getting harder for payers as networks grow but their teams don’t. We’re providing value by saying, ‘Let us represent your interests to our customers.'”
This positioning resonates. Rather than adversarial negotiations, Prosperity facilitates multi-year strategic planning between providers and payers.
The Win-Win-Win Philosophy
Brett emphasizes a critical mindset shift: transparency data must create value for all stakeholders.
“You cannot treat this like a gotcha with payers,” he cautions. “We view this as a win-win-win: for us as the service provider, for our provider customers, and for the payers. If you approach it that way, combined with a long-term vision, it reduces anxiety and sets everyone up for success.”
This philosophy extends to realistic timeline expectations. Healthcare operates in quarters, years, and decades – not days and weeks. Providers who’ve been undermarket for years won’t see 40% increases overnight. But with data-driven roadmaps and collaborative relationships, multi-year improvement plans become achievable.
Looking Ahead: From Pricing to Value-Based Care
Brett’s vision for Prosperity’s future with price transparency data follows a clear trajectory:
Near-term: Productize payer relations capabilities to scale across the customer base and integrate seamlessly for new customers.
Mid-term: Combine transparency data with revenue cycle management data and quality outcomes monitoring to create comprehensive data products.
Long-term: Use this integrated data foundation to enter risk-based arrangements with payers.
“If we had a 90-day no-readmission guarantee backed by real data, that would change the game for our provider customers and help payers see value in what we’re doing together,” Brett envisions.
Advice for the Behavioral Health Industry
For other behavioral health organizations considering price transparency data, Brett offers two key pieces of advice:
Think Long-Term: “In healthcare, you measure time in quarters, years, and decades. You have to think 5 to 10 years from now, not just next year. That has to inform your strategy.”
Build Trust, Not Gotcha Moments: “When you combine transparency data with a 10-year vision and a win-win-win approach, you reduce anxiety in conversations. You’re not making up an undermarket rate overnight, but you are building toward a 3-to-5-to-10-year journey together.”
Brett also warns about timing: “We’re advising customers not to be late to the game. Payer networks are going to close, and you don’t want to be last in line. Work with partners who have data, leverage your quality programs, and get to critical payers now.”
The Trust Gap in Healthcare
Rafiq reflects on a broader theme throughout the conversation: “There’s a trust gap in healthcare where no one trusts anyone else. If we can focus on making this data better and helping people see what’s actually there, you have at least one piece of the foundation to rebuild trust.”
Brett agrees emphatically: “Trust is the word.”
For Prosperity Behavioral Health, price transparency data represents far more than competitive intelligence. It’s a foundation for transforming relationships, building strategic partnerships, and ultimately improving care delivery in behavioral health.
As Brett puts it: “We’re looking forward to the amazing things we can continue to build together.”
