Here are my impressions and takeaways from the recent RosettaFest 2025 in Denver.

Industry observers say long-standing trends like hospital consolidation and rising health care costs contribute to the disputes, and Trump administration policies could make them more frequent as hospitals brace for about $1 trillion in cuts to federal health care spending as part of President Donald Trump’s sweeping budget law.

An arbiter selects either the provider’s or the insurer’s amount with no other option, and the losing side pays the fees.

Nine of the 10 largest PBMs share ownership with health insurers.