Reference Based Pricing
Healthplan reimbursement based on the fair market value of the services rendered.
Reduces healthplan spend
Improves operating margins
Lowers out of pocket expenses
Data Driven Pricing
Reference Based Pricing (RBP), also commonly known as Cost Plus Pricing, offers self-insured plans a defined benefit structure based on more economical reimbursement levels designed to be fair and reasonable to providers based on various pricing data sets, most notably Medicare. (Chart below shows spread in actual hospital costs as reported to the U.S. Government vs. hospital billed charges vs. what PPOs are paying.)
Employers are driving a trend toward alternative medical cost management seeking reprieve from inflated medical pricing and PPO overpayment. It is apparent we are paying too much for our care, and RBR is a solution growing exponentially in use that provides patient’s choice, saves employers money, and provides quality care. RBR eliminates the need for a PPO.