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.
AMPS RBR Solution
AMPS’ RBR solution provides a Health Plan reimbursement methodology based on the fair market value of the services rendered, optimizing every health care dollar spent. The result is a fair, transparent, defensible and therefore sustainable solution. (Chart below shows spread in actual hospital costs as reported to the U.S. Government vs. hospital billed charges vs. what PPOs are paying.)
ELAP RBR Solution
ELAP is a co-fiduciary to your plan and it is our responsibility to make sure your plan assets are appropriately managed.
BAS has partnered with ELAP, a leader in fiduciary protection. We work together to shield our members by auditing claims riddled with exorbitant charges from healthcare facilities, and to provide legal defense if balance billing or a collection attempt occurs. ELAP becomes the co-fiduciary of the health plan in the event of balance billing or a collections attempt.
ELAP is saving our clients an average of $150,000 per 100 employees the first year on our program or an average reduction in overall healthcare spend of 25% off the previous year (not trend, but actual spend).
We modify the plan documents to ensure clarity in how the claim will be reimbursed and the plans responsibility. 120% of Medicare or 112% of cost, the greater of the two.
Reference Based Pricing reimbursements average approximately 70% off the Facility billed charge.