Humana,

Views: Is reference-based pricing driving the recent spate of healthcare acquisitions?

Employee Benefit Advisor

Is ubiquitous ‘in-network’ health plan model on the way out? As more employers drop their fully-insured health plans in favor of self-funding and reference-based pricing strategies that could be the case.

The insurance network has long been the cornerstone of many insurance carriers’ value propositions. But reference-based pricing plans do not make use of network contracts, and many self-funded plans see less value in obtaining these agreements.

Without a network to fall back on, the country’s leading health insurers will be on more level footing with third-party administrators for self-insured and reference-based pricing plans. That has prompted some carriers to take steps to diversify their service lines, leading them to acquire physician networks and other healthcare providers.

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