Reference-based pricing is a market disruptor. It is a viable alternative to carrier-sponsored health plans where providers are paid on a Medicare Plus basis. For the first time, transparency allows consumers to price medical services prior to care being rendered. It also introduces provider accountability. Patients can access quality metrics and performance outcomes before scheduling appointments. This is in sharp contrast to traditional health plans where patients are billed after care is rendered and required to pay as presented. Employers are motivated to consider RBP plan alternatives since carrier plan assurances, over several decades have not contained cost nor managed care.

Using a cost-up pricing approach, RBP optimizes provider payments for medical services based on publicly available cost, pricing and quality data. It establishes fair pricing for medical services by geography to ensure equitable provider payments by market. In stark contrast to PPO health plans. RBP controls cost while managing medical inflation because it is tied to Medicare’s medical trend not arbitrary pricing. Critically important for RBP plans is enhanced patient/member satisfaction and improved outcomes as medical care is based on value and provider performance. Read More: BenefotsPRO