Meritain Health, an Aetna owned TPA, has developed a program in partnership with HealthCare Blue Book, that provides self-funded plans a viable solution to the high health care costs associated with traditional managed care plans.
Reference based pricing makes sense. For example, why should one employee get paid more than another for an MRI? Medical insurance indemnifies the insured, who in turn pays the provider. Assignment of Benefits is simply a billing function courtesy extended by the provider of medical services.
Reference based pricing solves the unequal medical “pay” problem among plan participants. It incentivizes the insured to check costs, something alien to many who have experienced managed care since the early 1980’s. Money affects behavior, OPM (other peoples money) drives ever increasing medical inflation and over utilization. Managed Care Plans are being replaced with Managed Money Plans.