“In 90-days you can offer your clients a legally defensible Medicare Plus model that is scalable and will eliminate the threat of balance billing to plan sponsors and their employees. Call or email today to learn more about Reference Based Pricing.”
Editor’s Note: This excerpt from Magellan Risk Management website (www.magellanrisk.com ) is another example of the dynamic and quickly evolving health insurance market spawned by the failure of managed care and continued, historically aggressive government interference in what’s left of our private health care delivery system. The upcoming HCAA annual Executive Forum (www.hcaa.org ) will include a session on Reference Based Pricing as an area of keen interest among industry insiders.
Third Party Administrators (TPAs) have long known the complexities behind PPO contracts. An arbitrary discount off arbitrary pricing is not an ideal model for transparency and risk management. With the national average charge for hospital services at 300-400% of cost, with many hospitals charging more, it’s critical that TPAs and medical stop-loss providers have the courage to address the matter of cost shifting for several reasons:
•With the complexities of ACA, many employers will drop their group health plans and send their employees to the exchanges unless plan cost are lowered (your market will dry up)
•Physicians will see lower reimbursements for members having coverage on the exchanges, thus they will be supportive of maintaining the group health model.
•Employees will not like the exchange model once they begin consuming care (fewer doctors accepting exchange plans, longer wait times, etc.)
•Although brokers hate change, with the threat of losing control of their client base, it’s in their best interest to support a model that drastically lower claims costs.
A “legally defensible” Medicare Plus model, which we refer to as Reference Based Pricing, can drastically lower claims cost and keep your client base from eroding. But is has to be done correctly and be scalable.
In 90-days you can offer your clients a legally defensible Medicare Plus model that is scalable and will eliminate the threat of balance billing to plan sponsors and their employees. Call or email today to learn more about Reference Based Pricing.
