Engage, Pay Less, Get Rewarded………………………..
By Bill Rusteberg
About six or seven years ago a Hedge Fund manager called me. His firm specializes in investing in small health care startups. He was interested in learning more about Reference Based Pricing. He kept calling me periodically over the next year to “pick my brain” about the strategy and the players within the market.
One memorable call took place about a year later when he called yet again. By now we had become pretty good friends. “Bill, where do you see Reference Based Pricing going and what, in your opinion, is the next major shift in how health care is paid in this county?”
Without hesitation I replied “Cash pay point of service claim adjudication through plan assets. This would be a duplication of sorts of the PBM model wherein members present their I.D. card, it’s swiped by a claim intake clerk, the provider gets paid in seconds, the member pays nothing, and the plan pays less than a status quo managed care plan or even in some cases less than a traditional RBP plan payment.”
A traditional third party administrator is not a requirement unless the plan offers a managed care plan or RBP plan aside the Cash Pay Option.
Well, guess what? The future is here. And it’s working well.
CPO vs PPO…………………………………………………
CPO (Cash Pay Organization):
“Engage, Pay Less, Get Rewarded”
– No Balance Billing
– No Deductible
PPO (Preferred Provider Organization)
“Pay More For Less”
– Balance Billing Risk
– Increasingly Higher Deductibles
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
