The annual Health Care Administrators Association annual Executive Forum held in Las Vegas in February 2014, addressed one of the hottest topics in today’s challenging health care delivery system – Reference Based Pricing, also known as Cost Plus Insurance.
“Reference Based Pricing provides an alternative to today’s ever-rising cost of health care. Using multiple data points, including Medicare rates, cost-to-charge ratios, and historical data as its baseline, Reference Based pricing ensures transparency and fair reimbursement for members, plans, and providers. During this session, the panelists will outline what works, what hasn’t, and what the future may look like.”
James (Jim) P. Farley is the President and CEO of J.P. Farley and has spent 40+ years in the employee benefits industry. He has spent significant time and effort driving innovation within his own company and as president or chairman of several national TPA industry organizations, including SPBA. He has also been quoted in the media, authored articles, and testified before state and national legislative committees. A serious student of the business, Jim has been an early adopter of many cost management techniques. In the late 90’s Jim implemented reference based pricing and, coupled with an understanding of the plan document’s power to influence costs, the adoption of specific benefit carve-outs. Since 2006 he has worked with customers on implementing and running successful fee schedule based plans with limited or no networks. Like many other ultimately successful cost containment techniques taken on by early adopters the initial reaction was “You really can’t do that, people will not accept that kind of thing.” Jim continues to embark on things “you really can’t do”.
Bill Rusteberg is a fee based insurance consultant and principal of RiskManagers.us since 1998. He has been involved in the insurance industry for over 41 years specializing in self-funded employee welfare plans.
RiskManagers.us is a specialty company in the benefits market that works directly with health entities, medical providers, and businesses to identify and develop cost effective benefit packages, emphasizing transparency and fairness in direct reimbursement compensation methods.
A fortuitous meeting in 2007 sent Bill on a mission to seek the truth behind ever increasing health care costs. In 2008 Bill spoke at the HCCA Executive Forum to discuss his findings as well as offer common sense solutions to ever increasing health care costs. The journey has continued since, a fascinating learning process that Bill shares with audiences at every opportunity, most recently at the annual Physician Hospital Association convention in September 2013.
In this age of growing government interference in health care, private enterprise and a free market is still a force to be reckoned with. Reference based pricing, cost plus and Medicare reimbursement benchmarking is a growing market phenomenon that cannot be overlooked or dismissed