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.
Healthcare Blue Book partners with employers and payers to deploy successful Referenced-Based Pricing Solutions, by:
1. Analyzing utilization and price variation within the employer’s market to identify which procedures represent the best opportunities to save, and to determine the optimal reference price for those targeted procedures;
2. Structure and communicate the reference price program to plan members across platforms (mobile, online, phone support, etc.) and via health programs (case management, wellness, onsite clinics, etc.);
3. Integrate with a focused pre-care process to ensure employees are alerted to opportunities to save in advance of receiving care; and help employees find high-value providers who deliver the quality care they need, at or below the reference price.
For more information or to request a demonstration, please contact The Healthcare Blue Book team:
firstname.lastname@example.org OR (615) 422-5213
Meritain Health, an independent subsidiary of Aetna, is one of the nation’s largest administrators of health benefits. We offer the resources of a national carrier and the unmatched flexibility and service of an independent, local administrator. Our approach provides employers with cost-effective plan administration within a custom framework of variable networks, industry-leading products and services, and cost management strategies. For more information visit www.meritain.com.