Back in 2007 nay sayers predicted Reference Based Pricing would never work. BUCA reps and their hospital partners circled the wagons with dire warnings to plan sponsors with the threat plan members would not be able to access care.
Then lawyers got involved, threatening lawsuits unless balance billing was paid in full, at full chargemaster rates. Few brokers were willing to jeopardize sales under the influence of their BUCA agent contracts containing a 30 day termination clause without cause.
HR departments joined the chorus of nay sayers.
But a few early adopters persisted with excellent results. Then middle adopters joined in. Now late adopters are edging towards the cliff of no return, almost ready, crawling ever so slowly, to jump off into shark infested waters where others have gone before. Most of the sharks have vanished and the few left are toothless……………..
“Reference-Based Pricing presents an attractive alternative to traditional healthcare pricing strategies, advocating for transparency, consumer empowerment, competition, and sustainable healthcare costs.”
- “The company’s CEO should author a letter and present, either in person or through a recorded message, the potential savings of 20% to 40% that the new medical program will bring. The message should clearly translate to employees as an avenue to protect jobs, safeguard pay, and perhaps even create the opportunity for a bonus or healthcare dividend. Employees need to perceive this as a strategic move designed and implemented with their best interests in mind.”
- “The most significant hurdle in RBP is access. On a national scale, most RBP vendors report an acceptance rate of 90% or higher. This implies that around 10% of the time, employees may face resistance from a doctor’s office or hospital. In about half to three-quarters of these instances, a smooth negotiation process resolves the issue. This leaves about 2 to 5% of cases where an access problem persists.”