“RBP is Dying, Or It’s Dead”

By Bill Rusteberg

Sometimes we read things and wonder “what the heck were they thinking when they wrote this? Is there something I’m missing here!”

A recent post on Linkedin by has it wrong in our opinion:

“RBP is dying, or it’s dead.. and here’s why that’s a good thing for health care. RBP is a one-sided benefit in a three-sided equation. Employers benefit, while providers and patients suffer. Yes, I know the stats, supposedly 1-2% of RBP transactions have issues, but the 1-2% can be extraordinary and far outweigh any potential benefit for the employer in “savings”. “Savings” are often calculated as a delta to BUCAH networks or billed charges, but that’s nonsense math, how about calculating against other viable alternatives like a well-built direct contract network? Not only will the RBP savings erode, but it might be more expensive to use this broken method to reprice health care. Providers aren’t going to get on board with RBP, just as no one else would get on board with providing services then being jammed with a price below what you feel is valuable. It’s common decency to enter a transaction with integrity, and RBP erodes that. If a consultant introduces an RBP plan, ask these questions: 1. What’s my risk? 2. Why aren’t you doing a fully built out direct contract network instead? 3. If RBP causes catastrophic harm to the employee experience, who is responsible? Let’s move on from RBP, it had a short run and we shouldn’t look back.”

Here’s another point of view for the reader’s consideration:

RBP is not dying and it’s certainly not dead. It’s robust and growing. It’s not a new phenomenon either. It’s been around for many years.

  • Back in the 60’s and 70’s they were called indemnity plans. A RBP plan is an indemnity plan.
  • Texas Workers Compensation is an indemnity plan.
  • Out-of-network benefits administered  and paid by insurance companies are often based on RBP too. Will PPO’s heed the author’s advice and eliminate this common out-of-network benefit reimbursement strategy? Probably not.

RBP embraces traditional American business practices. Freedom to choose who you do business with is core. A seller and buyer agree to an offer. If one or the other doesn’t that’s OK. There’s a chance someone else will.

Justin’s concerns are not unfounded though. Health care is an emotional issue as evidenced by his post.

The truth is health care is a business that doesn’t embrace traditional American business practices. Therein lies the problem.

Post Graduate Class Reading Assignment:

The Payer You Never Heard Of

“With the explosive grown of RBP plans, physicians and their administrators should establish an action plan for RBP patients or potential patients seeking their services. What transpires at the point of contact with a patient can be critical. A knowledgeable staff insures adequate controls in determining patient financial responsibility. Turning away patients is not always a good business practice and is unnecessary in cases where RBP payment parameters are within a practice’s normal scope of acceptance”

The Health Care Payers That No One Has Ever Heard Of

“Do you take Medicare” they ask. “Why yes, we do.” “Great, you are really going to like my insurance because it pays more than Medicare!…………… “Really? If this payer who we have never heard of pays more than we get now from Medicare for example, why would we not accept it?.”