We have been managing self-funded Reference Based Pricing plans in Texas for more than two decades, from North Texas to South Texas, From West Texas to East Texas.
Certain regions in Texas provide a better environment than others for Plan Sponsors interested in breaking away from 40+ years of a failed health care delivery system.
The Best Regions of Texas For Reference Based Pricing Plans
The best region is in deep South Texas where Reference Based Pricing is alive and well and has been for many years. Area hospitals, of which there are more than you can shake a stick at, readily accept Reference Based Pricing patients with very little, if any, pushback. Balance billing is a rarity. Several hospitals have decided to join in by offering Medicare based agreements ranging from 100-130% of Medicare with no contract outliers. Prospective plan sponsors don’t need a strong backbone with the will to succeed as others before them have paved the way, surviving a tortured path to final market acceptance.
The second best Reference Based Pricing region is San Antonio. Several high profile corporate clients, including medical businesses, have led the way for others to follow. Politics have delt a winning hand to Reference Based Pricing proponents. One major hospital system has joined the Reference Based Pricing movement by offering a straight 130% Medicare based contract. The remaining hospitals simply cash our checks at 120% of Medicare.
A close second-place runner up is the Corpus Christi, Coastal Bend region. The first political subdivision in Texas to adopt Reference Based Pricing more than a decade ago has led the way for others to follow. A regional Federally Qualified Health Center (FQHC) was the first in the nation to directly contract with a Reference Based Pricing plan.
The Worst Regions In Texas For Reference Based Pricing Plans
West Texas, especially Amarillo and Lubbock. Medical care in both towns is a monopoly controlled by local hospitals. Although they will contract directly with Reference Based Pricing plans, they won’t budge below 200% of Medicare in most instances. Most primary care physicians are slaves, owned by their hospital slave masters. In order for Reference Based Pricing plans to be successful they must employ domestic medical tourism, sending patients to other parts for elective surgeries. Prospective plan sponsors must have a strong backbone, with strong “Take No Prisoners” leadership abilities, and a wiliness to stand up to egregious hospital billing and threats of retribution.
East Texas is not Reference Based Pricing friendly either. Hospitals dominate and have political staying power. Unless you have unusual, uncommon leadership qualities with a drive towards winning, stay with Blue Cross and be happy and stop griping about rate increases and reduced benefits.
Austin – forget about it. Good luck trying. The local broker community for the most part is welded to the BUCA’s and fully-insured plans. Tech companies don’t need to save money, they print it.
Houston – Five BUCA loving brokers control the Houston market leaving smaller brokers to fight for the Mom & Pop business. Pure Reference Based Pricing schemes are few and far between.
