The Evolution of Reference Based Pricing

Change over time is a constant……………………………………

MyHealthGuide Source: Kenneth Berry and Ryan DayHST, 3/18/2019, Benefits Magazine via HST (full text)

The evolution of Reference Based Pricing (RBP) has seen significant progress in the past ten years. The use of RBP continues to make significant impact in reducing costs for self-insured medical plans. There is no other cost-containment solution we’ve seen in the past ten years that has reduced costs more.

RBP Features

  • Self-insured employers typically see a reduction in overall medical claims cost of 20 to 30%.
  • Plan members also benefit from savings as well.
  • The plan should see additional savings from their Stop-loss premiums of 10 to 30% reduction on Spec premiums, and 5 to 10% on Aggregate premium, as compared to BUCA + PPOs.
  • When these services are delivered on a PEPM basis, plans generally see at least a 45:1 return on their investment. Providers should also be fairly reimbursed in a timely manner.

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About HST

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