Reference Based Pricing / RBP

Is It Time to Cut The Network Cord?

  • About 70% of your medical claims are for facility

  • Standard health plans pay facilities  3 x or more what Medicare pays

  • RBP pays 140% of Medicare

  • Care Coordination is the perfect compliment to help members w/ RBP

Reference Based Pricing allows the employer to significantly lower the cost of facility claims.  BUCA (The Blues, United Healthcare, Cigna, Aetna.)  often pays a facility 3 x the rate of Medicare or more.  And there is not necessarily any relationship between quality and cost.  Reference Based Pricing allows the employer to reimburse the facility at a rate that is a lot lower, 140% to 200% of Medicare.  Approximately 95% of facilities will accept this reimbursement with no negotiation.  For the remainder, your RBP plan will negotiate the acceptable charge.