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As more employers seek out alternatives to high cost healthcare, solutions like reference-based pricing, also calledmetric-based pricing, are becoming more mainstream. It can be acomplex concept that may be misunderstood by employers, but as abroker, you can make your clients aware of this exciting solution.Reference-based pricing offers substantial savings, and partneringwith a qualified solutions provider puts you in the best positionpossible to offer strategic counsel to clients who are exploringwhether they should make the switch.

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It's not uncommon for employers who are intrigued by the costsavings and control that comes with reference-based pricing to beworried about leaving their familiar PPO plan behind. This is often coupled withapprehension about how reference-based pricing may cause disruptionto their employees, so it's your job as broker to vet options andfind a partner who aligns with your clients' needs andobjectives.

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Choose a partner with experience andexpertise

With more and more solution providers to choose from, it'skey to evaluate the industry and look for partners that are trustedand experienced. That means they are open to site visits andwelcome prospective clients, they sign on as a strong plan partneror co-fiduciary, and they offer expert help in assisting with thetransition from traditional insurance to reference-basedpricing.

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Site visits can be invaluable

To truly understand who is representing your client, adedicated broker should request to see the company's operation inperson. A site visit can help brokers understand if thereference-based pricing provider is financially secure, committedto their clients and if they have adequate resources to act onbehalf of each client.

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Experienced reference-based pricing partners will also encouragereference calls with their current clients, which can provide thebroker with an opportunity to view performance metrics firsthandand receive valuable information about how relationships withsolution providers progress over time. With first-hand knowledge ofthe reference-based pricing solution's day-to-day operations and alook into a successful reference-based pricing client, you can restassured you are recommending a dedicated and experiencedorganization to meet your clients' needs.

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Why co-fiduciaries matter

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As you evaluate different reference-based partners, ensure thatthe solution provider you select is fully invested in the successof the health plan. It's important to consider partnering with asolution provider that is willing to sign on as a co-fiduciary,since they may be asked to assist in managing the financial assetsof your client's plan, and stand shoulder-to-shoulder with yourclient.

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Often, the biggest pain point for an employer aboutreference-based pricing is selling their employees on a “new” typeof health insurance. Educate your clients and their employees onthe solution by bringing in an experienced reference-based pricingpartner early in the process to talk with your client and their HRleaders. Reference-based pricing experts are eager to assist andshare their passion with employers.

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The solution should encompass a robust plan for membercommunication, dedicated support specialists who the broker andclient can contact directly, and convenient digital resources. Havea good understanding of what tools and member touch points areavailable with your recommendation.

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Develop direct relationships with employers and medicalproviders in the community

One size does not fit all when developing reference-basedpricing solutions. There is demand in the marketplace fornegotiation and settlement options as well as direct contractingwith hospitals and facilities. Reference-based pricing partnersthat emphasize collaboration with health systems, especially thosewith already established partnerships, demonstrate their dedicationtoward fair provider reimbursement and minimizing disruption foremployees. Direct contracting can be a win-win solution for allparties, and experienced reference-based pricing solutions will beopen to different options for each new client.

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Stay actively involved in client'ssuccess

The best brokers stay engaged with their clients throughout theyear and they are proactive in ensuring successful implementationof reference-based pricing solutions among their clients with thehelp of a reliable referenced-based pricing partner. For example,monthly reporting that demonstrates cost savings — which in turn show your value tothe client — and dedicated support specialists that support thebroker, not just the clients and members, can help make your jobeasier, too.

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Steve Kelly is the co-founder and CEO of ELAP Services, aleading healthcare solution for self-funded employers based inWayne, Pa. He is a recognized expert in the insurance, employeebenefits and risk management industry, bringing more than threedecades of experience solving his clients' complex healthcarechallenges.

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