Health care affordability remains a monumental issue, presenting a daunting fiscal challenge for individual consumers, employers, and public budgets alike. Skyrocketing health care costs have introduced roadblocks to essential health services and prompted a vigorous search for new and robust strategies to mitigate this escalating crisis.
More than any other development in my 21 years in this industry, reference-based pricing (RBP) has emerged as one of the most compelling and progressive approaches to this challenge. This innovative model, championed by disrupting self-insured employers, defines a maximum limit or "reference price" they're willing to pay for health care services. Different repricing entities use varying metrics, but this often ties the claim payment to a derivative of Medicare that results in the employer paying from 140% to 150% of Medicare, on average.
Opaque pricing shrouds the legacy health care sector. The actual costs of services have historically remained elusive for both patients and payers, often only disclosed post-provision. This murkiness precipitates pricing inconsistencies, engenders inefficiencies, and cultivates an environment ripe for bloated costs and rampant fraud.
Continue Reading for Free
Register and gain access to:
- Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor
Already have an account? Sign In Now
© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.