July 25, 2024

Could RBP help you better control your organization's health benefits costs?

Commercial health care spending is estimated to grow 8% between 2024 and 2025, the highest level in 13 years, according to PwC’s 2025 Medical Cost Trend: Behind the Numbers report. This near-record high is driven by continued inflationary pressures, prescription drug spending, and behavioral health utilization without new meaningful deflators.

Despite rising costs, many employers offer the same employee health benefits year after year. Whether you’re relying on a broker to provide you with the best options, passing along more and more costs to employees or are simply overwhelmed by the complexities of health insurance – we get it. But eventually the cycle becomes untenable, especially with health care spending predicted to grow 8% year over year. If that’s you, it might be time to shake up the status quo.

There are countless innovative ways to control costs while providing high-quality benefits to your employees. One such strategy to consider is reference-based pricing (RBP). This approach can help you manage health care expenses and improve employee satisfaction.

 

What is Reference-Based Pricing (RBP)?

A traditional health insurance plan relies on negotiated rates within a network of providers. RBP uses a different pricing model, that sets a standard price for medical services, usually based on a percentage of Medicare rates. It sets a standard price for medical services, which serves as a reference point for reimbursement. For example, a plan might set the reference price at 150% of the Medicare rate for a particular service. Providers are reimbursed based on the established reference price, regardless of their usual charges. This creates a consistent and transparent pricing structure.

 

Why Consider Reference-Based Pricing?

1. Cost Control and Savings

This standardized pricing helps keep health care costs predictable and manageable. This transparency can lead to more strategic decision-making and financial planning.

2. Encourages Provider Competition

Reference-based pricing encourages providers to compete on both cost and quality. With a set reference price, health care providers are motivated to offer competitive rates, leading to more efficient healthcare delivery and potentially lower prices for services.

3. Flexibility and Customization

Reference-based pricing allows you to customize your health plan to better meet the needs of your workforce. Additionally, employees have more freedom to choose their health care providers. This can be especially beneficial in areas with limited provider networks.

4. Employee Engagement

RBP helps employees become more informed health care consumers. By understanding the costs of services, employees can make more thoughtful and cost-effective health care choices. Further, savings achieved through RBP can be passed on to employees, resulting in lower premiums and reduced out-of-pocket expenses. This not only enhances employee satisfaction but also promotes better utilization of health care resources.

5. Potential for Improved Health Outcomes

You might consider integrating RBP with medical management programs, available through your third-party administrator (TPA) or other vendors, to optimize care and effectively manage chronic conditions. This integration helps deliver more comprehensive and coordinated care.

6. Data-Driven Insights

RBP plans generate valuable data that can be analyzed to identify trends, monitor plan performance, and make data-driven decisions.

Reference-based pricing offers a compelling alternative to traditional health insurance models, providing significant cost savings, enhanced transparency, and greater flexibility. By considering RBP, you can achieve better control over health care spending, and deliver high-quality, cost-effective care to your employees. With the support of experienced TPAs, you can seamlessly implement and manage RBP, reaping the benefits of this innovative approach.

Explore how reference-based pricing with Nova can transform your employee health plan and drive value for your organization.