Reference Based Pricing

a critical component of the next generation health plan

Referenced Based Pricing (RBP)- a reimbursement calculation utilizing the
Medicare allowance and mark up value; a reasonable level of reimbursement to
medical professionals

• Comparing prices for healthcare services and supplies is difficult given

  • The variation in billing practices from office to office
  • The difference in the charges for the SAME medical service can be intimidating and confusing.

• In order to find a universal standard, a common reference was needed to determine geography and risk adjusted price

• Why are we using Medicare as a reference?

  • Medicare allows for a relative consistent standard to compare hospitals to physician’s and other medical services (or locations).
  • Medicare’s calculation process is publically available
  • Medicare is the largest healthcare payer in the country
  • Medicare is adjusted for case mix and geography rather than on individual hospital charge masters


What if you could save 30% on the cost of your healthcare benefit,
while at the same time increase benefits and reduce payroll
deductions for your employees?

YOU CAN!

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