Christine Cooper and Jack Towarnicky presented on behalf of aequum Reference Based Pricing – Optimized, A Strategic Response to the No Surprises Act, Transparency Requirements. This complimentary webinar, in collaboration with the Self-Insurance Institute of America (SIIA), confirmed why reference-based pricing (RBP), “done right”, is the most appropriate plan design response to recent legislation – the Consolidated Appropriations Act and No Surprises Act (NSA).
To view a recording of the entire webinar, click here. Key insights include:
- NSA increases plan and participant costs
- “Surprise” ≠ “Unexpected”
- Transparency “looks back” and is incomplete
- RBP offers a strategic cost management solution and opportunity to gain a competitive cost advantage for both plan sponsors and participants
RBP is one of the fastest growing solutions in health benefits cost management. It brings stability to health care prices and point of purchase cost sharing by using Medicare reimbursement rates and other provider cost data to provide an objective cost baseline. This offers disciplined pricing – fair and rational reimbursement for providers.
Adopting a ‘pure’ RBP plan design helps to avoid unreasonable or excessive provider charges. Given the variation of provider charges for the same services, a pure RBP design offers an opportunity to avoid excessive and unreasonable provider fees and charges – to reduce eligible expenses which will lower participant out-of-pocket costs, and lower the cost of coverage, today and in the future.
Employer sponsors should take strategic action to ensure their plans incorporate the most effective strategies available for the ‘health and wealth’ of their participants. A quality health plan provides easy, direct access and understanding of pricing, benefits and out-of-pocket expense information so plan participants can make informed and cost-effective decisions.