Barriers to RBP Plans

“Few employers are using reference-based pricing (RBP) benefit design, even though there is broad awareness of its potential for delivering savings,” according to a qualitative study published in the February issue of The American Journal of Managed Care®.

“Evaluations of US RBP programs have found reduced spending between 13.9% and 31.0% for joint replacement surgery, colonoscopy,laboratory tests, prescription drugs, and ambulatory surgery.”

Despite these savings, only 5% to 6% of employers were using RBP in 2015-2016. The study surveyed a small sample of 13 individuals across 12 organizations, including human resources executives at large self-insured employers and representatives of consulting firms and purchasing coalitions.

“Despite broad employer awareness of RBP’s potential for cost savings, few employers are including RBP in their benefit design. The major barriers to RBP adoption were the complexity of RBP benefit design, concern that employees could face catastrophic out-of-pocket costs, lack of a business case for implementation, and concern that RBP could hurt the employer’s competitiveness in the labor market. The few employers that have adopted RBP have implemented extensive, year-round employee education campaigns and invested in multipronged and proactive decision support to help employees navigate their choices.”