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More Transparency, More Savings

Reference Based Pricing

PBA offers a Reference Based Pricing (RBP) benefit plan model for our clients seeking to regain control of their healthcare costs. RBP is a payment model that pays the medical provider an amount that covers the actual cost plus a reasonable profit margin. Our solution provides full transparency by establishing price-to-value for medical services. Claims are benchmarked against Medicare Cost and proprietary reference databases before payment is released.

PPO discounts give a false sense of security by offering significant discounts but it's a discount off of an undisclosed price. A large discount on an item that's marked up 300% - 2,000% doesn't count for much! RBP concretely determines a fair price and then holds providers accountable for charging these fair, reasonable prices in a way that no discount can.

PPO Repricing vs. Reference Based Pricing

Based on Actual Claims Data

PPO Repricing Reference Based Pricing
Total Claim Count 5,372 5,372
Billed Charges $12,769,542.15 $12,769,452.15
Savings $7,056,448.99 $9,493,482.67
Allowed Charges $5,713,093.16 $3,275,969.48
Overall Saving Percentage 55.26% 74.35%
Reference Based Pricing results in $2,437,033.68 in additional savings in this exmaple.