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Reference Based Pricing (RBP)

Healthcare systems are notorious for lacking price transparency. PBA is helping change that by offering a Reference Based Pricing (RBP) benefit plan model for our clients seeking to regain control of their healthcare costs.

What Is Reference Based Pricing?

RBP is a payment model that pays medical providers an amount that covers the actual cost plus a reasonable profit margin. It offers a cost-containment strategy in which the employer, supported by PBA, pays a set price for each healthcare service, instead of negotiating prices with providers. Under RBP, the employer pays doctors, hospitals, clinics, and labs an established amount for the service.

The Difference Is Transparent

Our solution provides full transparency by establishing price-to-value for medical services. Claims are gauged against Medicare Costs and proprietary reference databases before releasing payment.

Under a preferred provider organization (PPO), the discounts provided give plan participants a false sense of security. These plans offer significant discounts, but they don't disclose the actual price of the service. Receiving a large discount on something that's been marked up 300% to 2,000% isn't really a discount at all. Discounts on undisclosed prices just don't count for much!

RBP plans precisely determine a fair price, then hold medical providers accountable for charging these fair, reasonable prices.

Key Benefits of RBP

PBA believes employers should be able to buy medical services in the same transparent manner as any other materials or services. Some key benefits of RBP plans include:

  • Transparent upfront pricing communicated to the provider before services are rendered;
  • Accurate price estimates established by procedure using a comprehensive database;
  • Establishes optimal reimbursement rates for medical services;
  • Reduces claims costs by imposing pricing accountability; and,
  • Clear, concise communication from pre-authorization to claim payment.

PBA Member Advocates are here to help members navigate their RBP plan. We're experts at helping reduce our clients' expenses.