Reference-Based Pricing

What is Reference-Based Pricing?

Reference-Based Pricing (RBP), also referred to as Value-Based Pricing, ties provider payments to the actual cost of delivering services.

Centers of Medicare and Medicaid Services (CMS) sets Medicare rates using FACTS (i.e., the costs of delivering care based on annual data submitted by providers).

The RBP strategy uses Medicare as its foundation in determining reimbursement. It’s widely used to promote healthcare service quality and value. This pricing transparency enables informed and comparative purchasing, resulting in better rates and superior value. While not a magic bullet or holy grail for health plan management, it’s clearly one of the most reliable tools that employers and their strategic partners have for bending the proverbial cost curve and promoting healthcare consumerism.

Why Reference-Based Pricing?

Lowered Costs

Immediately helps lower costs by 18% to 22%

Sustainability

Medicare trend approximately 1.3% from 2010-2016

Accountability

Maximizes pricing accountability and transparency

Increase Engagement

Empower employees to be better healthcare consumers

Meet a Few of Our Contributors

Testimonials

What RBP pioneers are saying about…

Cost Savings
“We faced a significant cost increase to our medical plan that quite honestly we did not know how we were going to take on. When our consultant first brought the idea of reference-based pricing to our attention, we were skeptical. But halfway through the first plan year, we have saved nearly 20% compared to what we had spent at the same time point last year!”
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Balance Billing
“We had been aware of the Reference-Based Pricing strategy for a few years and understood the potential for savings but were not convinced that the experience for our employees would be positive. After deciding to offer an RBP option to employees looking to reduce their contribution, we realized the disruption to our employees was non-existent under that program. In many cases, our employees reported the advocacy process was extremely helpful in reducing their financial obligation.”
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Facility Access
"Many of our employees are located in rural areas where there may only be a single medical facility for them to access . Our worry was under a Reference Based Pricing plan those employees might lose access to their only local option in seeking major medical services. In working with our plan administrator we identified these facilities and directly negotiated with on a case-by-case basis. The result was not only did we provide access to all employees, but at a reduced cost to what the facility had been charging in the past; a significant savings for both the plan and our plan members."
Learn More
Cost Savings
“We faced a significant cost increase to our medical plan that quite honestly we did not know how we were going to take on. When our consultant first brought the idea of reference-based pricing to our attention, we were skeptical. But halfway through the first plan year, we have saved nearly 20% compared to what we had spent at the same time point last year!”
Learn More
Balance Billing
“We had been aware of the Reference-Based Pricing strategy for a few years and understood the potential for savings but were not convinced that the experience for our employees would be positive. After deciding to offer an RBP option to employees looking to reduce their contribution, we realized the disruption to our employees was non-existent under that program. In many cases, our employees reported the advocacy process was extremely helpful in reducing their financial obligation.”
Learn More
Facility Access
"Many of our employees are located in rural areas where there may only be a single medical facility for them to access . Our worry was under a Reference Based Pricing plan those employees might lose access to their only local option in seeking major medical services. In working with our plan administrator we identified these facilities and directly negotiated with on a case-by-case basis. The result was not only did we provide access to all employees, but at a reduced cost to what the facility had been charging in the past; a significant savings for both the plan and our plan members."
Learn More

          RBPricing.com is proud to announce Bruce Shutan as our new Editorial Director. 

Bruce Shutan is a versatile Los Angeles freelance writer who has written extensively about the self-insurance space, including reference-based pricing, since 2011. He has penned thousands of articles for more than 100 publications or corporate entities during a journalism career that spans more than 35 years. Shutan has been quoted about employee benefit trends in The Wall Street Journal’s interactive edition and syndicated radio program on work-life issues, Reuters and other media outlets. His reporting on the American workplace dates back to 1985. Three years later, he began covering HR and employee benefit topics for Employee Benefit News, Human Resource Executive, Plan Sponsor, The Self-Insurer and other industry publicationsShutan has been a member of the Society of Professional Journalists and Los Angeles Press Club. He earned a Bachelor of Science degree from Boston University’s School of Public Communication. 

With the addition of Shutan to our team, RBPricing.com remains committed to providing quality resources to the marketplace in an effort to educate the healthcare industry on reference-based pricing. 

Bruce Shutan is a versatile Los Angeles freelance writer who has written extensively about the self-insurance space, including reference-based pricing, since 2011. He has penned thousands of articles for more than 100 publications or corporate entities during a journalism career that spans more than 35 years. Shutan has been quoted about employee benefit trends in The Wall Street Journal’s interactive edition and syndicated radio program on work-life issues, Reuters and other media outlets. His reporting on the American workplace dates back to 1985. Three years later, he began covering HR and employee benefit topics for Employee Benefit News, Human Resource Executive, Plan Sponsor, The Self-Insurer and other industry publicationsShutan has been a member of the Society of Professional Journalists and Los Angeles Press Club. He earned a Bachelor of Science degree from Boston University’s School of Public Communication. 

With the addition of Shutan to our team, RBPricing.com remains committed to providing quality resources to the marketplace in an effort to educate the healthcare industry on reference-based pricing. 

About Us

RBPricing.com is dedicated to educating the marketplace about Reference-Based Pricing with the larger strategic goal of changing how healthcare is purchased over a sustainable period of time. 

Our mission

To support the expansion of a compelling strategy that supports increased transparency, lower costs and better health outcomes as well as employees becoming better healthcare consumers.

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