Ep 16 - Reference-Based Pricing: A New Way to Contain Costs

It should come as no surprise that recent events around the world have created an atmosphere of change almost everywhere. People are living radically different lives than they were three years ago, and with those changes comes a desire for the services they use to keep up with their lifestyles. In this environment, it seems almost inevitable that something like the reference-based pricing model for healthcare would emerge as a much-needed solution to modern issues.

A reference-based price model, in short, gives patients and payers a way to ensure adequate healthcare is administered, paid for, and covered while avoiding staggering provider contract fees or out-of-network prices. RBP can be used in several ways, including as a full network replacement, as support for out-of-network savings, narrow networks, or even custom network build options.

This is largely thanks to the aforementioned open access to providers and zero network limitations, which allows members to make informed provider decisions that align with their personal preferences. Additionally, RBP helps providers make sure that if someone comes in needing assistance, they can administer care without the worry of a long and arduous arbitration process if the patient is not an in-network member.

To better explain the concept, and to offer additional context as to the benefits of RBP, Mary Piecuch, Senior Vice President of Product Strategy and Erick Russell, Director of Network Operations, both at Zelis, joined the latest installment of the Future Healthcare Today podcast.