Zelis Healthcare, a healthcare technology company, and Amino, a healthcare and financial wellness platform, have teamed up to launch RBP Guidance, a tool which enables employers to more easily understand and evaluate reference-based pricing health benefit plans.
Reference-based pricing refers to pricing outside what is set by traditional insurance carriers. Provider reimbursement is based on a percentage of what Medicare would typically pay the provider, which often ranges from 120% to 170% of Medicare reimbursement.
“Reference-based pricing plans can sometimes be a mixed bag, which is why a solution like RBP Guidance is so essential,” says David Vivero, co-founder and CEO of Amino. “The plans can be complex to navigate, the burden of which has largely been left on the member.”
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Setting predetermined maximum reimbursement amounts for healthcare services is growing in popularity as employers continue to look for ways to manage health care costs.
RBP Guidance finds providers who are likely to accept reference-based pricing reimbursements and are well-qualified based on consumer-input search terms. The tool also utilizes Amino’s Smart Match technology, which automatically surfaces the best ranking providers, to highlight providers’ educational experience, patient reviews and facilities with high safety grades. The first employers implementing RBP Guidance will begin in mid-August.
Reference-based pricing puts more control in the hands of employers, says Danielle Schweiger, a benefits adviser with Gregory & Appel Insurance. But, there are some drawbacks. Unless a direct contracting arrangement has already been agreed upon with a provider, Schweiger says, reference-based pricing can be viewed as an aggressive approach.
“This then can trickle down into the member experience in the form of balance billing the patient, wrestling between the provider/facility and third party reference-based pricing vendor, credit impairments, and so on,” Schweiger says.
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However, there are more member-friendly reference-based pricing solutions making their way into the market, which will still yield savings for the employer and protect the employee from balance billing and other negatives.
“I think in terms of advising an employer as to whether or not reference-based pricing is right for them depends on the employer’s appetite for risk, their resources to support the strategy internally and of course their geographic market,” Schweiger says. “I don’t think a blanket yes or no response in regards to reference-based pricing can be applied across the board. In making this decision, an employer needs to work with an experienced and educated consultant who can speak to the pros and cons entailed with reference-based pricing.”
