Catalyst for Payment Reform

Anchoring to Medicare: Can Reference Pricing Turn the Rising Tide of Health Care Costs?

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Anchoring to Medicare: Can Reference Pricing Turn the Rising Tide of Health Care Costs?

April 29, 2021 Eastern

Thursday, April 29 from 2pm-3:30pm EDT/ 11am-12:30pm PDT

According to the Health Care Cost Institute, approximately 75% of the increase in per-person spending in the U.S. is explained by growth in prices for health care services, as opposed to increased utilization. Reference-based pricing presents a new opportunity for purchasers to attack health care cost inflation at its root.

Under a reference-based pricing (RBP) model, a vendor sets a maximum price it will pay to providers for individual health care services, which is usually expressed as a percentage of Medicare rates.  If a provider refuses to accept this price and/or bills the patient, the RBP vendor will negotiate payment on the patient’s behalf.  Purchasers have historically been skeptical of RBP – why would providers accept lower rates from vendors than from health plans?  Is this just an invitation for a deluge of balance billing?  CPR dug deep into these issues to understand the risks, rewards and feasibility of RBP models. We’re excited to share our findings with you! Plus, our recent blog post outlines how the vendor-convened RBP model is distinct from the models pioneered by CalPERS and Montana.

During this Virtual Summit, CPR will provide an overview of reference-pricing: how/why it works, how the model evolved, and where it’s going next. You’ll hear experts discuss the risks, rewards, and regulatory implications of RBP. We will also host a panel of real-world purchasers who have implemented an RBP strategy, who will talk about why they chose reference-based pricing, how it’s impacted their health spending, and lessons learned along the way.



Thank you to our event sponsors:

Payer Compass HST


CPR is recognized by SHRM to offer Professional Development Credits (PDCs) for the SHRM-CP® or SHRM-SCP®. The live event qualifies for 1.5 PDCs.


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April 29, 2021