Catalyst for Payment Reform

Reference-Based Pricing: Risks and Rewards of Playing Health Care Hardball

Reference-Based Pricing: Risks and Rewards of Playing Health Care Hardball

CPR evaluated eight reference-based pricing (RBP) vendors and one RBP TPA and interviewed multiple consultants and industry experts to harvest insights into how, why and whether RBP can be an effective cost-containment strategy.

Commercial health care costs continue to rise, unabated, continuing to outpace workers’ earnings and the consumer price index.  Multiple studies confirm that the root cause of high health care costs is the prices we pay for services, not how much or what type of care we consume.  Reference-based pricing plans constrain cost inflation at its root by tying provider payment to an external, rationalized benchmark – usually a multiple of Medicare rates.  RBP vendors pay providers at these (drastically) lower rates with or without a formal contract.

CPR’s white paper Reference-Based Pricing: Risks and Rewards of Playing Health Care Hardball examines the evolution, mechanisms and strategy behind RBP solutions, and explores the most important questions health care purchasers should consider when evaluating an RBP vendor.

The report includes:
  • The Evolution of Reference Pricing Models
  • Unpacking the RBP Model: Key Findings
  • Risk Mitigation Strategies
  • Further Considerations for Health Care Purchasers
  • Next Steps and Additional Resources
Additional resources for health care purchasers and consultants:
  • Toolkit: The reference-based pricing toolkit includes RFI questions and specifications, and RBP program evaluation template.  The toolkit is free to health care purchasers and CPR members.
  • Summary scorecards: Profiles of the 9 vendors who participated in CPR’s RBP study, which are available for purchase and free for CPR members.
  • Detailed scorecards: Verbatim responses from RBP vendors for the full set of questions included in the RFI, an exclusive resource for CPR members.
  • Virtual Summit: On April 29th, CPR hosted a 90-minute virtual summit to share key findings from our research, and invite panels of RBP experts and RBP customers to share their insight and experience.  A recording of the summit is available to health care purchasers for free, and to all others for a nominal fee.

Type: White Paper