Catalyst for Payment Reform

Toolkit: Reference-Based Pricing

Toolkit: Reference-Based Pricing

This toolkit contains evaluation questions and detailed specifications to meet the needs of employer-purchasers considering or reviewing reference-based pricing (RBP) solutions.

In 2020, CPR set out to determine how and why RBP can work, the risks and trade-offs it poses, and explore strategies for merging RBP with more traditional value-oriented health care strategies.  To this end, we developed a Request for Information (RFI), which we distributed to eight RBP vendors and one third-party administrator (TPA) who partners with multiple RBP plans.  Through the course of reviewing responses and consulting with experts, stakeholders, and RBP clients, we developed the RBP Evaluation Toolkit.

CPR’s RBP vendor evaluation toolkit identifies attributes that can help purchasers understand vendors’ value proposition and service offerings.  CPR is releasing the toolkit publicly to help set an industry standard and push the marketplace to better meet the needs of employer-purchasers.

For purchasers interested in conducting their own evaluation of RBP vendors, or measure the performance of an existing vendor partner, the toolkit contains:
  • Request for Information (RFI) Template – includes all questions CPR fielded to vendors in the course of our RBP study, and the purchaser-validated specifications CPR used to evaluate vendor responses. The RFI is organized into 6 sections covering the product description, provider contracting and rate setting, administrative model, patient services, customer reporting, and results.
  • RBP Reform Evaluation Framework (REF) – provides a standardized program evaluation tool that purchasers can use to look at an RBP program’s impact on costs, clinical quality, utilization and member experience. This will evaluate changes in the total cost of care and savings/losses, impact on members’ out-of-pocket costs, and changes in outcomes and provider behavior.
How to use the toolkit:

Employer-purchasers and their consultants can download the editable evaluation framework, customize it to their needs, and send to external partners for responses.  Note, we recommend against substantial customization, as purchaser alignment sends a consistent signal to the marketplace.  Once users receive the responses, they can compare them to CPR’s specifications.  CPR also encourages health plans, providers, and vendors to use the toolkit to internally evaluate their programs against employer-purchaser expectations.

Additional RBP resources for health care purchasers and consultants:
  • White PaperReference-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.  This paper is free for all audiences.
  • 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.

As a health care purchaser, you can log in to get FREE access!

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Type: Toolkit



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