Guiding Members to High-Value Choices through Reference Pricing: Self-Insured Schools of California (SISC)

Find out how SISC’s Value Based Site-of-Service Benefit program used reference-based pricing to achieve $3.1 million in savings in its first year.


Aware that common procedures, such as colonoscopies, can be delivered at Ambulatory Surgery Centers (ASCs) instead of pricier hospital-based facilities without compromising quality of care, SISC worked with Anthem Blue Cross to implement a reference-based pricing program designed to encourage plan members to seek care from higher-value sites of service.

Written exclusively to help purchasers learn from one another and spread best practices, this case study covers:

  • The circumstances that led SISC to create a new benefit design for plan members.
  • How SISC selected routine procedures for its program and created incentives to seek care at ASCs.
  • How SISC rolled out the strategy and communicated the benefit to members.
  • The projected and actual results the program achieved.
  • Key insights, lessons learned, and next steps.

CPR conducted interviews with John Stenerson, Deputy Executive Officer of Self-Insured Schools of California and Sheila Amiri, SISC Account Executive at Anthem Blue Cross to inform this case study.

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