Company founder Marty Joseph outlined the perils, benefits and
successful strategies of RBP
CHICAGO–(BUSINESS WIRE)–#RBP–More brokers and employer groups are exploring reference-based
pricing (RBP) as a way to control skyrocketing healthcare costs
while simultaneously achieving greater transparency and better access to
care. Marty
Joseph, founder of Benefit
Administrative Systems (BAS), a division of HealthComp
Holdings, discussed this model at the World
Health Care Congress in Washington, D.C. In his session, Joseph drew
on his years of experience in the RBP industry to talk about the
challenges and benefits of RBP, as well as key strategies for
successfully implementing and administering RBP plans.
“Innovative CEOs and CFOs are frustrated by year over year double-digit
increases in healthcare spending within traditional health plans,” said
Joseph. “At the same time, they don’t have the data or cost transparency
to know what’s behind this cost escalation. They want to approach
healthcare differently. Many of them are coming to BAS
as a Center of Excellence in this area and saying, let’s talk about reference-based
pricing. In 2018, 75% of our new business inquiries were around RBP.
This represents significant movement in the market – it’s changing the
landscape and giving companies more power to impact costs and outcomes.”
According to Joseph, executives are particularly interested in RBP since
it could save them up to 20-30% on healthcare spending in the first
year. With these results, RBP will likely continue to gain in
popularity, especially as healthcare costs continue to rise.
Many hospitals and healthcare facilities charge inflated prices.
Traditional health plans negotiate discounts to these prices through
provider networks, but this model still results in high costs. RBP, on
the other hand, does not utilize a carrier or provider network. Members
may see any healthcare provider; this freedom of access coupled with
cost transparency helps foster better-informed healthcare consumers.
In addition, provider reimbursement in RBP is based on either a
percentage of Medicare reimbursement rates or the true cost of the
healthcare service. This simple and fair methodology is what yields the
cost transparency, a core tenant of the RBP model. Employers have claims
and cost information, so they can better assess how their plans are
performing and address problem areas in a very data-driven
approach.
As part of the session, a success story was shared of an employer group
that recently switched from a traditional preferred provider
organization (PPO) to an RBP plan. This group had about 1,200 employees
across more than 35 states. Before RBP, it spent about $5 million a year
on healthcare. An initial analysis and forecast of the group’s claims
projected it would save approximately $1.1 million in the first year
using RBP. After just 10 months, however, the group reduced its
healthcare spending by an estimated $1.7 million, far exceeding the
initial projection.
According to Joseph, for RBP to be successful, employer groups have to
be “all in.” The key is to provide plan members with ongoing
communication, education, and support. As such, it’s critical to partner
with an RBP administrator that has the experience and processes in place
to seamlessly handle implementation, administration, and member
support.
“With RBP, members must engage and take action,” said Joseph. “Member
education is the foundation, so they understand how RBP works, and
what to do in case of balance billing. In the case study presented, we
saw 98.7% of all claims go through without a balance bill. If you look
at PPO plans today, they experience roughly the same rate. However, with
RBP, members actually receive extensive support to assist and resolve
these bills.”
In addition, BAS has established an outreach program that alerts members
with a text and live phone call when an RBP claim is processed. Members
are constantly reeducated on the steps they need to take. “Overall, our
process gives members a high-touch
experience, along with empowerment,” added Joseph.
To hear Marty Joseph speak about RBP and how employers are using this
model to reduce healthcare spending, tune into his video interview at
the World Health Care Congress:
https://healthcomp.com/whcc-tv-interview-healthcomps-marty-joseph-talks-reference-based-pricing/
About Benefit Administrative Systems, LLC (BAS)
BAS,
a division of HealthComp Holdings, is a results-driven third-party
administrator that was founded in 1983. The company has a track record
of delivering cost savings and customer satisfaction. It utilizes
specialized services, tools, and partners to create a robust partially
self-funded plan as unique as each client. BAS is headquartered in
Chicago, Illinois.
About HealthComp Holdings
For more than 35 years, HealthComp
Holdings has been dedicated to transforming benefits management into
an experience that employees and employers love. Bringing together
concierge-level service, operational excellence, powerful analytics and
cost management, we’ve built a solution that integrates seamlessly with
any benefits ecosystem. As one of the nation’s leading benefits
administrators for self-funded employers, we are comprised of two
Centers of Excellence: Our Center of Excellence for PPO administration
is based in Fresno, California, and our Center of Excellence for
Reference-Based Pricing (RBP) is based in Chicago, Illinois.
Contacts
Media Contact:
Joy Scott, CEO, Scott Public Relations
[email protected]
Phone:
818.610.0270
