A Healthcare Management Company
Reference Based Pricing
The Lowest Healthcare Cost Solution
Humana, Anthem, UHC, Cigna, AETNA PPO Networks pay an average of 241% - 345% of Medicare. Ohio averages 326.96%. Our “No Network” solution begins negotiations at 120% - 150% of Medicare. The percent differential becomes the amount saved by the Plan Sponsor, per claim. Medicare pricing is considered 100% “True Cost.” Providers need 122% to break even.
Installing the “Best” Reference Based Pricing Vendor comes with a certain level of pain, usually ending 6 to 9 months into the solution. All claims will be paid, and providers will accept the negotiated prices in due time. RBP must contain a guarantee of “No Balance Billing.”
Reference Based Pricing many times is unfamiliar to the provider. Education must be accomplished before the plan operates smoothly. Most RBP vendors should not be considered as they have gaps in their deliverable.
Many combinations of Network, Centers Of Excellence, Direct Contracting, Direct Primary Care can be custom crafted providing the best of all (if TPA is flexible).
Be sure you are working with a highly qualified Broker and experienced RBP vendor and TPA before choosing this solution. It works when you have the experienced professionals on your team, and you could cut your consumed healthcare cost up to 50%.