Reference Based Pricing

Cost Containment How You Need It

Prime Health can offer a fully bundled or unbundled program for reference based pricing to self-insured employer groups who are looking for a cost containment strategy. The reference based pricing (RBP) strategy uses Medicare as its foundation in determining reimbursement. It is widely used to promote healthcare service quality and value. This pricing transparency enables informed and comparative purchasing, resulting in better rates and superior value.

While self-funded employers cannot control medical facility charges, Prime Health Services can help an employer achieve a fair and reasonable reimbursement payment for health care services rendered. Coupled with the PRIMEpon (Prime Health Services' physician only network), our RBP model out-performs expectations from a standard RBP model.

With decades of experience in the self-insured markets in both commercial group health and workers’ compensation, along with a deep understanding of the cost of medical, our system’s algorithms allow for reimbursement rates to defensible with little to no pushback.

Are you considering self-funding your medical plan? 

If your company has a self-funded medical plan or you plan to do so, consider reference based pricing as an option to help control escalating medical plan costs.

What is reference based pricing (rbp)?

Reference based pricing is a medical management strategy designed to reduce health care spending by the employer, while also engaging the health care consumer. A plan pays a fixed amount for a certain procedure and contracts with medical providers who agree to accept that fixed amount as full payment. Naturally, plan enrollees are driven to use in-network medical providers.

Is your business struggling with the burden of ever-increasing medical costs? 

If your employees are avoiding necessary care because of high deductibles and out-of-pocket costs, now may be the time to explore a reference based pricing (RBP) solution. We like to help a client's bottom line by reducing the increasing cost of health care.

What if you could be more transparent on health care costs?

With reference based pricing, both plan members and medical providers take initiative in learning the true costs of health care services and avoid the substantial variations in pricing that can exist. Consumers are also encouraged to review pricing information in advance to make the best decision for their situation.

In health care, what is reference based pricing? Reference based pricing is a medical cost containment model that limits what a group health plan will pay for certain high-cost services, including outpatient facility and hospital charges. Prime Health Services is on a mission to help lower the cost of health care, and this is one tool available to payers, self-insured companies, and governmental entities. Reference-based pricing sets fair-and-reasonable rates for hospital and outpatient facility services, based on the average cost primarily paid by Medicare.