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Strategic reference-based pricing: A cure for the medical overbilling epidemic

April 12, 2024
Business Affairs

With appropriate participant protections in place, this novel approach has lowered both the employee point-of-purchase cost sharing in the form of annual deductibles, copayments and coinsurance, as well as the cost of benefits. Over time, it lowers the cost of coverage by reducing both employee and employer contributions.

RBP is one of many effective strategies for addressing today’s economic challenges, ensuring the health and wealth of benefit plan participants. Related initiatives include adequate participant protections against balance billing, participant advocacy and litigation support, as well as acquisition cost-based pharmacy pricing and Health Savings Account-capable coverage.

While RBP designs have long been part of self-insured health plans and established a meaningful track record in reducing health spend, there hasn’t been meaningful adoption of these plans amid provider resistance, a litigious climate and employee friction. However, with pure RBP and other improvements, more employers are expected to embrace this approach.

When implemented in the right way, RBP proactively anticipates the challenge of balance billing and provides participant representation. And at a time of rising healthcare costs, the pure model is the best approach for avoiding the medical overbilling epidemic, which erodes not only benefits coverage and wages, but also employee well-being, morale and productivity.

About the author: Christine Cooper is the CEO of aequum LLC and the Co-Managing Member of Koehler Fitzgerald LLC, a law firm with a national practice. Christine leads the firm’s health care practice and is dedicated to assisting and defending plans and patients.

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