Reference-based Pricing is Gaining Momentum - Here's Why
Healthcare and pharmacy costs continue to rise. We have focused on the wrong issue. We don't have a healthcare issue; we have a billing issue.
Reference-based pricing attacks the problem - targeting billing. Here's how it works - typically, a preferred provider organization network achieves a 50-60% discount on billable charges. However, after this 50-60% discount, the cost of care is still double or triple what Medicare pays for the same service. For example, the same cholesterol blood test can range from $10 to $400 at the same lab. The same hospitalization for chest pain can range anywhere from $3,000 to $25,000. Reference-based pricing allows employers to pay for medical services based on a percentage of CMS reimbursements (i.e. Medicare + 30%), rather than a percentage discount of billable charges. This model ensures that the above-mentioned hospitalization cost an employer $3,000 rather than $25,000. ur text here ...
As such, referenced-based pricing is becoming increasingly popular and we are prepared! We have several carriers that offer reference-based pricing: Allied, Starmark and HealtheChoices.