Reference-Based Pricing: Setting Price Limits on Healthcare

Healthcare costs continue to rise which means employers are in search of techniques to contain or reduce their group health plan expense. One self-funded strategy some health plan sponsors have begun to explore is reference-based pricing (RBP). RBP is basically a method for calculating payment to certain providers (i.e., hospitals) using a “reasonable fee” based on a reference point. The most common reference point is the Medicare fee schedule. For example, reimbursements for hospital or diagnos
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