AWS Business Advisors, a national executive consulting firm, has helped companies in a wide variety of industries save money. From employee health insurance to voluntary benefits and Medicare costs. With the insurance market perpetually fluctuating, the expenses that businesses pay out for insurance is rapidly increasing every year. We have solutions that can dramatically reduce your costs and our programs have been Implemented for very small companies to fortune 500 companies. This is how we save you money and increase benefits.
This whitepaper provides a high-level overview of how reference-based pricing for healthcare service payments can increase transparency, health literacy and the bottom line for both an employer and their employee population.
What is Reference-Based Pricing in Healthcare?
The increase in both the company and member expense has driven the market to consider multiple strategies and tactics to increase cost-controls without sacrificing quality, like the use of Reference-Based-Pricing (RBP) models. In its simplest form, RBP is the establishment of a maximum amount that an employer plan sponsor will pay providers for certain, specified medical or prescription services in a group benefit plan. Often, these services have a wide cost variation between providers with no discernible difference in quality. The reference payment amount is usually based on a framework established by a third party, like Medicare (CMS), and the services are typically geared toward facility expenses where costs are experiencing record-breaking trends.
Enrollees who seek care from providers charging more than this “reference price” are responsible for paying the difference between the actual price of the service and the established plan price. Additionally, this excess amount, called “balance billing,” does not count toward the patient’s deductible or annual out-of-pocket maximum. Patient advocacy, transparency, and education for the healthcare consumer are essential to protect from balance billing. The traditional use of provider networks in RBP health plans is usually limited to the professional component only, if usual at all. By their nature, emergency services are typically excluded.
It is imperative to follow the complex rules and cumbersome compliance laws. The impact on non-compliant companies is dramatic and very costly. Our company has experts in the field that will review your program at our time and expense. AWS Business advisors can do this all without changing vendors or insurance brokers.
It’s important to note that our compensation for these services does not come from the business so you can take advantage of our services without taking any risk or incurring any cost.
Contact us today for more details on how we can help your company.