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What is Reference-

Based Pricing?

There has been a lot of talk in recent years about Reference-Based Pricing (RBP) as an indispensable tool for avoiding wild price variations on a range of costly medical services.

But confusion and consternation also have been part of that discussion with lawsuits and surprise balance bills serving as a backdrop. 


What exactly is RBP?


Simply put: a strategy that seeks to reimburse facility-based services by using the actual costs of delivering those services as a reference point. We have developed a 2.0 version of RBP removes any obstacles, serving as an employee benefit advisor’s secret weapon to help clients and prospects tame the healthcare beast.


To learn more about our unique approach, which is producing 40%-60% profit versus current medical program costs, click on the accompanying link to download this informative RBP Fact Sheet. 

Key Benefits of Reference-Based Pricing


Cost Savings

RBP strategies save both employers and employees on their medical costs by attacking the high price and variation of medical services. By basing reimbursements off actual facility costs, payments under an RBP program are consistently lower than typical PPO reimbursement for facility-based services; sometimes up to half as much for the exact same procedure.



Most facilities under the current PPO model are unable to provide employees with pricing information before they seek service. RBP models provide upfront pricing information and allow patients to evaluate their options before any services are performed. By helping patients become better consumers of their individual healthcare, they in turn help drive down your organizations healthcare costs.


Patient Advocacy

Patient Advocacy teams works directly with both patients and providers prior to services to establish a mutually agreed upon reimbursement, virtually eliminating the potential of balance billing. In rare cases, less than 1%, where patients are balanced billed, Case Advocates work directly with hospitals on the employee’s behalf to resolve quickly.

This graph is a savings analysis for an employer with 277 employees covered on their health benefit plan. This projection equates to an estimated $4,687,000 in savings over three years.


Estimated trend of current plan costs at 12% and RBP trend at 5% compounded each year.

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© 2019 by Next Impact

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