With healthcare costs skyrocketing at unsustainable levels, employers are considering nontraditional methods of funding their medical plans. One nontraditional method that employers are starting to consider is called reference based pricing, or RBR. This method has proven to reduce overall benefit spend 20 to 30%, when compared to the traditional discount healthcare delivery model.
What is Reference Based Pricing?
The reference in RBR refers to Medicare. In a typical, traditional PPO carrier discount model, the claim after discount ends up being 250 to 450% of what Medicare reimburses for that claim. That’s two and a half to four and a half times what providers accept for Medicare patients. Employers that want to bridge that gap can partner with an RBR vendor to skirt the traditional carrier discount system. Instead of the claim passing through and have the typical carrier discount applied to the gross claim, the RBR, using Medicare benchmarking data, will negotiate the claim on behalf of the employer. An employer with medical claims of $5 million annually can reduce their benefit spend north of $1 million.
Due to this nontraditional method of providing benefits to employees and paying claims, a comprehensive employee communication plan is imperative when implementing this system. For Innovative’s RBR clients, we have tailored our employee advocacy, our Benefit Guardian service, to include support services for RBR structured pricing. As we know, savings are crucial to the success of an employee benefits program, but member satisfaction and taking care of all the family members is of the highest priority. With that being said, the two crucial components to reference-based pricing, or RBR, are cost savings and ensuring that the member experience and the communications are done adequately. While this method may be the ideal fit for some employers, it certainly is not for everybody, so a thorough evaluation is highly recommended.
Should you need help or have any questions regarding reference-based pricing, or to see if it may be a fit for your organization, please feel free to reach out to us at firstname.lastname@example.org.
Feedback From Our Happy Customers
I wanted to take a moment and tell you how absolutely thrilled I am to have Innovative Benefit Planning as my broker. We moved over roughly a month ago and I have never received service like I have since making the transition. With so many employers being challenged with COVID19 and us making the move right in the middle, it could not have been more seamless. Everything was set up to exceed all expectations and it continues. Innovative Benefit Planning has taken the worry and stress away. It was truly the best decision for Title Alliance and I look forward to a long and productive partnership.
The Innovative team is well respected at AFS. My staff and I feel they are an extension of our HR team! Since implementation, they have always remained committed to assisting AFS with all of its healthcare needs; in fact, it doesn’t matter what time of day, they always respond in a timely manner.
Each year they come up with fresh material so our employee’s interest is always peaked. A few years ago, Innovative provided us with documentation to show that moving from a fully insured program to self-insured would be more cost effective for AFS, and it has been! Innovative has truly made our jobs easier so we can focus on other tasks.
As an HR professional, Innovative makes my job easier and benefits administration much less overwhelming than it would otherwise be.
They are truly a partner with me to make sure our team members have the best benefits and service around their benefits that we can offer. Innovative’s team is responsive, professional and resourceful. (They are at the forefront of knowledge in many areas, including ACA reporting and compliance, which can get highly complicated.)
As a client for the last 4 years, we love working with our Innovative Benefit Planning team because of their service model, scope , depth and quality of expertise in handling our benefits and renewals.
Their level of commitment just keeps getting better each year. They have more than met our expectations on renewal negotiations, response time, assistance with ongoing plans, open enrollment material, meetings, support, bill auditing, and wellness programs.
Since our partnership with Innovative Benefit Planning in 2017, it has been a seamless one. Innovative always provide options, suggestions and recommendations when it comes to our benefits renewal.
Innovative is always present even when open enrollment ends, their year round communication reminds me that I can always reach out for help at any time. Their professionalism is the utmost one can expect. My account representative Jenni is wonderful, courteous, knowledgeable and very helpful.
We have been dealing with Innovative Benefit Planning for many, many years. They have given us nothing but exceptional service.
We can pick up the phone or email them and they always resolve our questions and take care of our employees insurance issues in a very timely manner. They negotiate our insurance rates every year and have managed to reduce the increase every year. Every account manager we’ve had throughout the years have been great to work with.
I have been working with Innovative Benefit Planning for over six years. Previous to Innovative, I had used the same broker for about 25 years. I was used to doing everything myself during open enrollment with my previous broker.
When Innovative came on board, I was pleasantly surprised how “on top” of things they were. I never have to call them and bother them about getting rates to me for open enrollment, as they are in touch with our carriers on a regular basis, and they get me my information for open enrollment as soon as they receive it from the carriers.