Reference-based Pricing

A data-driven approach to determine
fair and acceptable payments for
healthcare reimbursements.

A data-driven approach to determine fair and acceptable payments for healthcare reimbursements.

What is Reference-based Pricing?

Reference-based pricing (RBP) is a method of determining an allowable amount to pay the healthcare provider or the facility. RBP refers to pricing outside of those set by traditional insurance carriers.

Using a data-driven approach, we compare the cost of the service that was reported by the hospital or physician and Medicare reimbursement rates. By using this method, we are able to determine a fair and reasonable payment to providers.

Why Reference-based Pricing is the Right Solution

Lower healthcare spend by up to 40%, with our RBP solution

Allows for “open access” for all, eliminating network dependency

An unbundled plan integrating quality

Gives members control over their own health plan

Creates flexible reimbursement and contracting

Allows for more innovation
in plan design

Learn how reference-based pricing helps determine fair and reasonable payments.