Creating Value Beyond Reference Based Pricing
As the cost of health benefits continues to rise faster than the rate of inflation, many plan sponsors are looking for alternatives to traditional PPO networks. Plan sponsors want benefits administration partners that can deliver creative and comprehensive solutions that control costs while delivering high quality clinical outcomes and member satisfaction.
SmartDecision, HealthSmart’s approach to Reference Based Pricing (RBP), offers a unique alternative.
Reference based pricing refers to a reimbursement system for hospitals and other facilities that provides reimbursement based on a multiple of Medicare, rather than a discount from billed charges, as most PPO networks function. HealthSmart offers a comprehensive alternative to traditional RBP programs. Our concierge hosts help members navigate the health system, which contributes to a less stressful member experience and to higher compliance with treatment recommendations. We also offer a bundled approach to non-emergency procedures that includes both facility and professional fees to provide high quality care with no deductibles for members and no balance billing in several markets.
In this webinar, Craig Julien, EVP, TPA Operations for HealthSmart and Kevin Glass, VP of Business Development for HST, will discuss how providing a superior member experience combined with industry-best benefits administration can change the frame of reference from pricing to value.
Attendees will learn:
- How a Reference Based Pricing program compares to traditional PPO networks;
- How SmartDecision protects members from balance billing, collections and credit across their RBP program;
- How a comprehensive concierge approach to managing the member experience improves satisfaction while reducing benefit costs;
- How bundled pricing for non-urgent episodes of care, inclusive of facility, professional and ancillary fees creates higher value for self-funded plans in select coverage areas; and
- How pricing and quality transparency matched with technology and clinical judgement deliver overall average savings of 70 percent or more from billed charges; and
- How industry-leader HST’s services combine with HealthSmart’s SmartDecision program to create greater value than conventional approaches to RBP