July 2018

Reference Based Pricing, At Your Service

7/17/2018 8:38:57 AM

By Tom Mafale, Executive Vice President and Chief Sales Officer

Healthcare costs are rising faster than inflation. Chargemasters at hospitals and facilities have taken pricing to extremes, billing anywhere from 200 to 2,000 percent of Medicare rates, with an average of 500 percent.

As more self-funded employers look to alternative reimbursement strategies, reference based pricing is gaining traction as a method to lower medical plan costs while providing quality healthcare for their employees.

At HealthSmart, we look at things differently. There are several solutions out there, but maybe, just maybe, there are even better ways of doing things. What if we could take a powerful RBP solution and pair it with our proprietary solutions that would work to reduce costs in different situations and make it simple for the member?

This is exactly what we did.

We made healthcare smart

We have a multi-faceted approach to our newly launched Reference Based Pricing solution, SmartDecision™. At the foundation is our HealthSmart RBP solution, powered by Zelis® Healthcare. Our solution pays pre-negotiated rates to hospitals and facilities at various rates of Medicare pricing. Compare this to PPOs that offer 25 to 50 percent discounts from billed rates. If the hospital bills at 500 percent, this mean the PPO is paying, on average, 250 to 375 percent of Medicare rates. This equates to savings upwards of 60 to 70 percent off hospital and facility charges.

SmartDecision also offers bundled pricing for elective, non-emergent surgeries and procedures. MyDecision™ is a unique solution that works with providers to pay for services in their entirety. Using this approach, medical plan spending is reduced with ZERO out-of-pocket for the member.

SmartDecision also offers directory tools to manage and control physician and ancillary costs, as well as transparency information on provider quality and pricing. All combined, these solutions and tools make up a powerful approach to reducing costs.

We made healthcare simple

SmartDecision is a truly unique approach to reducing medical plan costs. But one thing we don’t want to do is make it complicated or difficult, therefore we created the SmartDecision Concierge Desk to serve as the member’s personal health navigator. The member talks to a real person to help with questions about benefits and coverage and to understand their options. Our Concierge Specialists direct members to the most cost-effective, high quality providers. Likewise, they work directly with providers to confirm reimbursement amounts and answer associated questions.

SmartDecision is a different approach to reference based pricing that lowers costs with high quality providers. When you add in SmartDecision’s high-touch concierge services, you have something very unique and effective.

We like to think out of the box at HealthSmart. We like creative solutions that solve big problems. SmartDecision is just one example.

Contact us to learn more about SmartDecision and the HealthSmart suite of customer solutions.