Blog // HealthSmart Blog // November 2020

WEBINAR: SmartDecision- HealthSmart's Comprehensive Approach to Reference Based Pricing

12/1/2020 3:19:32 PM

WEBINAR: SmartDecision- HealthSmart's Comprehensive Approach to Reference Based Pricing 

Recorded Wednesday, December 9, 2020
Duration: 1 hour

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 network of hospitals and other facilities that accept reimbursement based on a percentage of Medicare basis, rather than discounts 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.
When clients add our integrated clinical care management service, they gain the benefit of our experienced and understanding clinical staff, best-in-class technology and a specialized network strategy that can produce significant savings for plan sponsors. Care managers provide members with a “soft landing” after their surgery or episode of care, resulting in higher member satisfaction. And our decades of experience managing the care of members with chronic, complex conditions helps ensure better clinical outcomes.
In this webinar, Thomas Mafale, EVP, Chief Sales and Client Officer, and Pam Coffey, RN, EVP and Chief Clinical Officer, will discuss the advantages of using a network of providers compensated based on Medicare pricing rather than provider charges. When Specialty Care Management is included in the plan, clients get even more significant returns.

Attendees will learn:
  • How a Reference Based Pricing network compares to traditional PPO networks;
  • How SmartDecision protects members from balance billing across their RBP network;
  • How bundled pricing for non-urgent episodes of care, inclusive of facility, professional and ancillary fees create 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