Reference Based Pricing
PBA offers a Reference Based Pricing (RBP) benefit plan model for our clients seeking to regain control of their healthcare costs. RBP is a payment model that pays the medical provider an amount that covers the actual cost plus a reasonable profit margin. Our solution provides full transparency by establishing price-to-value for medical services. Claims are benchmarked against Medicare Cost and proprietary reference databases before payment is released.
PPO discounts give a false sense of security by offering significant discounts but it's a discount off of an undisclosed price. A large discount on an item that's marked up 300% - 2,000% doesn't count for much! RBP concretely determines a fair price and then holds providers accountable for charging these fair, reasonable prices in a way that no discount can.

PPO Repricing vs. Reference Based Pricing
Based on Actual Claims Data
PPO Repricing | Reference Based Pricing | |
---|---|---|
Total Claim Count | 5,372 | 5,372 |
Billed Charges | $12,769,542.15 | $12,769,452.15 |
Savings | $7,056,448.99 | $9,493,482.67 |
Allowed Charges | $5,713,093.16 | $3,275,969.48 |
Overall Saving Percentage | 55.26% | 74.35% |