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|
|Overall Saving Percentage||55.26%||74.35%|