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Reference-Based Pricing “Myths and Realities”
Self-funded health insurance programs have adopted various cost-control strategies over the decades, one of the most recent being the advent of Reference-Based Pricing (RBP). This session will provide a comprehensive overview of RBP, where provider reimbursements are based on Medicare-like payment levels as a “reference” point. Along with discussing the components of an RBP program, we’ll delve into the reasons RBP programs were created as an alternative to typical UCR payment models. The presentation will include key factors for identifying clients for whom RBP may be a viable option, as well as which factors to weigh when evaluating TPAs, repricers, and stop loss carriers to ensure a successful RPB program.

Top Take Aways
• Understanding of Reference-Based Pricing strategy
• Strengths and weaknesses of Reference-Based Pricing programs - what’s true versus what isn’t
• Keys for identifying the right clients and vendors for successful implementation of Reference-Based Pricing programs

CEBS - qualifies for 1.5 hours of CPE
HRCI - approved 1.5 HR (General) credit
SHRM - valid for 1.5 PDC
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