Revolutionize Healthcare Costs

With Our New Reference-Based Pricing Model
Now Available in Georgia

In today's world, it’s tough to find ways to make healthcare affordable without sacrificing quality. Thankfully, there’s a simple solution: Reference-Based Pricing (RBP) 2.0. In cities where costs are high, brokers and employers are turning to RBP to make care more affordable without compromising on quality. At Planned Administrators, Inc. (PAI), our RBP model does just that, and without balanced billing.

What is Reference-Based Pricing 2.0?

It’s simple—RBP sets a fair price based on how much the care actually costs. It’s a step away from traditional fee-for-service models. 

Here’s how it works:

1. Setting a Benchmark Price: Our partner, Fairos, looks at how much a medical service or procedure usually costs across different healthcare facilities to decide how much to price things at. We can also use the rates Medicare pays as a starting point.
2. Negotiating With Providers: Once a fair price (benchmark) is set, Fairos talks with providers to agree on the payment amount. This is how hospitals, doctors, and others agree to charge the reference price for the services they perform, without balance billing the member. 
3. Transparency: RBP helps employees see clearly by giving them information about the reference price for medical services right from the start. It helps patients pick providers who charge the reference price or check other options if the costs are higher than the set benchmark. 
4. Shared Savings: RBP is different because cost savings are shared between the payer and the employee. This means lower out-of-pocket costs for employees and reduced overall healthcare spending for employers. 

Our Reference-Based Pricing Model 

After 40+ years of experience providing excellent service and value for our clients, we know a thing or two about RBP. Our focus on this care model helps us stand out from the crowd and offers brokers a new way to boost their service offerings. It’s one of the easiest ways to attract new clients, increase retention rates, and minimize risk. 

PAI's RBP Highlights: 

• Free and open provider choice—no network restrictions!
• No surprise bills.
• Flexible administrative solutions and benefit plan design.
• Transparency in care costs for everyone involved.
• Maximize cost control through established reimbursement limits.

With PAI’s RBP model, you can expect:  

Employers are tired of high healthcare costs, especially in cities where care costs are rising dramatically. Our RBP model reduces plan costs and gives employees more freedom in choosing quality providers. It’s in the best interest of employees and everyone else involved in the care process, including brokers and benefit advisors. 

Simply put, our Reference-Based Pricing model:

1. Makes healthcare affordable.
2. Helps brokers offer flexible plan options that meet the specific needs of their clients.
3. Brings transparency to healthcare costs and helps make cost-containment simple without compromising care options. 

Are You Ready to Gain Your Competitive Edge? 

If you’re interested in learning more about how our RBP model can boost your plan offerings and help you retain clients, reach out today. 

Source: https://www.benefitspro.com/2023/09/21/navigating-the-wild-west-of-rbp/