The basics of reference-based pricing

Reference-based pricing (RBP) can help combat the rising cost of medical care. RBP is a reimbursement method that uses Medicare reimbursement rates (or a derived equivalent) as a reference and prices claims based on a multiple of that rate.

No networks

Unlike traditional PPO plans, RBP doesn't require the use of a network. The plan reimburses the same amount — no matter which health care provider members choose. So, there's no need to worry about out-of-network charges.

The benefits of reference-based pricing

RBP is designed to deal with cost variations for the same service or procedure across providers.

In contrast, traditional PPO health plans negotiate individually with every provider in their network. Because of this, prices can vary widely in the same community for the same care.

Health plans that use the RBP model pay based on widely-accepted Medicare reimbursement rates.

RBP plans use a fair, collaborative approach to health coverage that:

• Reduces health care costs by up to 20%.¹
• Eliminates wide variations in the cost of care, compensating providers equally for the same care.
• Increases transparency of cost and empowers plan members to make better decisions.

The U.S. Centers for Medicare and Medicaid Services (CMS) establish Medicare reimbursement rates based on the actual cost of providing care. Allstate Benefits' RBP plans pay 100% to 150%² of the Medicare reimbursement rates or other derived equivalents for services.

Everyone wins: providers are compensated in an equitable way while members and employers save money.

How Allstate Benefits can help

If you're looking for group medical coverage for your small- or mid-sized business, the Core Value plan through Allstate Benefits combines savings with quality care.

Are there different reference-based pricing plan designs?

Yes, we have a suite of Core Value reference-based pricing products, our original Core Value plan, Core Value Flex and Core Value Access. All three can be customized to fit the needs of the business.

Not only that, but with Allstate Benefits Core Value plans the Member Advocacy Program (MAP) team is included to help members seamlessly transition and work with a reference-based pricing plan.

Value-added features

What separates our reference-based pricing program from the rest? These value-added features are available with Allstate Benefits Core Value plans:

• Musculoskeletal care: Vori Health is a nationwide specialty medical practice delivering virtual-first muscle and joint pain solutions to help members get back to their lives faster. With Vori Health, members will get treatment from a specialty physician, physical therapist, and health coach who work together to manage all aspects of care. This holistic model reduces unnecessary surgeries, lowers spend, and improves outcomes. Read more about Vori Health.
• Cancer support: Cancer Coach by Osara Health is designed to empower members impacted by cancer to thrive using expertise, empathy and technology. This is an educational, support and behavioral change program designed by oncologists to help people take control of their cancer care and achieve better outcomes.
• Flexible family care: Allstate Benefits partners with Papa to offer flexible family care benefits to employees and their loved ones. Papa delivers real human help right to an employee's front door via its curated national network of Papa Pals - compassionate individuals who bring companionship and provide assistance with everyday tasks. Read more about Papa.
• Wellness program: Plan administrators have the option to add on a wellness program through Vitality® with most plan designs. With this unique program, along with the self-funded plan, employees can get healthier, while enhancing and protecting their lives. When plan members are healthy, they can not only improve their own lives, they can also lower their health care expenses.
• Healthcare Bluebook™: Prices for the same procedure can vary up to 500%, depending on the providers your members choose for care. Healthcare Bluebook is a cost and quality navigation tool that makes it easy for members to shop around for low-cost, high-quality providers, which means both you and your employees save.³
  

Nuts and bolts

Reference-based pricing plans are an innovative way to help employers save on health care costs. They provide transparency and up-front knowledge of health care costs and pay the providers a set amount regardless of the price the provider or hospital charges for care.

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