Reference-based pricing: getting a handle on medical costs

It's time for another look at the trend of reference-based pricing, where employers place a cap on the amount they will pay for a health service. Reference-based pricing can help employers and employees alike gain a little more cost certainty on medical care. One particularly valuable aspect of reference-based pricing: employees are empowered to take charge of their health care spending, as any amount above the price limit could come out of their pockets.

Luckily for employees, there is more and more data available regarding pricing. One example of a medical group that does this very well is the Surgery Center of Oklahoma, which lists market prices for procedures from an Achilles tendon repair to lumbar fusions. Need a Cochlear implant? That will be $8,800, which includes the facility fee, the surgeon’s fee and the anesthesiologist’s fee as well as initial consultations. An ACL tear -- an all-too-common injury suffered by athletes -- costs nearly $6,800 to repair, with a new ligament $3,000 more.

Why is referenced-based pricing taking hold? Consumers have become educated about the real prices of procedures, and employers and employees are under pressure to reduce health spending. With employees carrying a bigger and bigger share of this burden, they need tools that can help make the right decisions, and this sort of price transparency at the speed of the Internet looks to be a trend that here is to stay.

For more information on reference-based pricing, contact Plexus via the Web, or contact a Plexus Groupe client service team member at 847-307-6100 (Deer Park), 312-606-4800 (Chicago / Loop), 972-770-5010 (Dallas) or 405-840-3033 (Oklahoma City). We're here to help -- and we're happy to help.