Alleviate concerns about reference-based pricing disruption


Are concerns holding your clients back from innovating their healthcare?

As more employers seek out alternatives to high cost healthcare, solutions like reference-based pricing are becoming more mainstream. It can be a complex concept that may be misunderstood by employers, but as a broker, you can make your clients aware of this exciting solution. Reference-based pricing offers substantial savings, and partnering with a qualified solutions provider puts you in the best position possible to offer strategic council to clients who are exploring if they should make the switch.

It’s not uncommon for employers who are intrigued by the cost savings and control that comes with reference-based pricing to be worried about leaving their familiar PPO plan behind. Coupled with apprehension about how reference-based pricing may cause disruption to their employees, it’s your job as broker to vet options and find a partner who aligns with your clients’ needs and objectives.

Choose a partner with experience and expertise

Experienced reference-based pricing partners will also encourage reference calls with their current clients, which can provide the broker with an opportunity to view performance metrics firsthand and receive valuable information about how relationships with solution providers progress over time. With first-hand knowledge of the reference-based pricing solution’s day-to-day operations and a look into a successful reference-based pricing client, you can rest assured you are recommending a dedicated and experienced solution provider to meet your clients’ needs.

As you evaluate different reference-based partners, ensure that the solution provider you select is fully invested in the success of the health plan. It’s important to consider partnering with a solution provider that is willing to sign on as a co-fiduciary, since they may be asked to assist in managing the financial assets of your client’s plan, and stand shoulder-to-shoulder with your client.

Often, the biggest pain point for an employer about reference-based pricing is selling their employees on a “new” type of health insurance. Educate your clients and their employees on the solution by bringing in an experienced reference-based pricing partner early in the process to talk with your client and their HR leaders. Reference-based pricing experts are eager to assist and share their passion with employers.

The solution should encompass a robust plan for member communication, dedicated support specialists who the broker and client can contact directly, and convenient digital resources. Have a good understanding of what tools and member touch points are available with the solution provider you recommend.

Develop direct relationships with employers and medical providers in the community

One size does not fit all when developing reference-based pricing solutions. There is demand in the marketplace for negotiation and settlement options as well as direct contracting with hospitals and facilities. Reference-based pricing partners that emphasize collaboration with health systems, especially those with already established partnerships, demonstrate their dedication towards fair provider reimbursement and minimizing disruption for employees. Direct contracting can be a win-win solution for all parties, and experienced reference-based pricing solutions will be open to different options for each new client.

Stay actively involved in client’s success

The best brokers stay engaged with their clients throughout the year — they are proactive in ensuring successful implementation of reference-based pricing solutions among their clients with the help of a reliable referenced-based pricing partner. For example, monthly reporting that demonstrates cost savings — which in turn show your value to the client — and dedicated support specialists that support the broker, not just the clients and members, can help make your job easier, too.


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About the author

Steve Kelley

Co-founder & CEO
Steve, a recognized expert in the insurance, employee benefits and risk management industry, has dedicated his career to solving his clients’ complex healthcare challenges. He co-founded ELAP Services to address the national issue of employers being overburdened by skyrocketing healthcare costs and lack of representation in the ongoing healthcare debate.

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