Reference-based pricing is gaining momentum — here’s why - Employee Benefit Adviser article

Si's Library Navigation

This room contains pieces drawn from my experiences at Health Decisions. It offers practical advice for anyone involved in managing group health plan expenses.
From the present, this room contains articles and reports by others that I wanted to share. Reasons for sharing will vary, so expect a potpourri.
This room provides reference points and norms I have observed or documented that can be used by persons trying to get their bearings in the often confusing world of group health.
This room contains my views on the future of the US health care system. My intent is not to convince anyone, but to broaden the discussion beyond the political debate that passes for health reform in America.
This room contains recordings and trasncripts of conversations I've had with interesting people I have had the privilege of meeting. Some are friends, some professional acquantances; all have interesting perspectives worth sharing.
From the past, this room contains some of the talks and articles I have done that I thought were worth sharing.

Topics of Conversation Health Care Reform News and Views Tools of the TradeSi's Library

Use the above navigation buttons to filter Si's Library by category.

Thursday, July 26, 2018 11:54:00 AM Categories: News and Views

This article makes a good case for billing and payment reform. Reference-based pricing using Medicare is a vast improvement over meaningless PPO “discounts” that currently dominate the self-funded market. Providers have completely co-opted PPO billing across the country. With the support of national payers, PPO provider agreements have become secret documents that self-funded plan fiduciaries are unable to see. The terms in those agreements determine how the self-funded plan’s money is spent, yet plan fiduciaries can’t see those terms: Talk about lack of transparency! Using Medicare payment levels puts the self-funded plan back in control of how provider bills get paid.

Share This Using Popular Bookmarking Services
Comments are closed on this post.
409 Plymouth Road, Suite 220 • Plymouth, Michigan 48170
phone 734­.451.2230 • fax 734­.451.2835
© 2011 - 2024 Health Decisions, Inc.