Reference-Based Pricing "Myths and Realities" 

Tue February 25, 2020 10:30 am - 12:00 pm 

Self-funded health insurance programs have adopted various cost-control strategies over the decades, one of the most recent being the advent of Reference-Based Pricing (RBP). This session will provide a comprehensive overview of RBP, where provider reimbursements are based on Medicare-like payment levels as a “reference” point. Along with discussing the components of an RBP program, we’ll delve into the reasons RBP programs were created as an alternative to typical UCR payment models. The presentation will include key factors for identifying clients for whom RBP may be a viable option, as well as which factors to weigh when evaluating TPAs, repricers, and stop loss carriers to ensure a successful RBP program.

Top Take Aways 

  • Understanding of Reference-Based Pricing strategy
  • Strengths and weaknesses of Reference-Based Pricing programs - what’s true versus what isn’t
  • Keys for identifying the right clients and vendors for successful implementation of Reference-Based Pricing programs

Musculoskeletal Procedures and Costs 

Wed February 26, 2020 12:00 pm 

In this webinar, Bruce Campbell M.D. provides an overview of the commonest Musculoskeletal conditions, including medical and surgical treatments for them. Bruce will also address common questions and provide best practices.

Key takeaways for HR professionals include: 

  • Understanding the importance of cost variation and Place of Service;
  • The role of Centers of Excellence in care of musculoskeletal condition treatment;
  • How to address “experimental and non-FDA approved treatments;
  • Out of Network providers and elective treatments;
  • Which indicator codes and safe harbors apply to various employment situations (e.g., waiting periods, changes in cost, changes in employment status);
  • How to address other situations, such as opt-out payments, union employees, and conditional offers of coverage to spouses

Connect with our team!

Email Us Schedule a Meeting 208.345.9944

Connect with our team!

Email Us Schedule a Meeting 208.345.9944