Last month we hosted one of our favorite webinars yet, “Employee engagement + RBP: Employers’ secret to lowering healthcare costs.” The speakers shed light on how implementing a cost-containment solution like reference-based pricing (RBP) doesn’t mean an employer has to sacrifice the employee experience. During the webinar, our attendees came at us with some really great questions. Their questions were so good that we had to share with you, here on our mBLOG.
1) In my experience, employees don’t pay attention to education or information regarding healthcare until they actually need it. Any suggestions for combatting this?
It is true that employees often only show an interest in benefits that apply to their situations. One way to combat this is by approaching employee education with a marketer’s mindset, by focusing on awareness, interest, consideration and action.
First, identify the general actions you need employees to take. Then, develop a communication plan to relay the necessary information in an easily digestible manner. Finally, make it easy for employees to understand their options and use them in a way that makes sense for their situations.
2) If I will be undergoing surgery, whose responsibility is it to determine if the providers will accept a plan with RBP?
Unless there is actual acceptance of RBP in the form of a contract, there is no way to build absolute certainty about access to a specific provider for an upcoming surgery.
However, some RBP partners will provide proactive patient advocacy to help schedule things like surgeries with receptive providers, either as a pre-arranged bundle or with up-front payment options. Also, some take it one step further by carving out networks for labs or imaging to help alleviate the access issue for scheduled, non-emergent care.
3) How does Maestro Health assist groups in implementing successful transition to RBP?
We begin by taking a look at the group, the demographics and the local healthcare markets to determine what is best for employees. From there, we start a discussion around cost-containment strategies for the plan. This may begin by transitioning from traditional self-funding to an independent third-party administrator (TPA) with a network to avoid access disruption and achieve a transparent environment to analyze claims and service patterns.
In addition, we arm employees with the education and resources they need to help them navigate the healthcare system using an RBP model. This ensures that they’re prepared to know what to do when they receive a balance bill, as well as understanding the advantages of visiting a provider that has a contract with the RBP plan.
It should be noted that our deep RBP knowledge is what allows us to implement solutions, create employee communication strategies and partner with the right vendors to create a transparent healthcare ecosystem that works for everyone involved.
4) Are there any shared characteristics of providers who are more willing to accept RBP plans?
Hospital systems in competitive markets may be more willing to tolerate predictable reference-pricing payments, especially if employers began to steer employees to that hospital system instead of the larger hospital systems in their area, creating a "safe harbor." Providers that are not connected to hospital systems may also be better candidates because they have more flexibility and are willing to make unique arrangements with employers.
5) Is there an element of quality that is considered when setting the payment level to the provider with an RBP solution?
Unlike many carrier networks, an RBP plan does not restrict the administrator's ability to direct care to high-quality, low-cost providers. While the benefit level may be a set multiple of Medicare, the flexibility in provider choice, possible incentive and transparent discussion about quality can result in employees seeking higher quality care for the same rates.
6) Do you foresee an RBP methodology being applied to pharmacy benefits?
RBP can be applied to Rx in limited situations outside of a pharmacy benefits manager (PBM). For instance, RBP can be applied in hospital services that focus on high cost drugs, or in instances where the plan design limits payment for a drug and facilitates better negotiation around that item.
7) What if providers don’t accept a plan with RBP and therefore employers would end up paying 100% of the billed charges?
In situations where healthcare providers refuse to accept RBP but access to that provider is a necessity, your RBP partner will typically assist the employee in negotiating payment. Payment is rarely 100% of billed charges. Further, in some markets, there are often alternative providers or means of access, like bundled services for some surgeries.
Of course, the best practice to ensuring providers are willing to accept a plan with RBP is by working with a partner that involves providers in their discussions when designing an RBP model. We’ll be diving into how this works on May 14th during our webinar, “Build the dream: Constructing a cost-containment ecosystem for your organization.” Don’t miss it.