Ep 16 - Reference-Based Pricing: A New Way to Contain Costs

Ep 16 - Reference-Based Pricing: A New Way to Contain Costs

It should come as no surprise that recent events around the world have created an atmosphere of change almost everywhere. People are living radically different lives than they were three years ago, and with those changes comes a desire for the services they use to keep up with their lifestyles. In this environment, it seems almost inevitable that something like the reference-based pricing model for healthcare would emerge as a much-needed solution to modern issues.

A reference-based price model, in short, gives patients and payers a way to ensure adequate healthcare is administered, paid for, and covered while avoiding staggering provider contract fees or out-of-network prices. RBP can be used in several ways, including as a full network replacement, as support for out-of-network savings, narrow networks, or even custom network build options.

This is largely thanks to the aforementioned open access to providers and zero network limitations, which allows members to make informed provider decisions that align with their personal preferences. Additionally, RBP helps providers make sure that if someone comes in needing assistance, they can administer care without the worry of a long and arduous arbitration process if the patient is not an in-network member.

To better explain the concept, and to offer additional context as to the benefits of RBP, Mary Piecuch, Senior Vice President of Product Strategy and Erick Russell, Director of Network Operations, both at Zelis, joined the latest installment of the Future Healthcare Today podcast.

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Jaksot(25)

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

Ep 25: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 2

On the Future Healthcare Today Podcast with Lucas Hunsicker, Kristin Gasteazoro, Senior Vice President of SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice President of Brand...

24 Heinä 202415min

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

Ep 24: Revolutionizing Healthcare: Enhancing Engagement with Technology and Personalization Part 1

In the Future Healthcare Today Podcast, hosted by Lucas Hunsicker, featuring Kristin Gasteazoro, Senior Vice President, SmartShopper Sales and Client Performance at Zelis, and Reagan Greene, Vice Pres...

24 Heinä 202421min

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Ep 23: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 2

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

21 Touko 202415min

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Ep 22: Strategies for Meaningful Member Engagement to Simplify Healthcare Complexities Part 1

Despite healthcare’s critical importance, the intricate nature of insurance plans and healthcare information can often leave individuals feeling adrift. A recent Bend Financial report found that 56 pe...

20 Touko 202417min

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

Ep 21: Care Guidance Tools Helps Deliver High-Quality Care for Members

People often turn to family, friends, and Google to make healthcare decisions and find healthcare providers. This can lead to confusion and misinformed decisions. Healthcare partners can – and should ...

18 Joulu 202323min

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

Ep 20 - Brokers Step in to Fill Knowledge Gaps as Healthcare Becomes More Complex

The Affordable Care Act, far from simplifying healthcare, has introduced many more complexities, making the jobs of HR workers even more challenging as they attempt to keep pace with the fast-changing...

17 Joulu 202311min

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

Ep 19 - New Transparency in Coverage Regulations for Machine-Readable Files Affect the Market

The Transparency in Coverage (TiC) regulations provide further clarification for the use of Machine-Readable Files (MRFs) for the health insurance industry. These rules require that healthcare plans a...

16 Joulu 202315min

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

Ep 18 - Clarity, Control, and Guidance: The Future of Healthcare According to Zelis

The healthcare industry has seen its fair share of disruptions in the last few years. With the advent of telehealth and a renewed interest in taking charge of their healthcare, many members have inter...

15 Joulu 202317min

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