Looking to evaluate your reference-based pricing program?

The Reform Evaluation Framework (REF) for Reference-Based Pricing evaluates your program’s impact on costs, member outcomes and utilization. For the purpose of this tool, we define reference-based pricing (RBP) as a benefit design strategy that caps the amount the purchaser pays for particular shoppable, non-emergent services with high variation in price. The tool will measure your RBP program’s impact by comparing 12 months of current data to the 12 months prior to program implementation.  The tool allows the purchaser to select from the 5 procedures (plus “Other”) that are most commonly used in RBP programs.

CONTENTS 

1. Definitions: Provides definitions of terms, cost and quality measures
2. Report: Worksheet for evaluating purchaser’s experience with the RBP program

By using this tool you will gain insight into:

• The changes in the total cost of care and savings/losses accruing to your organization
• The RBP program’s impact on members’ out-of-pocket costs
• Changes in quality outcomes, care experience and utilization patterns
• Changes in provider behavior, including the proportion of providers who accept the reference price, and the number of procedures performed at lower intensity sites of service (i.e. any site other than an inpatient facility setting)