Reference-based pricing (RBP) programs were created to assist patients in selecting lower-price facilities for medical services. Insurance plans determine a reference price for a medical service and cover the cost for that service up to the reference price. Patients are responsible for paying any remaining difference.
Investigating an RBP program for outpatient imaging services, assistant professor of health economics and policy at the Harvard T.H. Chan School of Public Health Anna Sinaiko, PhD, and associate professor of health care policy Ateev Mehrotra, MD, MPH found that the program resulted in modest savings.
During the first year after the RBP program implementation, there was no change in selection of lower-price facilities for imaging procedures and out-of-pocket costs paid by enrollees increased.
By the second year, enrollees were 22% more likely to choose a lower-priced facility after being exposed to the RBP program. Net prices for imaging procedures were 8% lower than they had been in year one, and enrollee out-of-pocket had decreased.
While some enrollees did shift to lower-priced facilities, the RBP program was associated with only a minimal savings with net savings representing 0.3% of outpatient spending. Utilization of imaging procedures did not change, and higher-priced providers did not lower their prices.