In MyOpinionIMPLEMENTING A VALUE-BASED PRICING HEALTH PLAN - THREE STEPS TO SUCCESSBy Laura Schneider, Chief Human Resources Officer, Core & Main LPIf you are looking for an innovative way to add much-needed transparency to your health care plans and offset fast-rising healthcare costs, then Value-Based Pricing (VBP) is worth consideration. Our journey into VBP is just a few years in, but it has helped us realize significant savings, both for our associates and the company. We are sharing some background and tips for implementation based on what we've learned.How It WorksSimply put, VBP sets pricing outside of the pre-determined or negotiated discounts offered by traditional networks. You may have also heard of Reference-Based Pricing in the same breath. However, we see them differently. VBP does not balance bill consumers, while Reference-Based Pricing may pass a balance bill onto plan members. Our current goal is to cover any balance bill for members using all the resources we have through a patient advocacy team. VBP reimbursement is based on a percentage of what Medicare would typically pay the provider. According to the Society for Human Resources Management (SHRM), VBP plans usually pay more than the Medicare rate, typically somewhere between 120 and 300 percent of the Medicare pricing for a given service. (Our goal is between 140 and 200 percent for our plan.) For reference, most hospitals are billing at least 500% above Medicare reimbursement on a traditional plan as their in-network discount.Three Points to Consider for a Successful Launch1. Establish a Patient Advocacy TeamWhile medical providers will be paid for the negotiated price, they still may balance bill the patient for what the provider considers the rest Laura Schneider| | MARCH 2024MANAGEHRMAGAZINE.COM8
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