Reference-Based Pricing
Reference‑Based Pricing (RBP): Transparent, Defensible Cost Control
With PAI, RBP is implemented as a member‑friendly, managed solution—not just a pricing method.
Reference‑Based Pricing gives employers a clearer, more predictable way to manage healthcare spending by basing payments on an objective benchmark—usually Medicare or a cost‑plus formula—rather than traditional network discounts. This approach delivers stronger cost control, greater transparency, and the flexibility to guide members to high‑value facilities without being limited by a PPO network. RBP is especially effective for employers looking to reduce facility costs, gain budget stability, and increase visibility into how healthcare dollars are actually being used.
We help employers design a defensible reimbursement strategy, communicate clearly with employees, and ensure the plan runs smoothly from day one.
How PAI Supports a Successful RBP Strategy
With PAI, employers get the savings and transparency of RBP with the guidance, protection, and expertise required to make it sustainable and member‑friendly.
PAI handles the operational heavy lifting that makes RBP work seamlessly for employers and members. We apply your reimbursement methodology consistently, manage provider outreach, and support your employees through every step of their care experience. When a provider pushes back or issues a balance bill, our support team steps in to educate, resolve, and advocate on the member’s behalf—reducing confusion and protecting the employee experience.
