We gather here today to mourn a once-promising innovation in self-funded healthcare: Reference-Based Pricing (RBP). For years, RBP strutted into boardrooms, pitching itself as the savior of runaway healthcare costs:
"Just benchmark payments to 120%-150% of Medicare and you’ll save a fortune!"
But as we stand here — shovels in hand — it’s clear: RBP isn’t a solution anymore. It’s a symptom — a symptom of an industry that clung to blunt instruments when sharper tools were desperately needed. And while RBP’s defenders may ruffle their feathers at this declaration, we’re not here for comfort — we’re here for clarity.
The Promise (and the Problem) of RBP
To its credit, RBP was bold. At a time when employers were desperate for relief, it offered a simple equation:
- Ditch the PPO network
- Pick a Medicare multiple
- Cut your healthcare costs
But RBP overlooked some hard realities:
- No PPO network means no contracted protections
- No contracted protections mean balance billing
- Balance billing leads to litigation risk, member abrasion, and headaches for employers
At its worst, RBP turned CFOs into litigants and employees into billing advocates. Predictable healthcare spend gave way to courtrooms and confusion.
Why ProVision Health Works
This is where the conversation gets interesting — and where feathers get properly ruffled. ProVision Health delivers better financial outcomes than RBP while using one of the nation’s largest and most trusted PPO networks — the very infrastructure RBP tried to bypass.
Let’s be clear (especially for our friends at the PPO Network):
- We do not renegotiate PPO contracts
- We do not negotiate claims “inside” PPO agreements
- We respect all network rules and operate in full compliance
So, what are we doing?
We’re using the PPO allowed amount as a credible, measurable benchmark for evaluating TPA performance — a sharp tool where RBP offered only a blunt one. How we achieve these results is proprietary — and no, we won’t be sending you our playbook.
The Data: Proof of Performance
The results speak for themselves:
- 198,678 unique facility claims processed
- Total charges: $795,895,361
- PPO allowed amount: $351,685,834
- ProVision paid: $163,604,993
- Savings: $188,080,840 below the PPO allowed amount
On a Medicare equivalency basis:
- ProVision average paid amount: approximately 141% of Medicare
- Typical RBP plans targeting 150% Medicare often pay around 220% after all the disruption and negotiations are accounted for
Why This Matters
So yes, this gravestone isn’t just clever imagery. RBP’s time is over. It was a noble experiment, but the future belongs to solutions that deliver results without disruption — measurable, transparent, and compliant with the networks that serve America’s workforce.
If your strategy still relies on RBP to “fix” your healthcare spend, you’re living in the past. At ProVision Health, we’ve found a better way — and we’re proud to say we’re not just talking about transparency; We’re proving it.
Curious how your facility claims stack up?
We’ll gladly run a comparative analysis — no assumptions, no theories, just facts.
Send us an email at hello@provision.health to learn more.