Employee Benefits
Reference-Based Pricing Helps Client Save Big on Employee Medical Benefits
60-70%
Savings on Medical Claims
16%
Decrease in Employee Premiums
500
Traveling Nurses Covered
Industry
Healthcare
Employees
500
Entity
S Corporation
Ownership
Private
Location
45 States
Challenge
Soaring medical costs for a nationwide traveling nurse workforce.
Even for healthcare organizations, employee medical insurance costs can be daunting. Our client coordinates traveling nurses across the country. After years on a self-funded plan through a big-name carrier, soaring expenses prompted a search for alternatives.
500
traveling nurses deployed across 45 states — a workforce that makes traditional group plans painfully expensive.
What Is Reference-Based Pricing?
RBP pays for medical claims based on actual hospital procedure costs — typically a flat % of Medicare reimbursement rates. A third-party administrator handles claims and negotiation, reducing costs for both employers and employees.
Solution
Switching to reference-based pricing to cut claims at the source.
Cornerstone reviewed the client’s hospital medical claims over several years and identified that reference-based pricing could significantly reduce claim expenses:
1
Claims Analysis
Deep dive into years of hospital claim data to benchmark actual costs against carrier charges.
2
RBP Implementation
Replaced carrier-set rates with reference-based pricing tied to Medicare reimbursement, with a TPA managing negotiations.
3
Ongoing Advocacy
Patient advocates handle any balance-billing disputes, ensuring employees are never caught in the middle.
Outcome
Dramatic savings for the company and its employees.
Claims Savings
One year after switching to reference-based pricing, the client yielded savings of 60%-70% on all medical claims.
Premium Reduction
Employees received a 16% decrease in their medical benefit premiums — an actual decrease, not just a smaller increase.
“
We went from dreading renewal season to actually seeing our costs go down. Reference-based pricing changed everything for our traveling nurse program.
— Client, Healthcare Staffing Firm
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