Key to a cost-saving RBP plan? High-touch care teams and powerful data tools manage health status, and deliver on promise to employees and employers

Careful attention to the healthcare status of employees and their families, with both high levels of personal attention and better use of data, is the hallmark of the latest generation of reference-based pricing (RBP) plans. These RBP plans, often referred to as value-based pricing (VBP) plans, aren’t forcing employers to choose between savings and a high-quality customer experience.

RBP can be an ideal pricing strategy for self-insured health plans to cut costs and provide members with the freedom to choose their own providers. But the first generation of RBP plans, which were rolled out in 2004, created negative and confusing patient experiences. 

Most RBP plans establish agreed-upon pricing with providers in advance, at a standard today such as 140% of Medicare reimbursement. That may be significantly lower than the standard payment to a private insurer (which averages about 240% of Medicare), but without careful attention to member needs—including support—RBP can result in a dissatisfied member. 

However, VBP plans have learned from the mistakes of the first generations of RBP plans. A focus on high levels of service from a care team, plus the power of real-time data to better inform decision-making, helps deliver on the promise of RBP. 

What are the most critical considerations when tracking a member’s health status? Consider these three important steps to staying on top of member health status to maximize cost savings and provide the best possible service to members.

  1.  Automatically sync health history data with healthcare usage data. The capabilities of modern technology to assemble, process and connect data mean there’s no excuse for health plan administrators who are unable to track each member’s health needs and usage.

    For instance, each night, Lucent Health shares current data feeds with its care coordination team. This daily information detailing claims and healthcare visits is assimilated into the care team’s existing data to maintain complete files on each member. With more comprehensive information, the care team can better help employees and their families manage their health, especially complex or chronic conditions.
  1.  Provide ongoing support for employees. The best RBP health plans feature patient care teams that are available to support and advise members directly.. Your members deserve to understand their treatments, medications and options when facing medical questions—and a dedicated team can provide helpful, unbiased guidance.

    Plus, when a trained care team is available to answer questions and provide support, members will be less likely to schedule unnecessary healthcare visits out of confusion or fear. Members who can reach this care team by phone, text and video chat can better manage their health and reduce healthcare spending.

    In addition to a live care team, mobile apps can also provide ongoing support for members. Lucent Health’s free app makes it easy for employees and their families to track symptoms, manage prescriptions, find and read educational health materials, locate providers, pre-price procedures, and get instant responses to issues or questions.
  1.  Make it easy for employees to pay healthcare providers at the time of service. According to the Society for Human Resource Management (SHRM), RBP plans pay providers fees for their services on par with what they receive from a standard health plan. Plus, those fees are paid quickly at prices that have been agreed upon in advance, so there’s no back-and-forth about claim acceptance or denial. This keeps providers happy, which helps ensure that plan members can receive top-notch care.

    An easy way to facilitate quick payments is by providing members with a virtual credit card to cover a bill at the time of service. Because members can choose any provider they want rather than solely focusing on in-network providers, they may choose a physician who is unfamiliar with the plan. In such a case, a Lucent Health member can simply reach out to their care team contact, who can take care of the bill with a virtual card on the spot. The system saves patients from worrying about handling a bill later, and providers immediately get what they need.

To learn more about RBP and Lucent Health, visit

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