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Reference Based Pricing

BigBang uses Reference Based Pricing to reimburse hospitals. Our approach has the following advantages over traditional hospital contracting and even those few payers who have started using Reference Based Pricing.

Case Study - Reference-Based Pricing (RBP)

RBP Findings & Results 3 Levels of Savings

Plan Type

Annual

PPO RBP
Claims: $2,896,377 $2,519,840 $376,537
(13% savings)
Stop Loss: $791,677 $574,018 $217,659
(28% savings)
PPO Fees:
(PEPM)
$15.67 $5.05 $29,311
(67% savings)

Sustainability

  • All of your current providers are eligible.
  • The methodology is based on Medicare reimbursement which is based on actual hospital costs.
  • Claim surveillance examines every claim automatically and benchmarks results against Medicare pricing, cost, average reimbursements, or commercial claim payments.
  • True claims cost management solutions based on federally reported cost information.
  • Recognized by Stop Loss carriers so results in lower Stop Loss premiums.
  • Reimbursement amounts are communicated to the hospital and member before the service is delivered eliminating retroactive audits and protection for the member. Eliminates balance billing of members.
  • Provide highest value on Member protection.
  • Price is negotiated and sign-off agreement is secured based on reduced amounts.
  • Not dependent on reimbursement negotiated by somebody else.
  • Reference Based Pricing has been shown to reduce total claim cost by 10 to 15% relative to traditional hospital contracting.