Reference based (RBP) pricing is making its way to the forefront of conversations between employers and their benefits consultant. Opinions vary drastically on whether or not RBP can be an effective and sustainable long-term strategy for an employer-sponsored health plan. It’s widely known that RBP plans can save money, but hesitancy comes from a number of unknowns about: customer service, balance bills, denial of services from a healthcare provider, collections or credit impairments, or even litigation against a plan member. Picking the right vendor is crucial and it can be hard to delineate the meaningful differences and know what you are buying. It doesn’t help that despite the very clear differences in models we are all lumped together as RBP. The broker gets put in a tough position of having to take vendors at their word for what they will deliver.
Fool Me Once
More than ever, we are seeing consultants separating their belief in RBP from the failures of an RBP vendor. They buy into resisting the waste and abuse that takes place in the current network system and know RBP is the most impactful and sustainable way to bend the curve. They recognize when the vendor they selected is failing and needs to be replaced instead of scrapping the entire strategy.
I recently helped move a group from a bad situation where the consultant did an excellent job putting all the pieces together for success. They brought in a transparent PBM, a solid TPA, and even layered in a direct primary care system with some creative plan design. It all started crashing because the discount RBP vendor could not deliver on their service. The consultant didn’t blink, they made a change to bring in another PEPM RBP vendor only to see them perform equally as bad. They had just blown through two of the more prominent PEPM players in the market….now what. Instead of pulling the plug these long-time believers in the PEPM model acknowledged they needed to get past the fee metric on their spreadsheet and choose success. Success meant being open to the ClaimDOC story and understanding we can deliver what they envisioned for their client. This took guts and this took humility, but most importantly it took caring about their client.
It’s All about Onboarding and Confidence
Rolling out RBP can be challenging enough without the complications of transitioning away from a struggling vendor. How do we pick up the pieces? The critical component that puts everyone at ease is communication and education, but I’m not talking flyers and payroll stuffers. I’m talking about creating an environment where human resources feel educated, confident, empowered, and supported. We believe the internal strength our clients possess that drives success is a byproduct of the organized and detailed implementation process we lead. It becomes a collaborative effort to effectively engage employees, not just at open enrollment, but year-round. Leadership and members will know what to expect. Setting the proper expectations is the difference between failure and success. We establish a minimum of weekly meetings during critical launch time to review questions and concerns. This meeting cadence is encouraged until the client is comfortable scaling back. We also require access to plan members to ensure they are getting the correct messaging. When I describe our framework it is often met with “sounds pretty standard”, which it probably does because the others over-promise and we over-deliver. ClaimDOC clients know the difference and the experienced consultants who have used other vendors know it. Our relationship managers stand in the line of fire because we are confident in our member-centric solution. If your current vendor is not front and center holding your client’s hand, then it might be time to make a change.
Failing is Learning
Different philosophical beliefs can take consultants different paths on the journey for creating financially sustainable healthcare. The market changes, client demands change and more than anything we are seeing the other RBP competitors changing for the worse. That is good news for ClaimDOC from a competitive standpoint, but that is bad news for consultants that trusted them and it’s putting a stain on RBP. There is no shame in trying something that you had resisted in the past. Hurdles will exist with any platform that can drive significant savings, however, you can be assured with ClaimDOC you will be getting a partner and your client won’t be treated like a number.
So, if you’re considering RBP or if you’re already doing RBP, make sure your vendor is putting the employee experience first, helping tailor the plan so that everyone wins, and doing more for you than simply re-pricing your claims. If they’re not, you can always call ClaimDOC.