Reference Based Reimbursement

RBR

Data Driven Pricing

Referenced Based Reimbursement (RBR), also commonly known as Cost Plus or Reference Based Pricing (RBP), offers self-insured plans a defined benefit structure based on more economical reimbursement levels designed to be fair and reasonable to providers based on various pricing data sets, most notably Medicare. (Chart below shows spread in actual hospital costs as reported to the U.S. Government vs. hospital billed charges vs. what PPOs are paying.)

Employers are driving a trend toward alternative medical cost management seeking reprieve from inflated medical pricing and PPO overpayment. It is apparent we are paying too much for our care, and RBR is a solution growing exponentially in use that provides patient’s choice, saves employers money, and provides quality care. RBR eliminates the need for a PPO.

Click to Enlarge | Source: AMPS MBR Database (1,600 Hospitals, 10,150 Claims)

Click to Enlarge | Source: AMPS MBR Database (1,600 Hospitals, 10,150 Claims)

The AMPS Difference

For every 1,000 employees on an employers’ RBR health plan, this 37% decrease in cost equates to approximately $2,600,000 in savings.

Currently 200+ companies nationwide use AMPS RBR as their health plan, replacing their PPO. Over the last 3 years, AMPS average reimbursement level on hospital claims averaged 156% of Medicare—approximately 37% less than BUCA PPO reimbursement levels.

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Introducing Care Connex

AMPS’ RBR solution, Care Connex, brings the pressures of consumerism and the free market to the medical world. Employers set a certain dollar amount—a defined contribution—they will reimburse per procedure based on multiple data points (Medicare being one of many). Patients then connect with an AMPS Care Navigator to find a local provider that will conduct the desired procedure. Cost transparency is thus stimulated by providers.

Care Connex Service & Benefits

On Demand Portal:

AMPS provides TPAs/Brokers with a next-generation portal and analytics platform, which will provide anywhere, anytime visibility into claims flow, performance metrics, and trends. The portal provides on-demand insight for both internal and client review meetings, including performance monitoring, reporting, TAT tracking, claims management, contracting, and pricing.

Still Have Questions? Contact an AMPS Client Representative