Value Based Pricing
for the Self-Funded

Helping the self-funded community find RBP-friendly providers so that they can be better healthcare consumers.

Value Based Pricing Tool Value Based Pricing

As of 2018, The Centers for Medicare & Medicaid Services require at least 50% of healthcare payments to be value-based, which is a break from the traditional fee-for-service model. The emphasis is shifting from quantity to quality to benefit patients and reduce the cost of care. For nearly half of all healthcare providers and payers, value-based contracts account for less than 10% of their portfolios. Most payers and providers feel consumers need to assume more control using a value-based model. Consumers overwhelmingly say they want to take the reins, but need help getting there.

Payer Compass offers proprietary solutions that support greater adoption of value-optimized pricing in healthcare, empowering health plan administrators and employers to bridge the consumer gap for healthcare consumerism

What Is Value Based Pricing?

With value-based pricing, the cost is calculated by the quality of care, rather than the number of healthcare services provided or the number of patients treated. Incentives for providers to engage in this care model are based on metrics like:

  • Reducing hospital admissions
  • Decreasing mortality
  • Increased immunization rate
  • Improving access to preventative care
  • Patient feedback surveys
  • Medicare spending per beneficiary
  • Using certain types of certified health technology

Value-Based Pricing and Care

The healthcare value equation is further supported with value-based care, bringing the pay for performance model full circle. Using an approach deeply rooted in evidence-based data and practices results in benefits all around, from payer and consumer to provider and vendor and the population as a whole. Proactive care, such as preventive screenings, is a common value-based strategy that uses data and technology to understand emerging illnesses and diseases.

Examples of Value-Based Pricing Strategies

A healthcare provider focused on value-based care may recommend:

  • Dietary changes, tailored fitness plans, and wearable technology
  • Emotional support counseling and emphasis on total mind/body wellness
  • Getting a second opinion and the use of a team-based approach
  • Easy access to medical care, such as onsite employer health centers

Pros of Value-Based Pricing

The value of value-based pricing healthcare has a ripple effect. By removing the overuse and waste of expensive or unnecessary tests, patients save on out-of-pocket costs. Patient outcomes are also improved, which typically results in a higher-rated patient experience.

Self-funded employers, third-party health plan administrators, and brokers all realize the savings. Provider incentives and preventive care lead to a healthier, more productive employee population, which spills over into more management health plan expenses.

Providers stand to gain the most under a value-based model when they are spending high amounts on healthcare services and have a high admission rate. By adopting technology and analytics, administrative burdens and the frustration of inefficient processes are alleviated for physicians and hospitals.

Our Solution to Healthcare Transparency using Value-Based Pricing

Encompass is one of the only value-based reimbursement offerings on the market.  Also referred to as a bundled payment solution, our unique approach applies a reference-based price to one of 90 clinically-defined episodes of care, redirecting the emphasis to the patient’s outcome, and away from their wallet or maxing out their health plan.

We help payers easily bundle payments, improve care, and boost cost outcomes.

Compared to fee-for-service, our clients recognize 12% bundled payment savings and 300% enrollment growth in a Value-Based Medicare Advantage Model. Contact us to learn how to take a more proactive approach to healthcare cost and quality.