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Benefit Administrative Systems (BAS) Champions Reference-Based Pricing at World Health Care Congress

BUSINESS WIRE


Company founder Marty Joseph outlined the perils, benefits and successful strategies of RBP

June 11, 2019 08:01 AM Eastern Daylight Time

CHICAGO–(BUSINESS WIRE)–More brokers and employer groups are exploring reference-based pricing (RBP) as a way to control skyrocketing healthcare costs while simultaneously achieving greater transparency and better access to care. Marty Joseph, founder of Benefit Administrative Systems (BAS), a division of HealthComp Holdings, discussed this model at the World Health Care Congress in Washington, D.C. In his session, Joseph drew on his years of experience in the RBP industry to talk about the challenges and benefits of RBP, as well as key strategies for successfully implementing and administering RBP plans.

Marty Joseph, founder of Benefit Administrative Systems, a subsidiary of HealthComp, discusses reference-based pricing and its benefits for #healthcare costs and outcomes at the World Health Care Congress #RBP #WHCC19Tweet this

“Innovative CEOs and CFOs are frustrated by year over year double-digit increases in healthcare spending within traditional health plans,” said Joseph. “At the same time, they don’t have the data or cost transparency to know what’s behind this cost escalation. They want to approach healthcare differently. Many of them are coming to BAS as a Center of Excellence in this area and saying, let’s talk about reference-based pricing. In 2018, 75% of our new business inquiries were around RBP. This represents significant movement in the market – it’s changing the landscape and giving companies more power to impact costs and outcomes.”

According to Joseph, executives are particularly interested in RBP since it could save them up to 20-30% on healthcare spending in the first year. With these results, RBP will likely continue to gain in popularity, especially as healthcare costs continue to rise.

Many hospitals and healthcare facilities charge inflated prices. Traditional health plans negotiate discounts to these prices through provider networks, but this model still results in high costs. RBP, on the other hand, does not utilize a carrier or provider network. Members may see any healthcare provider; this freedom of access coupled with cost transparency helps foster better-informed healthcare consumers.

In addition, provider reimbursement in RBP is based on either a percentage of Medicare reimbursement rates or the true cost of the healthcare service. This simple and fair methodology is what yields the cost transparency, a core tenant of the RBP model. Employers have claims and cost information, so they can better assess how their plans are performing and address problem areas in a very data-driven approach.

As part of the session, a success story was shared of an employer group that recently switched from a traditional preferred provider organization (PPO) to an RBP plan. This group had about 1,200 employees across more than 35 states. Before RBP, it spent about $5 million a year on healthcare. An initial analysis and forecast of the group’s claims projected it would save approximately $1.1 million in the first year using RBP. After just 10 months, however, the group reduced its healthcare spending by an estimated $1.7 million, far exceeding the initial projection.

According to Joseph, for RBP to be successful, employer groups have to be “all in.” The key is to provide plan members with ongoing communication, education, and support. As such, it’s critical to partner with an RBP administrator that has the experience and processes in place to seamlessly handle implementation, administration, and member support.

“With RBP, members must engage and take action,” said Joseph. “Member education is the foundation, so they understand how RBP works, and what to do in case of balance billing. In the case study presented, we saw 98.7% of all claims go through without a balance bill. If you look at PPO plans today, they experience roughly the same rate. However, with RBP, members actually receive extensive support to assist and resolve these bills.”

In addition, BAS has established an outreach program that alerts members with a text and live phone call when an RBP claim is processed. Members are constantly reeducated on the steps they need to take. “Overall, our process gives members a high-touch experience, along with empowerment,” added Joseph.

To hear Marty Joseph speak about RBP and how employers are using this model to reduce healthcare spending, tune into his video interview at the World Health Care Congress:

About Benefit Administrative Systems, LLC (BAS)

BAS, a division of HealthComp Holdings, is a results-driven third-party administrator that was founded in 1983. The company has a track record of delivering cost savings and customer satisfaction. It utilizes specialized services, tools, and partners to create a robust partially self-funded plan as unique as each client. BAS is headquartered in Chicago, Illinois.

About HealthComp Holdings

For more than 35 years, HealthComp Holdings has been dedicated to transforming benefits management into an experience that employees and employers love. Bringing together concierge-level service, operational excellence, powerful analytics and cost management, we’ve built a solution that integrates seamlessly with any benefits ecosystem. As one of the nation’s leading benefits administrators for self-funded employers, we are comprised of two Centers of Excellence: Our Center of Excellence for PPO administration is based in Fresno, California, and our Center of Excellence for Reference-Based Pricing (RBP) is based in Chicago, Illinois.

Contacts

Media Contact:
Joy Scott, CEO, Scott Public Relations
joy@scottpublicrelations.com
Phone: 818.610.0270

Chad Harris

Chief Executive Officer

 

Chad Harris serves as the CEO of HealthComp and is a value-driven healthcare leader with over twenty years of experience running business process and information technology businesses as a senior executive. Chad has a reputation for creating and controlling rapid growth by focusing on the intersection of customers, market dynamics, and the new digital world.

 

Chad has held many senior executive positions and led global teams of more than 10,000 people across dozens of counties. Chad has grown both large and small businesses, from those with less than $100M of revenue to those producing multiple billions of revenue, focusing on delivery, customer satisfaction, and innovation to create market leadership.

 

Chad's philosophy is to inspire change by doing what comes naturally, putting the needs of others before his own, working incredibly hard, and focusing on "how" to accomplish things, never "if they can be accomplished."

Thomas Martel

Chief Growth Officer

 

Tom serves as the Chief Growth Officer at HealthComp. In this role, Tom focuses on strategic initiatives aimed at accelerating HealthComp’s growth nationwide. His passion lies in assessing market and enterprise structures and creating efficiencies that enable teams to deliver best-in-class performance.

 

Previously, Tom led Cigna’s largest employer segment, largest region which was comprised of several health plans including the two largest health plans. He worked closely with Market Presidents and their leadership teams to develop and execute local market strategy and deliver growth for the enterprise. Tom earned his degree from Saint Anselm College and holds certifications from The Wharton School and the Darden School of Business at the University of Virginia. In his spare time, he enjoys sailing and holds a Master Captain’s license with the U.S. Coast Guard. He is also active in community outreach programs including local food bank and shelter services.

Sanoj Balakrishnan

Chief Technology Officer

 

Sanoj Balakrishnan serves as the Chief Technology Officer at HealthComp. In this role, he oversees the company’s overall technology strategy and architecture, building secure and highly scalable distributed systems.

 

Most recently, Sanoj served as Head of Healthcare Digital Business and Technology at Cognizant, working with payers and providers in developing solutions that reduced healthcare costs and provided a best-in-class experience for members. Earlier in his career, he worked at technology organizations in a variety of software engineering and architecture roles. Sanoj earned his B.S. from University of Mumbai and Computer Systems Management from National Institute of Information Technology.

Justin Tran

Executive Vice President, Product

 

Justin serves as the Executive Vice President of Product at HealthComp. He has 8 years of experience in developing and delivering solutions that reduce health care costs, improve quality, and provide a best-in-class experience for members. Most recently, Justin was an Associate Partner and business unit leader at McKinsey & Company where he helped large carriers and healthcare technology companies build new clinical services and solutions for fraud, waste, and abuse. Justin earned his B.S. in Accounting and Data Informatics from Indiana University, Bloomington.

Tucker Stein

Chief Financial Officer

 

Tucker serves as the Chief Financial Officer of HealthComp. Tucker previously worked for The Boeing Company in a number of finance and strategy roles, most recently as a finance lead for the Transactions and New Business Development group. In this role, Tucker led investments and strategic partnerships for Boeing’s Space and Communications portfolio. Tucker earned his MBA at Stanford’s Graduate School of Business and his Bachelors of Science at the University of Redlands.

Tom Georgouses

General Counsel

 

Tom is involved in multiple areas of HealthComp including Operations, Compliance and Legal Affairs. Tom was admitted to the California Bar in 1990 and started his legal career with Stammer, McKnight, Barnum and Bailey, LLP. When he left the firm to join HealthComp in 2014, he was the Managing Partner (he had represented HealthComp since 2003). In private practice, Tom’s areas of focus included healthcare and transactional work. Tom holds a Bachelor of Science Degree in Business Administration-Finance from California State University Fresno and received his Juris Doctorate from San Joaquin College of Law.

Rishab Bansal

Chief Transformation & Operations Officer

 

Rishab serves as the Chief Transformation & Operating Officer at HealthComp. Rishab focuses on transforming and modernizing HealthComp’s operations to provide delightful and distinctive experiences to its members, providers, and clients. His agenda includes integrating all entities towards a One HealthComp vision, driving profitable growth, and delivering value and business outcomes.

 

In his former work over the last 2 decades, he has helped clients across industries to transform themselves by bringing industry-leading practices and digital and data-led disruption. As the trusted advisor to the C-suite, Rishab helped his clients leapfrog on their transformation journey to accelerate business outcomes and helped them unlock new opportunities to drive profitable growth, profitability, and enhanced experience for their employees and clients.


Elaine Davis

Chief Human Resources Officer

 

Elaine Davis serves as CHRO for HealthComp. Elaine previously served as CHRO for Continuum Global Solutions and has served in executive leadership positions for Xerox and GlaxoSmithKline. Elaine holds Bachelor’s and Master’s degrees from the University of California at Berkeley.