National Survey Of Health Plan Brokers Reveals Growth For Reference Based Pricing

National Survey of Health Plan Brokers Reveals Growth for Reference Based Pricing

Renalogic releases industry report featuring trends to combat massive claims

PHOENIX, AZ and CHICAGO, IL —November 8, 2021 – Renalogic, the industry leader in dialysis risk management and cost containment sponsored market research with the country’s top benefits consultants to gauge frontline perspective on the evolution of reference-based pricing (RBP) programs. With survey respondents expecting 4-7x growth in utilization of RBP by their clients over the next three years, savvy brokers are adopting RBP for massive plan savings.

“The survey was completed by about 200 health plan brokers across the U.S.,” Scott Vold, Chief Commercial Officer at Renalogic said. “The respondents confirmed that the need for referenced based pricing and cost containment is growing. Brokers are adopting cost-saving measures available to plans.”

The research survey clearly suggests that Dialysis may be a specific situation where RBP can be adopted aggressively.  Because dialysis is a relatively low incidence, high-cost situation, employee abrasion fears are largely mitigated, if not wholly eliminated.  It is much easier for an employer and vendor to support, work with and explain RBP to just a few dialysis patients on a health plan, than 40-50% of members that might use a hospital-based service that is impacted by a general RBP plan.

The industry survey was conducted September 15 through October 10, 2021. Here are some more key findings:

Traction is growing particularly for high-cost patient management with specific diseases
The survey asked how likely brokers are to recommend a RBP program to manage costs for:
dialysis, diabetes, transplant, orthopedic, oncology, pharmacy, long-term acute care (hospital), surgery, cardiac, behavioral health and acute/inpatient claims. Responses show a healthy interest in presenting the RBP option “some of the time” for all categories. Additionally, diabetes, dialysis and transplant showed on average close to 20 percent of brokers willing to recommend RBP for those conditions “all the time.” Employers are laser-focused on disease prevention, management, and cost avoidance as a top priority.

Kidney disease is the most preferred disease category for RBP
While brokers believe that a minority of their clients are using RBP for dialysis claims today, brokers rank dialysis as the leading category that they are willing to recommend for RBP. Interestingly, the related categories of transplant and diabetes were next highest. Medical claims data can identify members at all stages of diagnosed chronic kidney disease and kidney impairment, but typical large case management models do not have a program that focuses on the issue of kidney disease, end-to-end renal care, or renal cost management solutions.

Benefits consultants still learning about vendor partners
When presented with a list of leading RBP vendors, 40-50 of brokers could provide a clear perception of any of the individual companies. While the survey sponsor, Renalogic, was the highest ranked in terms of perception, the overall lack of familiarity with vendors suggests that brokers would benefit from additional education around the performance and pros and cons of RBP vendors. Download a copy of the full report below.

Renalogic

Renalogic, headquartered in Phoenix, AZ, was founded in 2002 as a specialty dialysis cost-containment company to help clients understand the unique market dynamics in the dialysis provider community. The company has evolved to become a comprehensive provider of data-driven, end-to-end chronic kidney disease (CKD) care and cost management programs for the self-insured industry. Renalogic’s professional team includes leaders in healthcare administration, care management, legal specialists in ERISA and healthcare law, contract negotiation, payer/provider negotiation, and clinical experts.