F.A.C.T.™ Reference-Based Pricing


IS A REFERENCE-BASED PRICING MODEL YOUR SOLUTION FOR AFFORDABLE HEALTHCARE?

Focused Average Cost Tracking or F.A.C.T. is a reference-based pricing healthcare model for employers with self-funded medical plans that significantly lowers the cost of hospital and outpatient facility claims. Runaway healthcare costs may threaten a company’s long-term viability, but F.A.C.T.-based pricing focuses on capping hospital and outpatient facility charges based on average costs primarily tracked by Medicare.

F.A.C.T. REFERENCE-BASED PRICING REVERSES THE COST INFLATION TREND

Healthcare spending continues to increase year after year with hospital and outpatient facility services representing a significant portion of rising healthcare expenditures. Under the current private insurance system, hospitals and outpatient facilities can charge inflated prices that are discounted when services are received from in-network providers. Conversely, the Cherry Bekaert Benefits Consulting F.A.C.T. reference-based pricing approach sets fair-and-reasonable rates for hospital and outpatient facility services, based on the average cost primarily paid by Medicare which pays significantly less than private insurance for the same services your employees receive. Ask yourself – why should employers pay retail prices for in-network private insurance coverage when the same service can be provided at Medicare-based wholesale costs under the F.A.C.T. reference-based pricing approach?

ADVANTAGES OF F.A.C.T. REFERENCE-BASED PRICING HEALTHCARE PLANS

FIVE IMPORTANT FACTS YOU NEED TO KNOW

HOW DOES F.A.C.T. REFERENCE-BASED PRICING SAVE YOU MONEY?

F.A.C.T. reference-based pricing generally pays hospitals and outpatient facilities significantly less than private insurance by reimbursing the hospital or outpatient facility a percentage of Medicare (generally 120% to 150% of Medicare rates) which includes a reasonable profit margin for the provider. In some circumstances, the plan may pay the provider a reasonable profit margin over the actual cost for the service. Not only are there savings on actual claim costs, but other fixed costs such as stop-loss premiums are reduced as well because fewer high cost claims are expected.

IS F.A.C.T. REFERENCE-BASED PRICING RIGHT FOR YOU?

IT’S TIME TO BEND THE HEALTHCARE COST TREND DOWNWARD

By switching to a F.A.C.T. reference-based pricing healthcare plan and reducing your hospital and outpatient facility costs by 15 – 30% or more, you can save your company money, improve your bottom line and mitigate expensive cost increases in the future.

 

To get all the FACTS on strategic benefit planning and Cherry Bekaert Benefits Consulting’s Focused Average Cost Tracking reference-based pricing approach, please contact Kyle Frigon today at 404-733-3256 or kfrigon@cherrybekaertbenefits.com.