Reference-based pricing, or RBP, is a healthcare financing strategy that pays certain medical claims using transparent, rational benchmarks instead of relying solely on discounts negotiated within traditional provider networks. This approach gives employers greater visibility into healthcare prices and more control over hospital and facility spending.

RBP can reduce exposure to highly variable or inflated provider prices by establishing a clearer framework for reimbursement. When implemented effectively, it can help employers address rising medical costs, improve price transparency and create a more sustainable approach to healthcare spending.

Because RBP changes how healthcare services are paid for, members may need additional help understanding their benefits, choosing high-quality and cost-effective providers, and resolving billing or reimbursement questions. Healthcare navigation provides one place for guidance, care coordination and advocacy, making the RBP experience easier for members to understand and use.