Lower spending while improving experience

-1.3%

aggregate medical trend

+71

Net Promoter Score

<1%

balance bill rate

What is reference-based pricing?

Reference-based pricing is a healthcare financing strategy that reimburses certain healthcare claims using transparent, rational pricing benchmarks rather than relying solely on traditional commercial network discounts.

For employers, reference-based pricing creates more control over healthcare spend, especially where hospital and facility prices vary widely. For members, the experience must be simple: know where to go, understand what is covered and have support when questions or billing issues arise.

Tackle your top challenges

Rising healthcare cost trend

A manageable way to take on persistent medical inflation and address unit cost, reimbursement variation and high-cost claims.

Uncontrolled hospital pricing exposure

Reference-based pricing helps reduce dependence on inflated commercial reimbursement structures and creates a more sustainable financing model.

Limited transparency

By aligning reimbursement to benchmarks, employers gain a clearer framework for how care is paid for.

Why reference-based pricing needs navigation

Reference-based pricing changes how healthcare is paid for. Quantum Health changes how members move through healthcare.

We support reference-based pricing by helping members:

Understand their benefits and what to expect
Find high-quality, cost-effective providers
Navigate care decisions before costs escalate
Resolve billing and reimbursement questions
Access clinical guidance and care coordination when needed
Stay connected through one front door for healthcare support

The Quantum Health difference

Proactive engagement

We identify opportunities to support members earlier, help members make better decisions and give employers a path to reducing spend.

Quality-based provider guidance

Members receive guidance toward high-quality, high-value care, reducing care variation and supporting smarter utilization.

Human advocacy

Care Coordinators help members understand coverage, prepare for care, work through questions and resolve issues that could otherwise create confusion or delay.

Clinical coordination

For more complex needs, Quantum Health connects navigation, care management, provider coordination and clinical support into one experience.

Billing reimbursement and support

When members have questions about bills, provider balance billing concerns or reimbursement-related issues, Quantum Health helps them navigate the next step instead of leaving them on their own.

IMAGINE360

Proactive care meets smarter healthcare financing

Quantum Health partners with Imagine360 to help employers combine reference-based pricing with proactive healthcare navigation. If you already work with an RBP vendor, Quantum Health can help create a simpler, more connected member experience around your preferred model.

Reduce healthcare cost trend
Improve provider and site-of-care decisions
Lower avoidable high-cost claims
Improve the member experience
Reduce confusion around billing and reimbursement
Create a more sustainable healthcare cost-management strategy

How clients succeed

When clients paired reference-based pricing with healthcare navigation, they've taken control of rising costs.

Healthcare organization

84% overall engagement
$3.6 million in high-cost claims avoided
98% member satisfaction

Large food services employer

83% value plan engagement
-5.1% medical trend
+71 member Net Promoter Score

Reference-based pricing in one connected experience

Whether you are ready to explore Imagine360 or want to strengthen the member experience around your existing reference-based pricing partner, Quantum Health helps make the model easier to understand, easier to use and easier to manage.

Take control of cost trends

Let us show you why reference-based pricing and healthcare navigation are a winning combination.

Talk to sales

Reduce cost trend with reference-based pricing