Reference-Based Pricing

Reference-based plans, or scheduled benefit plans, offer group health plans the ability to place limits on what will be paid by the health plan. One of the biggest differences between a scheduled benefit plan, sometimes referred to as a “Cost Plus” plan, and the more common PPO plans is that no traditional provider network is involved. The other key differences stem from the way the health plan is administered.

Successful reference-based plans, like those administered by J.P. Farley Corporation, contain 5 key components that are critical to both the plan design and ongoing administration:

  • Claims Repricing
  • Plan Language
  • Education and Communication
  • Patient Advocacy
  • Patient Legal Representation

Tackling Rising Costs

J.P. Farley has helped many employer sponsored health plans attack rising costs by avoiding provider networks and adopting reference based pricing. While we still offer access to quality local, regional and national network options, an increasing number of our self-funded clients have adopted our innovative reference based pricing solution.

By moving to reference based pricing, plan sponsors are experiencing increased control over health plan costs and greater protection of plan assets, while giving their members increased access to healthcare providers.

Save Costs & Increase Transparency!

Reference Based Pricing is designed to reduce health care spending by the employer, while engaging the health care consumer.

Today’s business challenges include unique obstacles that make it increasingly difficult for employers to provide a competitive employee benefit package.

James Farley
Founder, J.P. Farley Corporation

Discover the Advantages of Reference Based Pricing

This brief video explains how a growing number of self-funded health plans are using Reference Based (or Cost Plus) Pricing to cooperate with area hospitals to agree on a pre-determined margin, thereby eliminating PPO networks.