Association of a national insurer's reference-based pricing program and choice of imaging facility, spending, and utilization

Health Serv Res. 2020 Jun;55(3):348-356. doi: 10.1111/1475-6773.13279. Epub 2020 Mar 10.

Abstract

Objective: To examine the association of a national insurer's reference-based pricing (RBP), program for outpatient advanced imaging-a benefit design to encourage patients to choose lower-price facilities.

Data source/study setting: Administrative and medical claims data for three self-insured employers that introduced RBP and a comparison group without RBP.

Study design: Difference-in-difference comparison of pre-RBP (2014) and post-RBP (2015-6) care between intervention and comparison groups.

Data collection/extraction method: We identified 137 680 imaging procedures (4602 intervention group; 133 078 comparison group) in 2014-2016.

Principal findings: In the first post-RBP year (2015), there was no change in choice of facility; by the second year, RBP-exposed enrollees were 21.9 pp (95% CI: 18.5, 25.3) more likely to choose a lower-priced facility and net prices were $101.05 (95% CI: -$130.65, -$71.46), a difference of 8.1 percent lower. RBP was associated with higher patient out-of-pocket spending in the first post-RBP year ($31.82; 95% CI: $10.91, $52.73). There was no change in utilization, and higher-priced providers did not lower prices in the postperiod. Net savings represented 0.3 percent of outpatient spending.

Conclusions: Reference-based pricing for advanced imaging was associated with a shift to lower-priced facilities, but net impact on outpatient spending was modest. Patients paid increased out-of-pocket costs, though the amount declined after the first year of the program.

Keywords: cost-sharing; health insurance; reference-based pricing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cost Sharing
  • Costs and Cost Analysis / methods*
  • Diagnostic Imaging / economics*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Insurance Carriers*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Reference Standards
  • Residence Characteristics
  • Young Adult