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

Health Services Research
Anna D Sinaiko, Ateev Mehrotra

Abstract

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. Administrative and medical claims data for three self-insured employers that introduced RBP and a comparison group without RBP. Difference-in-difference comparison of pre-RBP (2014) and post-RBP (2015-6) care between intervention and comparison groups. We identified 137 680 imaging procedures (4602 intervention group; 133 078 comparison group) in 2014-2016. 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. Reference-based pricing for advanced imaging was associated with a shift to lower-priced facilities, but net impa...Continue Reading

References

Jul 27, 2001·Journal of Health Economics·W G Manning, J Mullahy
Jan 2, 2013·Annals of Internal Medicine·Peter S HusseyAteev Mehrotra
Aug 17, 2017·The New England Journal of Medicine·James C RobinsonTimothy T Brown
Oct 24, 2017·Health Services Research·Xinke ZhangNeeraj Sood
Nov 29, 2017·JAMA Internal Medicine·Jeffrey T KullgrenAngela Fagerlin
Apr 5, 2018·The New England Journal of Medicine·Ateev MehrotraAnna D Sinaiko
Jan 1, 2013·Forum for Health Economics & Policy·Neeraj SoodAmelia M Haviland
Feb 1, 2019·The Quarterly Journal of Economics·Zack CooperJohn Van Reenen

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Citations

Aug 10, 2021·Health Services Research·Christopher WhaleyAteev Mehrotra

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