Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery

Health Affairs
James C RobinsonChristopher Whaley

Abstract

Some employers are using reference-based benefit (RBB) designs, also known as "reference-based pricing," to encourage patients to select lower-price ambulatory surgery centers instead of expensive hospital outpatient departments. This article analyzes the impact of such benefit designs for cataract removal surgery from the period 2009-13, using data on 2,347 surgical patients covered by the California Public Employees Retirement System (CalPERS), in comparison to 14,867 patients enrolled in non-CalPERS Anthem Blue Cross plans, which are not covered by RBB. After adjusting for changes in patient case-mix and other factors, the shift to RBB was associated with an increase in ambulatory surgery center use by 8.6 percentage points compared to trends among Anthem enrollees. Total employer and employee payments per procedure, after adjusting for changes in case-mix severity and market factors, declined by 19.7 percent compared with Anthem enrollees not subject to RBB. Consumer cost-sharing requirements increased for CalPERS patients who continued to use hospital outpatient departments but who were not exempted from RBB because of geographic or clinical factors. Reference-based benefits for cataract surgery saved CalPERS $1.3 million ...Continue Reading

References

Apr 9, 2014·Health Affairs·Winnie Chia-Hsuan ChiAndrea Devries
Jun 1, 2014·Journal of Health Economics·Ulrich KaiserHannes Ullrich
Oct 22, 2014·JAMA : the Journal of the American Medical Association·Christopher WhaleyNeeraj Sood

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Citations

Aug 2, 2015·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Stéphanie A van der Geest, Marco Varkevisser
May 2, 2017·Current Opinion in Urology·Daniel Pitts, Jesse D Sammon
Mar 8, 2017·Health Affairs·James C RobinsonChristopher Whaley
Jun 1, 2018·Acta chirurgica Belgica·Els Van CaelenbergMarc Coppens
Dec 7, 2018·Medical Care·Laurence C BakerDaniel P Kessler
Aug 17, 2017·The New England Journal of Medicine·James C RobinsonTimothy T Brown
Apr 30, 2017·Orthopaedic Journal of Sports Medicine·Dustin L Richter, David R Diduch
Dec 13, 2018·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Stéphanie A van der Geest, Marco Varkevisser
Sep 18, 2015·The Journal of Bone and Joint Surgery. American Volume·James C RobinsonKevin J Bozic
Nov 14, 2020·JACC. Cardiovascular Interventions·Kevin LiWilliam F Fearon
Mar 2, 2021·Health Affairs·Christopher M WhaleyDena Bravata
Jul 21, 2021·PloS One·Tasce BongiovanniJoseph S Ross

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