Reference and Value Pricing  

There is growing evidence of unwarranted price variation that has no connection to the value of the care being delivered.  Reference pricing aims to offer reasonable alternatives to high-cost providers without compromising quality.  Patients have the carrot of lower, and in some instances, no member cost share if they go to providers who charge at or below the reference price. This may make patients more sensitive to the price of service, and more likely to choose cost-effective hospitals or physicians.  Reference pricing can thus send a signal to providers that unnecessarily high prices are unlikely to be sustainable.

CPR has put together an Action Brief for health care purchasers that provides both an overview of the payment reform opportunity and steps purchasers can take to begin implementation.  In addition, CPR has crafted health plan request for information (RFI) questions on the topic that purchasers can use as part of their health plan sourcing process, and model contract language that purchasers can use with their contracted plans. These documents are also available on the right side of this page.