Association of a national insurer's reference‐based pricing program and choice of imaging facility, spending, and utilization. (10th March 2020)

• Record Type: Journal Article
• Authors: Sinaiko, Anna D.; Mehrotra, Ateev
• Is Part Of: Health services research. Volume 55:Number 3(2020)
• Page Start: 348
• Page End: 356
• Publication Date: 2020-03-10
• Subjects: cost‐sharing -- health insurance -- reference‐based pricing; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13279
• Languages: English
• ISSNs: 0017-9124

Abstract

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.