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.
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.
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 impact on outpatient spending was modest. Patients paid increased out‐of‐pocket costs, though the amount declined after the first year of the program.
