Reference Pricing: Will Price Caps Help Contain Healthcare Costs?

Tuesday, November 18, 2014
12:15 P.M. to 2:00 P.M.
Dirksen Senate Office Building, Room G-50

On November 18, ThinkAnthem and the Alliance for Health Reform hosted a briefing about referencing pricing, an approach to care payment that may reduce health care costs.

Many employers have begun to adopt this strategy to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge. Reference pricing can help raise awareness among patients about price differences across service providers, and exert competitive pressure on high-cost providers to bring down their prices. Evidence has also shown that reference pricing can lower costs and increase value in prescription drug plans.

The event panel discussed the benefits of reference pricing, in addition to the challenges the new strategy might pose to patients, payers and providers. Panelists explored the potential effects of this pricing system on medical and surgical services, contexts in which reference pricing may be more or less effective, lessons for public coverage plans and the impact of reference pricing on employers who offer health care coverage.

To learn more>>


  • Andrea Caballero, Program Director, Catalyst for Payment Reform
  • Theresa Monti, Vice President, Kroger Total Rewards
  • David Cowling, Chief of the Center for Innovation, California Public Employees’ Retirement System
  • Michael Belman, Medical Director, California WellPoint
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