Association of a national insurer's reference-based pricing program and choice of imaging facility, spending, and utilization

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.