A new, independent analysis of the Montana state employee health plan’s transition to reference-based pricing – which limits hospital prices to a multiple of what Medicare pays – found significant savings for the state in the two years after its implementation. Further, there is no evidence that utilization artificially increased as a result of the new payment model, which could occur if hospitals needlessly push more services onto patients to offset lower reimbursement rates, and, to date, there have been no hospital closures in the state.
State spending on health care for employees, retirees and health plans for teachers, university and municipal employees continues to challenge state budgets and raises questions about how best to allocate resources. It is also known that prices in the United States exceed those in other developed nations and that there is significant variation in prices paid by payers. In this webinar, we will hear from state health policy officials who are working to standardize prices paid to hospitals to maintain access and keep spending in check. This webinar will provide descriptions of two state models, and provide an opportunity to discuss the challenges these initiatives face and how they may be overcome. Panelists will answer your questions during this lively and substantive exchange.
Facilitated by Trish Riley, NASHP Executive Director
Marilyn Bartlett, Special Projects Coordinator, Office of the Montana State Auditor, will provide an overview of Montana’s success in implementing reference-based pricing, the savings it has achieved, and discuss whether other purchasers might join the effort.
Dee Jones, Executive Director, State Health Plan, State of North Carolina, will describe developing plans in North Carolina to implement reference-based pricing and the move to direct contracting.
Supported by Kaiser Permanente