Squashing the Bad Press Around RBP (Reference-Based Pricing)
By Julie D. Mueller, President & CEO
Throughout my career, I’ve had countless conversations with employers who felt trapped by rising healthcare costs and frustrated by how difficult it was to get clear answers about where their healthcare dollars were going.
For many of them, the challenge wasn’t just the cost itself. It was the lack of transparency, predictability, and long-term stability surrounding healthcare decisions that impacted both their businesses and their employees.
That frustration is part of what led us to launch TrueCost in 2012. At the time, Reference-Based Pricing (RBP) was considered cutting edge, especially here in the Midwest.
The reaction was strong. Hospitals pushed back. Carrier-owned PPO networks defended traditional models. Headlines focused on controversy instead of the growing pressure employers were under to find sustainable solutions.
Looking back, I believe employers were asking the right questions all along.
Employers Wanted More Visibility Into Healthcare Costs
When we introduced TrueCost, employers throughout Ohio, Kentucky, and Indiana were facing annual increases that felt impossible to control. At the same time, many had very little visibility into how healthcare prices were determined or why costs varied so dramatically between providers.
Traditional PPO discounts often looked impressive on paper, but employers were beginning to realize those discounts were frequently tied to inflated billed charges.
We believed there had to be a better way.
Our approach centered on Medicare-referenced pricing because Medicare reimbursement methodologies already provided a widely accepted framework tied to documented costs and geographic considerations.
For employers, that created a more transparent and predictable reimbursement structure. For employees, it simplified many of the frustrations that came with navigating complicated network arrangements and rising out-of-pocket costs.
Most importantly, it gave employers a way to think more strategically about long-term sustainability instead of simply reacting to annual renewals.
Experience Has Shaped Our Perspective
When we launched TrueCost in 2012, we knew we were challenging long-standing assumptions within the healthcare industry. We also understood that meaningful change rarely happens without resistance.
What kept us moving forward was the belief that employers deserved better options and stronger support than they had been receiving from the traditional system.
Over the years, the industry has learned an important lesson about RBP: reimbursement methodology alone does not determine success.
Successful plans require experienced administration, strong member advocacy, provider communication, and employer education. Employees need guidance and support throughout the process, especially when navigating a different healthcare experience.
That understanding shaped how we evolved TrueCost over time and it has grown well beyond the Midwest market to include members across the country.
We invested heavily in member advocacy and patient support because we recognized early that employers were placing a tremendous amount of trust in us. Healthcare decisions affect real people, real families, and real financial pressures. That responsibility has always mattered deeply to our team.
Building Stronger Partnerships
As the market evolved, so did our approach.
In 2015, we expanded our strategy through direct provider contracting relationships designed to create stronger alignment between employers and health systems.
Those partnerships helped improve the experience for everyone involved. Employers gained greater cost stability and predictability. Providers benefited from clearer
reimbursement structures and more direct relationships. Employees experienced richer plan designs and lower out-of-pocket exposure.
One thing I’ve learned over the years is that healthcare decisions are never purely financial decisions. Behind every reimbursement discussion are employees and families trying to access care with confidence and peace of mind.
That perspective continues to guide how we approach innovation today.
Why Regional Experience Matters
Healthcare is local, especially in states like Ohio, Kentucky, and Indiana where provider dynamics and health system consolidation continue to shape the marketplace. We understand the provider landscape. We understand the concerns employees may have. And we understand how important communication becomes during periods of change.
Over the past decade, we’ve built relationships, refined processes, and gained firsthand experience helping employers navigate the realities of RBP throughout this region. And we’re proud to say that it has grown to include employers and members in almost all fifty states.
Because, while our culture is defined by our region, our strategies are not limited by it. The need for stronger alignment with providers isn’t strictly a Midwest issue. It applies to organizations across the U.S. Today, those organizations are not looking for disruption simply for the sake of being different. They are looking for trusted partners who can help them create long-term sustainability while continuing to offer meaningful benefits to their workforce.
Looking Ahead
The conversation around Reference-Based Pricing has matured significantly since 2012.
Today, employers are asking smarter and more thoughtful questions:
- Who provides strong member advocacy?
- Who understands the local market?
- Who has experience managing these plans over time?
- Who will support employees when challenges arise?
Those are exactly the right questions to ask.
I remain optimistic about where healthcare is headed because employers are demanding greater transparency, accountability, and partnership than they were ten years ago. They
want advisors who will help them think strategically and support them through change instead of simply renewing the status quo year after year.
At Custom Design Benefits, that commitment continues to guide the work we do every day.
Julie D. Mueller
President & CEO
Custom Design Benefits