title: Reference-based pricing: an evidence-based solution for lab services shopping.
abstract: OBJECTIVE
  To determine the effect of reference-based pricing (RBP) on the percentage of lab services utilized by members that were at or below the reference price.
  
  
  METHODS
  Retrospective, quasi-experimental, matched, case-control pilot evaluation of an RBP benefit for lab services.
  
  
  METHODS
  The study group included employees of a multinational grocery chain covered by a national health insurance carrier and subject to RBP for lab services; it had access to an online lab shopping tool and was informed about the RBP benefit through employer communications. The reference group was covered by the same insurance carrier but not subject to RBP. The primary end point was lab compliance, defined as the percentage of lab claims with total charges at or below the reference price. Difference-in-difference regression estimation evaluated changes in lab compliance between the 2 groups.
  
  
  RESULTS
  Higher compliance per lab claim was evident for the study group compared with the reference group (69% vs 57%; P<.05). The online shopping tool was used by 7% of the matched-adjusted study group prior to obtaining lab services. Lab compliance was 76% for study group members using the online tool compared with 68% among nonusers who were subject to RBP (P<.01).
  
  
  CONCLUSIONS
  RBP can promote cost-conscious selection of lab services. Access to facilities that offer services below the reference price and education about RBP improve compliance. Evaluation of the effect of RBP on higher-cost medical services, including radiology, outpatient specialty, and elective inpatient procedures, is needed.
authors.affiliation: 701 Corporate Center Dr, Raleigh, NC 27607. E-mail: larry.melton@cigna.com.
authors.forename: L Doug
authors.initials: LD
authors.lastname: Melton
authors.forename: Kent
authors.initials: K
authors.lastname: Bradley
authors.forename: Patricia Lin
authors.initials: PL
authors.lastname: Fu
authors.forename: Raegan
authors.initials: R
authors.lastname: Armata
authors.forename: James B
authors.initials: JB
authors.lastname: Parr
mesh_terms: D016022:Case-Control Studies; D064790:Clinical Laboratory Services / Q000191:economics* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis / Q000379:methods; D055317:Evidence-Based Practice / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D012016:Reference Values; D012189:Retrospective Studies