Commercial Prices Relative to Medicare Were Lower Under An Employer-Based Reference Pricing Program

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ID: 319033
2026
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Abstract
Abstract Introduction Reference-based pricing has shown promise in reducing hospital prices and spending for state employee health plans. However, its impact among other commercially insured populations is not well understood. Methods We examined price and spending differences under an alternative health plan’s reference pricing program for self-funded employers relative to prices paid by employers and commercial payers from Round 5.1 of the Employer Hospital Price Transparency Study. The program we studied paid hospitals at approximately 140 percent of Medicare payments. Results We found that the prices paid to hospitals were significantly lower than prices paid by other commercial payers. As a percentage of Medicare, the reference pricing program paid on average 118 percentage points less for the inpatient services and 162 percentage points less for outpatient services. Relative to the prices paid by other commercial payers, we estimated that employers saved $417 million under the reference-based pricing program. Conclusion These savings represent 56.5% of what they would have spent on hospital care had they paid similar rates as other commercial payers.
Reference Key
openalex_W7166299762 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Roslyn C. Murray, Christopher Whaley
Journal Health Affairs Scholar
Year 2026
DOI
10.1093/haschl/qxag156
URL
https://doi.org/10.1093/haschl/qxag156
Keywords Keywords not found

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