Published by Thomas Coffey on October 17th, 2025

Brokers—and Clients—Benefit from the Reference-Based Pricing Model

Reference-based pricing (RBP) is a relatively new, but broadly emerging innovation in our health insurance Industry. In this article, I’ll share insights from Trustmark’s recent webinar, which gave brokers across the country a solid understanding of the concept, how it has evolved, and its emergence as an increasingly mainstream strategy for improving access to care and controlling health insurance costs.

Taking a fresh look at RBP

The webinar, From Resistance to Results: The New Era of Reference-Based Pricing (RBP), explored how brokers can take advantage of RBP to strengthen long-term relationships, more effectively prospect for new business and differentiate themselves by bringing significant cost containment to their clients.

We went beyond typical buzzwords and misconceptions to look at the real opportunity RBP brings to the market today, and walked brokers and employers through topics such as:

  • How health insurance evolved from HMOs to PPOs and now to RBP
  • A clear explanation of reference-based pricing and how it works
  • Dealing with misconceptions and common objections
  • Real-world examples that demonstrate employer savings and member satisfaction
  • Strategies brokers can use to help clients structure a program that works
  • Ways that RBP can help brokers succeed in today’s challenging marketplace

Key takeaways and real results

Any new market innovation experiences ‘growing pains’, just as RBP did upon introduction 14 years ago. That’s why longer tenured brokers still sometimes bring up common objections:
  1. “It doesn’t work.”
  2. “Doctors won’t accept it.”
  3. “Balance billing happens.”
  4. “Employers don’t understand it.”
I explained how these issues have since been resolved and how Trustmark has transformed reference-based pricing to benefit all participants:
  • Fair and reasonable reimbursement: Healthcare providers get paid 150% of Medicare rates for in-patient procedures and 130% for doctors and outpatient procedures.
  • Educating providers: Trustmark continues to invest in helping providers understand how RBP works and how it benefits them. Today, most groups see fewer than 2% of claims result in balance billing.*
  • Member protection: Members never pay a balance bill. If they receive one, they simply submit it to our Trusted Member Care Team—no extra steps, no cost.
  • Fast resolution: 90% of balance billing issues are resolved within two business days. If full resolution isn’t possible, the employer’s claims fund kicks in to settle the account.
  • Exceptional member experience: No networks to navigate. Simple plan documents. Freedom to seek care anywhere. No out-of-network worries. Direct access to the Trusted Member Care Team for quick answers and resolutions.
We took a poll during the webinar asking brokers if they saw employer acceptance of RBP improve over the last three years. 56% said ‘yes’, which we consider to be a reflection of the efficacy of both a maturing solution, as well as our unique approach to an improved member experience.

Trustmark is a unified, end-to-end solution as a stop-loss carrier and third-party administrator (TPA). That integration means everything works together to create an outstanding service experience.
 



Will RBP work for your clients?

The webinar’s interactive format with live Q&A shifted the conversation from “Does RBP work?” to “How can I bring this to my clients successfully?”

Another poll revealed brokers’ biggest barriers to recommending RBP:

  • 35% said client hesitation
  • 27% said provider pushback
  • 22% said lack of education/resources
  • 16% mentioned other issues

I shared hard data from Trustmark’s experience implementing RBP plans across diverse industries and workforce sizes. Since we’ve been offering RBP for so long, we have extensive data and expertise brokers can use to identify opportunities and show where RBP works best.

Participants explored regional and city-by-city data on where RBP is most likely to succeed and studied “profile of success” criteria to assess when to bring the option to a client. We also discussed when dual options make sense—offering flexibility without the typical 4% load. Brokers asked questions like:

  • “Are these plans more successful in urban areas vs. rural areas?”
  • “Can you tell me the RBP score for Miami?” Western Michigan? Central Kansas?
  • “Which is the smallest group you can cover? What is the ideal group size?”
  • “Do you have a tool on the Trustmark site where we can check scores?”
The feedback was clear: brokers are increasingly seeing RBP as a proven strategy, and not an experiment. Many said the data gave them confidence to revisit RBP with previously hesitant clients.

What brokers found most valuable

The webinar showed brokers when, where, and how to bring RBP to the table. Brokers can differentiate themselves by offering an innovative solution instead of the same PPO options with the associated customary rate hikes and higher deductibles. With RBP, they can deliver:

  • Long-term relationships: Groups are 15% more likely to renew.
  • Winning new business: A 20–35% less expensive premium solution can beat out incumbents.
  • Opening new opportunities: Serving groups that might otherwise struggle to afford Employer-sponsored coverage.

Benefit from the shift from resistance to results

The RBP conversation has changed. Employers want sustainable savings without sacrificing care quality, and brokers are ready to lead that change with the right knowledge and support. The story of RBP isn’t about resistance anymore—it’s about results. When brokers understand the evolution, they can help employers take control of healthcare spending with confidence.

If you missed the webinar, you can watch the recording here.

* Balance bill protection applies to covered eligible charges; additional member responsibility may apply for CDHP plans prior to deductible being met due to federal regulation.

Trustmark® and Trustmark Small Business Benefits® are trademarks of Trustmark Insurance Company. All other trademarks are the property of their respective owners, which are not affiliates of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company.