Free Research Report · 2026

The State of Reference-Based Pricing in U.S. Healthcare Markets

Where RBP is winning, where balance billing risk is highest, and which markets offer the largest cost containment opportunity — analyzed from 6,600+ hospital MRF files and Form 5500 employer data.

50+ Markets analyzed
6,600+ Hospital MRF files
32 Pages
Q1 2026 Data vintage

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What the Data Shows

A preview of what's in the full report — analyzed from Q1 2026 MRF and Form 5500 data.

3.1×
Median hospital rate spread between lowest and highest negotiated rate for the same procedure within a single market
Source: MRF analysis, 50 MSAs
23%
Median potential savings for self-insured employers switching to 140% Medicare RBP threshold in mid-sized markets
Orthopedic, imaging, and outpatient categories
14
Markets where more than half of high-volume hospitals have publicly posted rates within 10% of Medicare benchmarks
Favorable RBP acceptance environments
Difference in balance billing risk score between the most and least RBP-hospitable major markets
Full market risk rankings in the report

What's Inside the Full Report

32 pages of market-specific data, methodology notes, and actionable guidance for consultants, TPAs, and employers evaluating RBP strategy.

01

The RBP Opportunity Landscape

Current state of RBP adoption by market, employer size, and industry. Where momentum is building and where traditional networks still dominate — with data from Form 5500 filings across 35,000+ self-funded health plans.

02

Market-by-Market Rate Spread Analysis

Hospital rate variance within 50+ MSAs, ranked by spread magnitude. Identifies which markets have the most pricing inefficiency — and therefore the largest RBP opportunity — by taxonomy category.

03

Balance Billing Risk Index

A market-level risk score based on hospital rate positioning relative to Medicare benchmarks, history of rate volatility, and payer mix context. Essential reading before recommending RBP to an employer in an unfamiliar market.

04

Savings Opportunity by Service Category

Which procedure categories — orthopedics, imaging, outpatient surgery, cardiac — show the most consistent savings potential under 130%, 140%, and 150% Medicare thresholds, broken down by market tier.

05

Quality-Cost Landscape for RBP Steerage

Which markets have the highest concentration of facilities that are both below market cost and above quality floor thresholds — the conditions required for defensible RBP steerage recommendations.

06

Implementation Readiness Checklist

A practitioner-facing framework for assessing employer readiness: plan design, member communication, repricing partner selection, and quality floor criteria. Designed for consultants and TPAs building client proposals.

Built for the Practitioners Making RBP Decisions

Benefits Consultants & Brokers

Win more RBP engagements with market-specific data

  • Show employers their savings range before the proposal
  • Rank balance billing risk by their key facilities
  • Identify the best-value steerage targets in their market
TPAs & Repricing Partners

Defend repricing decisions with benchmark evidence

  • Understand rate positioning by market before setting thresholds
  • Quantify balance billing risk before onboarding new employer clients
  • Identify markets where RBP acceptance is growing
Self-Insured Employers

Evaluate RBP before committing to a strategy

  • Understand your market's rate spread and savings potential
  • Assess balance billing risk specific to your geography
  • Know what questions to ask your consultant or TPA
Health Systems

Understand the RBP environment in your markets

  • Track RBP adoption among self-funded employers in your market
  • See where your rates land relative to Medicare benchmarks
  • Prepare for payer negotiations with market context

Ready to See Your Market's Data?

The report gives you the market overview. The platform gives you the drilldown — by facility, category, and provider.

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