“Core” per member administrative expenses in Medicaid-focused plans grew by 2.4% in 2022, slower than the growth in 2021 at 2.6%. The Account and Membership Administration accelerated to an increase of 5.7% in 2022, up from an increase of 1.3% in 2021.

This analysis is based on the twenty-first annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of about 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of fifteen plans who collectively served 15.5 million people in comprehensive products. Ten of this year’s participants also participated in the prior year. The average plan participating in the Medicaid Sherlock Benchmarks this year served 1.0 million people under comprehensive products and the median membership was 675,000. The geographic reach of this universe extended from coast to coast.

Medicare-Focused plans experienced a 1.9% increase in administrative expenses from 2021 to 2022 compared with a 0.6% increase in the prior year. The largest cluster of functions, Account and Membership Administration, increased by 3.7%, shown in Figure 1. This is a more modest growth than reported by the Blue Cross Blue Shield and Independent / Provider – Sponsored universes despite Sales and Marketing growth being faster.

Eleven plans participated in the 2023 edition of the Medicare Sherlock Benchmarks, reflecting 2022 results. The participating plans collectively served 1.7 million Medicare Advantage members. These single state or regional plans served 16.4% of Medicare Advantage not served by the five largest share plans. An average of 30% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products, exceeded 20% of revenues in all cases, and was the plurality product in several cases. Eight plans participated in both the 2022 and 2021 benchmarking cycles and these were used for trend purposes.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of approximately 1,000 health benefit organization years.

Independent / Provider - Sponsored plan cost growth sharply accelerated in 2022 based on the results of 9 continuously participating plans in the Sherlock Benchmarks. Total per member costs increased from an increase of 1.9% to an increase of 6.7%. After holding the universe’s product mix constant, the real cost growth was 7.5%, compared to a 4.2% increase in 2021.

This analysis is based on the twenty-sixth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by October, approximately 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation is open to all Independent / Provider - Sponsored Plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

Blue Cross Blue Shield cost growth sharply accelerated in 2022 based on the results of 14 continuously participating Plans in the Sherlock Benchmarks. Total per member costs increased from a 0% increase to an increase of 7.2%. After holding the product mix constant, the real cost growth was exactly the same, 7.2%, compared to a 0.4% decline in 2021.

The Sherlock Benchmarks are the health plan industry’s metrics informing the management of administrative activities. They are based on validated surveys of health plans serving 60 million Americans and provide costs and their drivers on key administrative activities.

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.6% in 2021, a deceleration from 2020’s increase of 5.8%. Similarly, the Account and Membership Administration decelerated by 4.2 percentage points, from 5.5% to 1.3%. The rates of change reflected here hold both surveyed plans and their product mix constant in each year-over-year comparison. Cost trends in 2021 for both Core and Account and Membership Administration were below average, both of which were approximately 4%, since 2010. The cost trends for 2021 discussed are based on the results of ten continuous plans serving 11.2 million members in comprehensive products, of which 6.3 million were Medicaid or CHIP.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data.

Administrative expenses for Medicare-focused plans increased by 0.6% from 2020 to 2021. The largest cluster of functions, Account and Membership Administration, increased by 0.3%. Ten plans participated in the 2022 edition of the Medicare Sherlock Benchmarks, measuring 2021 data. The ten participating plans collectively served 12.3 million members. A median of 34% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products. Eight plans participated in both the 2021 and 2022 benchmarking cycles and these were used for trend purposes.

This analysis is based on the nineteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicare-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This 19th analysis of Medicare plans is based on a peer group of 10 plans who collectively serve 12.3 million people. Of the ten plans, eight were repeat participants from a year ago.

This 20th analysis of IPS plans is based on a peer group of fifteen Independent / Provider – Sponsored plans who collectively serve approximately 10.6 million people with Comprehensive products. In addition to the Comprehensive members, these plans also served 253,000 Managed Long Term Services and Supports members. We believe this universe to be quite robust. Participants in this year’s study serve about 52% of all membership in plans served by non-staff model plans of the Alliance of Community Health Plans and 35% of all membership served by commercial members of the Health Plan Alliance. The plans were geographically disbursed, serving 24 states.

Administrative expenses for the Independent / Provider – Sponsored plans increased in 2021 after experiencing a decline in 2020, but the rate of increase remained much lower than two years ago. Total expenses grew by 4.2%, which was higher than 2018 but well below the increase in 2019. The key area Account and Membership Administration, which composes 36% of total expenses, increased by 3.2%, but this was the second slowest rate since 2014.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 960 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation in this set is open to Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

For Blue plans, 2021 reflected trends in membership, the effects of cost management and a redeployment of expenses. Blues experienced a modest decline in costs, the first since 2015. Also, for continuous plans, this was the third year in a row of declines in the rate of growth. Total costs per member per month (PMPM) declined to a median decline of 0.4% from 5.2% in the prior year. The growth in in Account and Membership Administration (representing over 45% of all expenses) fell to 1.7% from 2.7% in 2020.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 950 health plan years. This 24th analysis of Blue Plans is based on a peer group of sixteen Blue Cross Blue Shield Plans who collectively serve approximately 49.1 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 71% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

This MCOL podcast features a discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial performance of value based care organizations for the fourth quarter 2021.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2021.

This MCOL podcast features a discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial performance of value based care organizations for the third quarter 2021.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2021.

Between 2019 and 2020, administrative cost growth for Medicare-focused plans accelerated from 5.2% to 5.6%, shown in Figure 1. Account and Membership Administration expenses lagged total cost growth, increasing by 1.8% and dropping sharply from last year’s rate of 9.3%. Thirteen plans participated in this year’s Medicare benchmarking study, collectively serving 12.2 million people. 

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 929 health plan years. This 18th analysis of Medicare plans is based on a peer group of 13 plans who collectively serve 12.2 million people. Of the thirteen plans, seven were repeat participants from a year ago. The average plan participating in the Medicare Sherlock Benchmarks this year served 1.2 million people and the median membership was 941,000. The geographic reach extended from coast to coast.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2021.

This analysis is based on the nineteenth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 929 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary.This 19th analysis of IPS plans is based on a peer group of 19 Independent / Provider – Sponsored plans who collectively serve approximately 9.6 million people, not including Managed Long Term Services and Supports and other products.

Expense growth in 2020 for Blue Cross Blue Shield Plans was sharply lower in 2020 compared with 2019. Total costs per member per month (PMPM) growth declined to a median of 5.2% from 6.6% in the prior year, the slowest growth since 2016. The decline in Account and Membership Administration (representing over 45% of all expenses) was even more dramatic, falling to growth of 2.7% from 6.0% in 2019.

These results are excerpted from the Blue Cross Blue Shield edition of the 2021 Sherlock Benchmarks The Sherlock Benchmarks for Blue Cross Blue Shield Plans provide a window to health plan adaptation to this event and to how the Plans built for the future on this foundation. This 23rd analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve approximately 41.5 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 61% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

Collectively in 2020, the health plan operations of these Plans earned annual premiums plus fees of nearly $130 billion and nearly $230 billion in premium equivalents. The median Plan participating in the Sherlock Benchmarks this year served 2.1 million people. The Plans were geographically disbursed, serving 22 states. Thirteen of this year’s fourteen participants also participated last year.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2020.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2020

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 894 health plan years over 23 years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform.

So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of ten plans who collectively served 8.4 million people in comprehensive products. Eight of this year’s participants participated in the prior year.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2020

This analysis is based on the twenty-third annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 895 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary. This 18th analysis of Independent / Provider - Sponsored plans is based on a peer group of thirteen plans who collectively serve 8.4 million people. Their median and mean membership is 554,000 and 640,000, respectively.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2020.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2019.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2019.

This analysis is based on the seventeenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of more than 858 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of twelve plans who collectively serve 10.3 million people in comprehensive products. Seven of this year’s participants participated in the prior year.

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2019.

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, over 855 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Blue Cross Blue Shield plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary

This 21st analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve 36.7 million people, excluding Host, specialty and other products. We believe this universe to be quite robust. Participants in this year’s study serve 52% of all Blue membership, excluding those served by publicly-traded firms. Collectively in 2018, the health plan operations of these Plans earned annual premiums plus fees of $106.7 billion

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2019.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2018.