Blue Cross Blue Shield, Independent / Provider – Sponsored Plans

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Transcripts and Slides

DougBy Douglas B. Sherlock, CFA sherlock@sherlockco.com

The Affordable Care Act is intended to create strong incentives to reduce the administrative costs of health insurers. The medical loss ratio rules and the new ACA-related taxes are manifestations of this policy, and the recent announced business combinations between leading national health insurers are adaptations to these incentives.

It follows that the most recent rate of increase in health plan administrative expenses, excluding the new taxes, is dramatically lower than in recent years. Sherlock Company materials summarizing the results of our surveys are found below.

Independent / Provider – Sponsored Plans

Blue Cross Blue Shield Plans

Assessment

The contents above are a very small portion of the 1,000 page Sherlock Benchmarks for each of these universes. The Sherlock Benchmarks are essential tools to manage administrative costs for your health plan.

budget

Conclusion

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[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

***

Benchmarks of Health Plan Administrative Costs

2011 Edition‏

[By John Park]

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Recently, we began the release of our fourteenth annual edition of administrative performance benchmarks for health plans. It is the culmination of 515 health plan years of experience with all major sectors of the health plan industry. The attached brochure briefly describes our 2011 benchmarks.

First Universe Release

The first universe to be released was comprised of data of Blue Cross Blue Shield plans. Nearly 70% of all Blue Cross Blue Shield licensees participated this year.  A summary of the results for this universe is here:

http://www.sherlockco.com/docs/navigator/Navigator%20July%2011.pdf.

Results

In short, per member administrative expenses increased by only 1.0% in 2010 and only 1.8% when you adjust to back out changes in product mix.

This growth rate is very low by any standard.

Sherlock Company’s Benchmarks

Between the MLR provisions of the Accountable Care Act, which are intended to “create incentives for” health plans” to become more efficient,” and a weak overall economy, health plans face greater pressure to optimize their administrative costs. Sherlock Company’s benchmarks of administrative expenses enable your plan to quickly determine whether it is operating at best practice and to identify which functional areas provide the highest return on management’s efforts to improve performance.

Accordingly health plans serving more than one-half of all insured Americans are users of our benchmarks.

Assessment

Additional information can be found at http://www.sherlockco.com/seer.shtml

Sherlock Company

Douglas B. Sherlock, CFA

Senior Health Care Analyst

sherlock@sherlockco.com

Ph:  215-628-2289

Fax: 215-542-0690

Conclusion

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[Health] Plan Management Navigator

For July 2011

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By Douglas B. Sherlock, CFA

Please find attached below the July 2011 Edition of Plan Management Navigator. In this month’s edition, we summarize the administrative cost trends of Blue Cross Blue Shield Plans participating in our recently completed benchmarking study. The 27 plans, nearly 70% of total Blue plans, collectively serve 38.3 million members with comprehensive products.

Results 

The median administrative expense ratio for this peer group in 2010 was 9.2%, down from 9.7% in 2009, 9.9% in 2008 and 10.4% in 2007.

While per member Sales and Marketing cost trends increased, Corporate Services costs decreased. Provider and Medical Management and Account and Membership Administration cost growth, per member, sharply declined.

Managed Expenses 

Health plans are heavily committed to the management of administrative expenses. To adapt to the weak economic environment, they are taking steps to assure that the effects of premium rate pressures and enrollment weakness do not amplify reductions operating profits. They do this by not treating their administrative expenses as substantially fixed. In addition, the Patient Protection and Affordable Care Act’s increased scrutiny of premium rates, and enforcement of medical cost minimums (relative to premiums), elevates administrative expense control as the central aspect of managerial discretion.

Assessment

Link: Navigator July 11

Conclusion

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[Health] Plan Management Navigator

January 2011

By Douglas B. Sherlock, CFA
Senior Health Care Analyst

Dear ME-P Readers and Subscribers,

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At the risk of appearing overwhelmed with New Year’s enthusiasm, we think this edition of Plan Management Navigator is especially interesting:

1. We report on the cost decisions made by low cost Blue Cross Blue Shield plans. Low cost plans make decisions that differ from their higher cost peers. Hallmarks of these decisions include levels and distributions of expenses between functions, the levels and distribution of staff between functions, the levels of compensation and its distribution between functions and the distribution between functions, and levels of, non-labor expenses. Overall, low cost Blue Cross Blue Shield Plans have “tactical” administrative expenses that are $5.75 PMPM, or 30%, lower than their higher cost counterparts. These tactical expenses are all administrative expenses excluding medical management and sales and marketing.

Last month we published a similar study of the choices of low cost Independent / Provider-Sponsored Plans. Low cost health plans had tactical costs that were 36% lower than their peers, or by $6.39.

A more detailed version of either of these analyses is available to licensed users of each of our benchmarks. Please call us for further information if you have an interest.

2. We introduce a new service on our website that will enable you to determine how a health plan is doing relative to the 2010 benchmarks. You can select your universe and then determine whether you are high or low and, if so, by how much.

3. We invite you to participate in the 2011 benchmarking study. We are now forming universes. We think that, under pending MLR rules, participation is very timely.

Link: Navigator January 2011

Thank you for your continued interest in our research.

Assessment

sherlock@sherlockco.com
Ph:  215-628-2289
Fax: 215-542-0690

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com and http://www.springerpub.com/Search/marcinko

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Health Plan Management Navigator

Mid-September 2010 Edition

By Douglas B. Sherlock, CFA

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In this edition of Plan Management Navigator, we summarize on the results of selected TPAs. Administrative expenses for core services of selected TPAs were 84% of fees in 2009. This was $11.56 per employee per month (PEPM) or $6.06 per member per month (PMPM). Core Medical product costs were $25.28 PEPM and $11.56 PMPM.

Elite Performers

While the universe of participants was small, at 5 TPAs, the surveyed TPAs may be elite performers. Function-by-function, these TPAs had lower costs than are typically found in competitive products of Blue Cross Blue Shield and Independent/ Provider-Sponsored plans.  They are also typically among the largest 20% of TPAs. Finally, they have accounting systems sufficiently robust to report with the granularity of the Sherlock survey. This may be an indicator of strong management if “you manage what you measure.”

Sherlock Expense Evaluation Report

The summary in Navigator is excerpted from the 2010 TPA edition of the Sherlock Expense Evaluation Report, which is now available to licensees and participants.

Web Conference 

We will host a web conference on Wednesday, September 22 from 2:00 PM to 3:00 PM East Coast Time to discuss the summary results. Doug Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, please register at https://www2.gotomeeting.com/register/ 933935259. Once registered, dial-in information and a link to connect to the web will be provided in a confirmation email. Please note that if more than one person from your firm would like to participant in the conference call and everyone will be in one room, only ONE person needs to register for the conference. 

Assessment

Thank you for your continued interest in our research.

Link: Mid-September 2010 Navigator 09-20

Sherlock Company
sherlock@sherlockco.com
Ph:  215-628-2289
Fax: 215-542-0690

Conclusion

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[Health] Plan Management Navigator

September 2010

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By Douglas B. Sherlock, CFA

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In this edition of Plan Management Navigator, we write on issues that are especially timely for health plans in their current budgeting process. Topics are as follows:

Trends in Health Plan Business Process Outsourcing

This analysis is based on data excerpted from recent editions of the Sherlock Expense Evaluation Report. Outsourcing and the use of external contractors has been increasing, especially in the information systems functional area.

TPAs: A New Universe for SEER

For the first time, we will be publishing on the administrative expenses of Third Party Administrators. We believe that this analysis is unprecedented in its depth and granularity. This publication is helpful for TPAs, those that compete with them and all their business partners.

Dashboard Summary

This reports on results and trends from the three months ended July 2010 for non-public health plans. Because of the timing of the publication of this data, we would expect this to be a leading indicator to national results.

SEER Publication Schedule

In the challenging economic environment and with the advent of health care reform, health plans are trying to identify whether they operate at best practice and, to the degree that they vary from this, what functional areas are the most fruitful for the focus of management attention! This outlines the publication schedule for the peer group that best matches your organization.

Assessment 

By the way, in the next month or so, Navigator will be summarizing the results of the Sherlock universes of TPAs, Medicare plans and Medicaid plans. We also will have an interesting discussion on best practices for Blue Cross Blue Shield Plans and Independent / Provider – Sponsored plans. (Incidentally, the definition of “best practice” that we will employ may be found in the Early July 2010 edition of Plan Management Navigator).

Conclusion

Thank you for your continued interest in our research.

September 2010 Navigator[1]

Sherlock Company
Senior Health Care Analyst
sherlock@sherlockco.com
Ph:  215-628-2289
Fax: 215-542-0690

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Update on the Medicare Oriented Universe

October Plan Management Navigator 

By Douglas B. Sherlock; MBA, CFAStetho-Claim

Please find attached the October 2009 edition of our Plan Management Navigator.

Medicare-Orientated Universe

In this month’s edition, we update ME-P and all readers on the results for the Medicare-Oriented universe, and provide summary functional area breakouts as well as expense trends. Holding constant the universe, and the product mix offered, administrative expense growth was higher than last year.

For example, eleven Medicare-Oriented plans serving 1.1 million beneficiaries participated in this year’s benchmarking study. In addition, the results from Blue Cross Blue Shield Plans and Independent / Provider-Sponsored Plans are also summarized. With these additional plans, we provide selected information on health plans serving 2.1 million Medicare beneficiaries, comprising approximately 22% of Medicare Advantage members during 2008.

Assessment

The analysis is based on materials from our Sherlock Expense Evaluation Report (SEER) for the Medicare-Oriented Plans. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting me.

Link: Navigator 10-09 

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. 

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Health Plan Management Navigator

August 2009 Edition

By Douglas B. Sherlock; CFA, MBALibrary

Linked below is the August 2009 edition of Plan Management Navigator. In this month’s edition, we update readers on the results for the Blue Cross Blue Shield universe, and provide product breakouts, summary functional area breakouts as well as expense trends. Cost increases are lower this year than last, though higher if product mix is considered. Twenty-two Blue Cross Blue Shield Plans serving 31.3 million members participated in this year’s benchmarking study.  Growth in Information Systems and Medical Management costs explained more than 40% of the total increase.

Link: Navigator August 09

Sherlock Expense Evaluation Report

This analysis is based on materials from our Sherlock Expense Evaluation Report (SEER) for Blue Cross Blue Shield Plans. Additional information about SEER is available at http://www.sherlockco.com/seer.shtml or by contacting us.

Assessment

In coming weeks, Plan Management Navigator will summarize other results of this year’s performance benchmarking studies. We expect to publish Medicare and Medicaid editions in late August or early September. Independent / Provider-Sponsored plan results were published two weeks ago in Plan Management Navigator and the associated presentation and transcript are found at  http://www.sherlockco.com/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sherlock Health Plan Management Navigator

Information System Implications on Health Plans

By Douglas B. Sherlock; MBA, CFAcomputer-hardware

Messrs. and Mesdames

Attached, please find the February 2009 edition of our Health Plan Management Navigator.
Link: sherlock-company

The Sherlock Expense Evaluation Report

In this month’s edition, we endeavor to better understand the functional area of information systems [IS] and its implications on health plans. Information systems, based on the results from out 2008 Sherlock Expense Evaluation Report (SEER) displayed overall anti-scalability in costs. In order to better comprehend IS and its influence on health plans overall, we performed numerous analyses that looked at relationships between IS and other aspects, such as scalability, variety of product offerings, commitment to ASO products and other functional areas.

Assessment

The results suggest that scale does not appear to play a role in IS costs and that more of a concentration in ASO products seemed to lower IS costs. It also appears that management of information systems, in the context of its support to other functional areas, is an inexact science.

Conclusion

Additional information about SEER is available at www.sherlockco.com/seer.shtml or; by contacting me at: sherlock@sherlockco.com

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