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PODCAST: First Quarter 2021 Health Plan Financial Results

Posted on July 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

THE SHERLOCK COMPANY

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

PODCAST: https://www.healthsharetv.com/content/first-quarter-2021-health-plan-financial-results-podcast

Your thoughts are appreciated.

Citation: https://www.r2library.com/Resource/Title/0826102549

THANK YOU

***

Filed under: Experts Invited, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Videos | Tagged: Douglas B. Sherlock CFA, Health Plan Financial Results, health plans, MCOL, Sherlock Company | Leave a comment »

Staffing Level Effects of Health Care Reform‏

Posted on April 22, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

April 2013 edition of Plan Management Navigator

***

By John Park jpark@sherlockco.com

[Health Care Analyst – Sherlock Company]

Greetings:

Please find attached the April 2013 edition of Plan Management Navigator. This month’s Navigator features three estimates of employment by U.S. private health plans:

***

1. The first estimate is of staffing as it exists at present, based on Sherlock Benchmarks.

2. The second estimate calculates the effect of the new private insurance enrollment through Medicaid and through the exchanges, as estimated by the Congressional Budget Office, on health plan employment. This second estimate employs the existing Sherlock Company staffing ratio benchmarks.

3. The third estimate applies the staffing ratios of low cost health plans participating in the Sherlock Benchmarking studies to all insurers.

Estimates

We estate that the combined effect of increased health plan enrollment and heightened efficiency to be a decline of 72,000 FTEs.

Webinar

On April 17^th we held a brief conference call on this topic. You may still contact us to answer any methodological questions you may have.

Assessment

April 2013 Navigator

About

Sherlock Benchmarks help to identify whether your plan has high staffing ratios and which functional area’s staffing should be targeted for a closer look. We invite you to consider participation in the 2013 survey with the nearly 50 organizations that have already committed to this valuable analysis.

Conclusion

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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Experts Invited, Practice Management | Tagged: John Park, Plan Management Navigator, Sherlock Company, Staffing Level Effects of Health Care Reform‏ | 2 Comments »

January 2012 [Health] Plan Management Navigator

Posted on January 25, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

With 2012 Benchmarking Study Invitation

By Marco Georeno

Health Care Analyst

Dear Dr. Marcinko and ME-P Readers

At the risk of appearing overwhelmed with New Year’s enthusiasm, we think the attached 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 were $5.63 PMPM, or 29%, lower than their higher cost counterparts. These tactical expenses are all administrative expenses excluding medical management and sales and marketing.

2. We provide an update on the most recent operating and financial results for firms participating in our monthly Dashboard.

3. We invite appropriate ME-P readers to participate in the 2012 benchmarking study. Participation is very timely given that the weak economy is placing great pressure on commercial enrollment, creating the risk that administrative expenses could be a source of negative operating leverage.

Assessment

A more detailed version of this analysis is available to licensed users of Blue Cross Blue Shield Sherlock Expense Evaluation Report (SEER). Please call us for further information if you have an interest.

Link: Navigator Late January 2012

Sherlock Company

mgeoreno@sherlockco.com

Ph: 215-628-2289

Fax: 215-542-0690

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please 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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Health Insurance, iMBA, Inc. | Tagged: Blue Cross Blue Shield, health plan benchmarking, January [Health] Plan Management Navigator, Marco Georeno, Sherlock Company, Shield Sherlock Expense Evaluation Report | Leave a comment »

[Health] Plan Management Navigator for September

Posted on September 7, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

Selected TPA Benchmarks

By John Park

sherlock@sherlockco.com

Dear ME-P Messrs and Mesdames:

In this edition of Plan Management Navigator, we summarize the results of selected TPAs. Administrative expenses for core services of selected TPAs were 98% of fees in 2010. This was $18.72 per employee per month (PEPM) or $8.08 per member per month (PMPM). Core Medical product costs were $22.15 PEPM and $10.99 PMPM.

Elite Performers

While the universe of participants was small, at 7 TPAs serving 1.4 million people, the surveyed TPAs may well 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 required of the Sherlock survey. If one subscribes to the adage, “you manage what you measure,” strong reporting is an indicator of effective management.

Sherlock TPA Benchmarks

The Sherlock TPA benchmarks are designed to overcome TPAs’ historic performance measurement challenges. We overcome the diversity of products sold through a highly granular presentation, and inconsistency of TPA reporting conventions through our unique, industry-based cost classification system. It is informed by 514 health benefit organization years of experience, and more than 60% of all insured Americans are users of the 2011 edition of the Sherlock benchmarks.

Assessment

The summary in Navigator is excerpted from the 2011 TPA edition of the Sherlock Expense Evaluation Report, which is now available to licensees and participants.

Link: September 2011 Navigator

Sherlock Company
Douglas B. Sherlock, CFA
Ph: 215-628-2289

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Accounting, Alerts Sign-Up, Health Economics, Healthcare Finance, Practice Management, Research & Development | Tagged: Douglas B. Sherlock CFA, John Park, Plan Management Navigator, Sherlock Company, TPA benchmarks | 1 Comment »

Benchmarks of Health Plan Administrative Costs

Posted on August 1, 2011 by Dr. David Edward Marcinko MBA MEd CMP™

2011 Edition‏

[By John Park]

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

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: Accountable Care Act, Benchmarks of Health Plan Administrative Costs, Blue Cross Blue Shield Plans, Douglas B. Sherlock, John Park, Sherlock Company | 2 Comments »

Understanding Low Cost versus High Cost Health Insurance Plan Decisions

Posted on December 23, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

December 2010 – Health Plan Management Navigator

[By Marco Georeno]

Dear ME-P Readers and Subscribers

Please find attached the December 2010 edition of Plan Management Navigator.

In this Issue

In this month’s edition, we look at how the decisions made by low costs plans differ from those made by higher cost ones. This analysis examines the differences for the Independent / Provider-Sponsored plans that participated in the Sherlock Expense Evaluation Report (SEER) in 2010. Navigator also discusses the latest Health Plan Dashboard results for the three months ended October 31, 2010.

Link: Navigator Early December 2010[1]

New for 2011

In addition, Sherlock Company is currently forming new universes for the 2011 Sherlock Expense Evaluation Report. If your plan would like to consider participation, we invite you to give us a call at 215-628-2289 or email us at sherlock@sherlockco.com

We will launch the surveys beginning in March 2011 to reflect 2010 calendar year results.

Assessment

Sherlock Company

mgeoreno@sherlockco.com

Ph: 215-628-2289

Fax: 215-542-0690

Channel Surfing the ME-P

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. It is fast, free and secure.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Healthcare Finance, Research & Development | Tagged: Health Economics, health insurance plans, Health Plan Management Navigator, Healthcare Finance, Marco Georeno, Sherlock Company, Sherlock Expense Evaluation Report | 1 Comment »

Health Plan Management Navigator

Posted on September 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Mid-September 2010 Edition

By Douglas B. Sherlock, CFA

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

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.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Healthcare Finance, Research & Development | Tagged: Blue Cross Blue Shield, CFA, Douglas B. Sherlock, Plan Management Navigator, Sherlock Company, Sherlock Expense Evaluation Report, TPA | Leave a comment »

[Health] Plan Management Navigator

Posted on September 14, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

September 2010

ADVERTISEMENT

By Douglas B. Sherlock, CFA

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Breaking News, Health Economics, Research & Development | Tagged: Blue Cross Blue Shield Plans, CFA, Douglas B. Sherlock, Expense Evaluation Report, Plan Management Navigator, Sherlock Company, TPAs | 1 Comment »

Health Plan Management Navigator

Posted on July 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

July 2010 Edition

By Erin Sawchuk

erinsawchuk@sherlockco.com

Dear ME-P Readers

Please find attached the early July 2010 Edition of our health Plan Management Navigator. In this month’s edition, we suggest an approach to quantifying best practice of administrative activities of health plans. Determining best practice for health plans is a knotty problem because of the complexity of the product and because some of what makes for best practice cannot be captured in the current year’s administrative expense line. We offer a solution that we hope to implement but we would be grateful for any insights you wish to share on this matter.

Financial and Operating Results

Navigator also summarizes some of the May financial and operating results of health plans reporting in our Dashboard. Operating earnings are weak on soft revenues and compressing margins. Enrollment trends in Medicare, Medicaid and ASO products are relative bright spots. Plans are adapting by reducing staffing ratios.

Link: Early July 2010 Navigator[1]

Web Casts

Please save 2:00 on July 16, and 2:00 on August 5 for two important web conferences. The first will summarize the results of this year’s SEER benchmarks for Independent / Provider-Sponsored plans. The second will summarize this year’s SEER benchmarks for Blue Cross Blue Shield Plans.

The Plan Management Navigators containing the respective peer group data will be sent to you a day or so before the web conference. There is no charge to participate, but we would be grateful if you would let us know in advance. Please reply back to me.

Assessment

Erin Sawchuk [Sherlock Company]

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

Conclusion

Feel free to comment and 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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: ASO, Blue Cross Blue Shield Plans, Erin Sawchuk, Medicaid, medicare, Plan Management Navigator, SEER, Sherlock Company | Leave a comment »

Benchmarks of Health Plan Administrative Costs

Posted on June 23, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

2010 Edition‏

Sherlock Company
ADVERTISEMENT

By Douglas B. Sherlock, CFA
[Senior Health Care Analyst]
sherlock@sherlockco.com

In the next few weeks we will be releasing our thirteenth annual edition of our administrative performance benchmarks for health plans. It is the culmination of 450 health plan years of experience with all major sectors of the health plan industry. The attached brochure briefly describes our 2010 benchmarks.

Weak Employment Environment

Many health plans are convinced that effective management of operating costs is central to their long-term success. This is especially the case in the current challenging environment. The weak employment environment pressures revenue yields and membership, forcing rationalization of operating costs. The weak credit environment heightens plan sponsor interest in self-insurance, which increases the visibility of administrative expenses.

Finally, health care reform heightens the interest in operating costs by external audiences. Accordingly health plans serving more than one-half of all insured Americans are users of our benchmarks.

Assessment

Our benchmarks 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. Additional information can be found at http://www.sherlockco.com/seer.shtml or by contacting me directly.

I hope you will not hesitate to contact me if I can answer any further questions.

Link: Sherlock Health Plan Benchmarks Brochure

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

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Alerts Sign-Up, Health Economics, Health Insurance | Tagged: CFA, Douglas B. Sherlock, Health Plan Administrative Costs, Sherlock Company | 2 Comments »

Customer Service in Medicare and Medicaid Plans

Posted on June 15, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

June Edition of Plan Management Navigator

By Erin Sawchuk

erinsawchuk@sherlockco.com

Please find attached by the link below, the June 2010 Edition of Plan Management Navigator. In this month’s edition, we estimate the strength of cost drivers for “Customer Services in Medicare and Medicaid Plans.”

We quantify the relationships of customer services costs to simple algebraic and other operational metrics within the Customer Services function. We also identify and test some of the potential interrelationships between customer services costs and other functions for Medicare and Medicaid Plans. This analysis draws on data from the 2009 Sherlock Expense Evaluation Report.

Benchmarks

Also included in this analysis is an update on our progress on our various benchmarking universes. Participation is up this year, we think due to public policy changes and economic weakness. While benchmarks for Independent / Provider-Sponsored plans will be published shortly, please let us know if you are interested in joining our 2010 Medicare, Medicaid or TPA universes.

Link: Navigator June 2010[1]

Assessment

Finally, we summarize the operating and financial trends identified in our recent Dashboard.

Sherlock Company

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289

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, be sure to subscribe to the ME-P. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: Credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, Career Development, Health Economics, Health Insurance, Practice Management, Research & Development | Tagged: Erin Sawchuck, Medicaid, medicare, Plan Management Navigator, Sherlock Company, Sherlock Expense Evaluation Report, TPA | 4 Comments »

On Medicare and Medicaid Cost Drivers

Posted on April 29, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Health Plan Management Navigator

By Douglas B. Sherlock; CFA

Dear ME-P Readers

Please find attached below the Mid April 2010 Edition of Plan Management Navigator.

In this month’s edition, we estimate the strength of cost drivers for claims processing in Medicare and Medicaid plans. We quantify the relationships of claims processing to simple algebraic expressions and operational metrics within the Claim and Encounter Capture and Adjudication function.

Assessment

Also included in this analysis is an update on our progress on our various benchmarking universes. Participation is up this year, we think due to public policy changes and economic weakness. Please let us know if you are interested in joining our Medicare, Medicaid or TPA universes.

Erin Sawchuk

Sherlock Company

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

erinsawchuk@sherlockco.com

Conclusion

Link: Navigator Mid April 2010

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Healthcare Finance | Tagged: Douglas B. Sherlock CFA, Erin Sawchuk, Health Economics, health plans, Medicaid, medicare, Plan Management Navigator, Sherlock Company | 4 Comments »

Update on Medicaid and Medicare Advantage Plans

Posted on April 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Impact of Health Care Reform

[By Christopher de Garay]

Please find attached below, the Early April 2010 edition of Plan Management Navigator.
Link: Navigator April 2010

Review

In this month’s edition, we review how health care reform will impact the top line of plans offering government managed care programs such as Medicare Advantage and Medicaid. Combined with new minimum health benefit ratios, these pressures will force health plans to look at their administrative expenses. In the next several issues of Navigator, we will look at specific operational metrics and their impact on functional areas such as claims processing.

2010 Benchmark Studies

This edition of Navigator also summarizes the timing for the 2010 benchmarking studies, which includes a new Third-Party Administrator universe.

Christopher de Garay
Senior Health Care Analyst
Sherlock Company
www.sherlockco.com
215-628-2289 Phone
215-542-0690 Fax
cgaray@sherlockco.com
P.O. Box 413
Gwynedd, PA 19436

Editor’s

If your plan would like to consider participation, we invite you to give Chris a call at 215-628-2289 or email him at sherlock@sherlockco.com.

Conclusion

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Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Managed Care, Research & Development | Tagged: Christopher de Garay, DHHS, Managed Care, Medicaid, medicare, Medicare Advantage, Sherlock Company, TPA | 12 Comments »

Critical Expense Issues in Healthcare Reform

Posted on September 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

American Academy of Actuaries Report

By John Park

Health Care Analyst

Sherlock Company

jpark@sherlockco.com

ME-P Subscribers

Late last week, the American Academy of Actuaries released the attached paper discussing administrative functions and expenses. It is designed to provide an actuarial perspective relating to various components of comprehensive health care reform proposals.

Assessment

Sherlock Company benchmarks, as excerpted in the Plan Management Navigator, are cited in the paper and we thought you might find it of interest.

Link: American Academy Actuaries

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

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Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: Alerts Sign-Up, Breaking News, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Research & Development | Tagged: American Academy of Actuaries, Healthcare Expenses, healthcare reform, John Park, Plan Management Navigator, Sherlock Company | 1 Comment »

Health Plan Management Navigator

Posted on August 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

August 2009 Edition

By Douglas B. Sherlock; CFA, MBA

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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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Accounting, Breaking News, Career Development, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Managed Care, Monthly Reports, Op-Editorials, Research & Development, Sponsors | Tagged: Blue Cross, Blue Shield, Douglas B. Sherlock, health costs, Health Plan Management Navigator, medical cost accounting, medical management, Sherlock Company, Sherlock Expense Evaluation Report | 1 Comment »

Health Plan Management Navigator

Posted on July 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

July 2009 Edition

By Douglas B. Sherlock; CFA, MBA

Attached below, find the July 2009 Edition of Plan Management Navigator. In this month’s edition, we summarize the results of Independent / Provider-Sponsored Healthcare Plans. The 16 plans collectively serve 5.7 million members and are leaders in their communities.

Link: Navigator_07-09

Conclusion

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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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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Health Insurance, Healthcare Finance, Managed Care, Monthly Reports, Research & Development | Tagged: douglas sherlock, Health Insurance, health plan, healthcare plans, managed care plans, Plan Management Navigator, Sherlock Company | 1 Comment »

Sherlock Expense Evaluation Report [SEER]

Posted on April 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Plan Management Navigator

By Marco Georeno

Ph: 215-628-2289

Please find attached the April 2009 edition of Plan Management Navigator. In it we provide an update on the timing of the Blue Cross Blue Shield universe and the Independent / Provider-Sponsored editions of the Sherlock Expense Evaluation Report (SEER). In addition, we expect to circulate the benchmarking surveys for the Medicaid and Medicare universes on or about June 1st, for completion by July 20^th, 2009.

Benchmarking Studies

If you are interested in participating in our benchmarking studies please contact us as soon as possible. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting Doug Sherlock (sherlock@sherlockco.com).

Best Practices for the Healthcare Enterprise

We also endeavor to provide an enterprise view of best practice. Best practice is typically considered to be the most efficient way of achieving a desired outcome. We believe that the best way of determining the best practice in its most practical application is to start with an overall objective and weigh all particular practices in light of how they contribute to that overall objective.

In that vein, over the next several months, Sherlock Company will be offering web conferences focused on best practices. The first conference will address activities within Customer Services, as well as activities or effects in other functional areas. This web conference will be held on Wednesday May 20th at 2:30 PM, Eastern Time. The costs will be $225. Participation is free of charge to health plans participating in our 2009 benchmarking studies. If you are interested in participating, please email Erin Sawchuk (erinsawchuk@sherlockco.com) or call at 215-628-2289.

Assessment

This edition of Navigator also discusses the latest private health plan Dashboard results for the trailing three months ended January 31, 2009.

Link: navigator

Sincerely,
Sherlock Company

Marco Georeno – Analyst
mgeoreno@sherlockco.com

Fax: 215-542-0690

Conclusion

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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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Filed under: "Advisors Only", "Doctors Only", Breaking News, Career Development, Health Economics, Managed Care, Monthly Reports, Practice Management, Research & Development, Sponsors | Tagged: Blue Cross, Blue Shield, douglas sherlock, Goereno Marco, health econoics, health maintenance plans, healthcare enterprise, Healthcare Finance, HMO, Managed Care, MCO, Medicaid, medicare, Plan Management Navigator, SEER, Sherlock Company, Sherlock Expense Evaluation Report | Leave a comment »

Sherlock Health Plan Management Navigator

Posted on March 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Information System Implications on Health Plans

By Douglas B. Sherlock; MBA, CFA

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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Filed under: Breaking News, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Managed Care, Monthly Reports | Tagged: ASO, Douglas B. Sherlock, health information systems, HIT, HMO, Loyola College, MCO, PPA, Sherlock Company, Sherlock Expense Evaluation Report | Leave a comment »

Introducing Douglas B. Sherlock MBA CFA

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About Our Newest Thought-Leader

By Ann Miller; RN, MHA

Douglas B. Sherlock CFA is President of Sherlock Company which assists health plans, their business partners and their investors in the treasury and control functions of finance.

Resume

Prior to the founding of Sherlock Company, Mr. Sherlock was Vice President of Financial Analysis of U.S. Healthcare, Inc. where he directed the company’s merger and joint venture activity, its investor relations program and its HMO product for Medicare beneficiaries. Sherlock was formerly Vice President of Salomon Brothers, Inc where he specialized in the financial research of prepaid health plans and hospital systems, and assisted in the capital formation and merger activities of health care companies. He was the Greenwich Survey First Place HMO Analyst and a runner-up in the Institutional Investor polls.

Professional Associations and Memberships

Mr. Sherlock is a Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee of the CFA Institute. He has served on the Editorial Board of Inquiry, a journal of health care organization, provision and financing published by the Blue Cross Blue Shield Association, and is a reviewer for Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee. Sherlock is a frequent speaker before health care groups including the American Association of Health Plans, the HealthCare Financial Management Association, and the Blue Cross Blue Shield Association. The research of Sherlock Company has recently been cited in such periodicals as The New York Times, Forbes, Investor’s Business Daily, Modern Healthcare, Hospitals, The Wall Street Journal, HMO Managers Letter, Business Week and The Medical Business Journal.

Educational Background

Mr. Sherlock holds an M.B.A. in finance from Loyola College in Maryland. He received his bachelor’s degree in economics from Franklin and Marshall College, Lancaster, Pennsylvania.

Conclusion

We look forward to his contributions and now professionally welcome him warmly, as our newest ME-P thought-leader.

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Filed under: Breaking News, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Op-Editorials, Practice Worth, Research & Development | Tagged: American Association of Health Plans, Blue Cross Blue Shield Association, Business Week, CFA, Chartered Financial Analyst, Douglas B. Sherlock CFA, Financial Accounting Policy Committee, financial analyst, Forbes, HMO, HMO Managers Letter, hospitals, Investor’s Business Daily, Modern Healthcare, Salomon Brothers, Sherlock Company, The Medical Business Journal, The New York Times, The Wall Street Journal | 1 Comment »

Blue Cross – Blue Shield Administrative Survey

Posted on August 3, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Cost Trends Demonstrate a Decline in 2007

By Douglas B. Sherlock; CFA

PRESS RELEASE REPORT

Gwynedd, Pennsylvania

The per-member [pm] administrative cost growth for BC/BS declined from 6.1% in 2006, to 4.3% in 2007. Adjusted to eliminate the effect of a shift in product mix, administrative expense growth declined from 6.5% in 2006 to 2.5% in 2007. Administrative expenses were 10.4% of premium equivalents in 2007. And, plans reported total administrative expenses of $25.36 PMPM.

All cited values exclude investment and non-operating income and expense, income taxes and miscellaneous business taxes.

Sherlock Expense Evaluation Report

These results are excerpted from the Sherlock Expense Evaluation Report, a benchmarking study comprising the results of 23 Blue Cross Blue Shield Plans surveyed by the Sherlock Company. More than 90% of participants also participated in the prior year’s survey and nearly 80% have five or more years of experience participating in our benchmarks.

Benchmarks and Metrics

The Sherlock Company benchmarks include thousands of operational and financial performance metrics. Besides Blue Plans, other universes include Independent / Provider-Sponsored plans, Medicare Advantage plans, Medicaid plans and larger plans. Collectively, the 46 plans serve approximately 36 million insured Americans.

Administrative Growth

The growth in administrative expenses ranged from a high of 10.0% for Medical and Provider Services to a low of 0.2% for Corporate Services.

In fact, the Sherlock Company said that, “The increasing emphasis of these Plans on Medicare Advantage had a profound effect on their expense trends. After holding constant the product mix, corporate service costs per member declined by 6.2% and provider and medical management costs increased by 2.2%.”

Assessment

Additional information is available in the Sherlock Expense Evaluation Report. We have also published a summary in July 2008 edition of the Plan Management Navigator accessible at www.sherlockco.com/docs/navigator/navigator-08-07.pdf

Conclusion

Your thoughts and comments on the above findings are appreciated? Do they agree, or disagree, with your factual or heuristic cost impressions of this institutional space?

###

The Sherlock Company www.sherlockco.com based in Gwynedd, Pennsylvania, provides informed solutions for health plan financial management. Since its founding in 1987, Sherlock Company has been known for its impartiality and technical competence in service to its clients.

Contact: Douglas B. Sherlock; CFA for more information.

215-628-2289, sherlock@sherlockco.com or visit www.Sherlockco.com

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Monthly Reports, Surveys and Voting | Tagged: Sherlock Company | Leave a comment »

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