Independent/Provider-Sponsored Plan Administrative Cost Growth Accelerated in 2022

In 2022, Independent/Provider-Sponsored plans’ costs increased by 7.5% per member compared an increase of 4.2% in 2021. These comparisons are of continuously reporting plans after eliminating the effect of product mix differences between the comparison years. Median PMPM costs were $41.16.

The results are published in Plan Management Navigator and are posted at sherlockco/navigator. Navigator excerpts from the 2023 Independent/Provider-Sponsored plan edition of Sherlock Benchmarks. This edition analyzes and reports on the in-depth surveys of 11 IPS plans serving 8.3 million members. Surveyed organizations serve many of the most prominent of this segment of health insurers.

The total cost increase essentially tied with 2019, the highest in the last 10 years. Account and Membership expenses climbed 7.4% from 3.2% in 2021. The growth in these expenses was exceeded only twice in the last 10 years. The fastest growing function was Claims, followed by Advertising and Promotion. Plan Staffing Ratios increased as did compensation.

Plans’ cost growth reflected changes in their product mix that emphasized low cost products, especially Medicaid. Cost trends were lower on an as-reported basis, especially in Sales and Marketing.

We will discuss the results via free web conference on Wednesday, July 19^th, from 2:00 PM to 3:00 PM Eastern Daylight Time. Douglas Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, please register at sherlockco.com/webinar. Once registered, dial-in information and a link to connect will be provided in a confirmation email.

The Sherlock Benchmarks are the health plan industry’s metrics informing the management of administrative activities. They are based on surveys of health plans serving 63 million Americans and provide costs and their drivers on key administrative activities. Health plans use them to determine whether their administrative costs are optimal and to prioritize improvements among numerous specific activities.

The Sherlock Benchmarks for 2023 will reflect 1,000 health plan years of experience spanning 26 consecutive years. They are the “gold standard” of benchmarks and used to measure and manage health plan administrative activities in health plans serving over 208 million members. Planning, budgeting and cost benefit analyses are informed by the Sherlock Benchmarks.

Besides the Independent/Provider-Sponsored universe, others include Blue Cross Blue Shield plans, Medicare plans and Medicaid plans.

Sherlock Company (www.sherlockco.com), based in Gwynedd Valley, 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.

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