PHILADELPHIA--(BUSINESS WIRE)--In 2013, total administrative expenses of selected Medicaid plans grew by effectively 0%, as Core expenses increased in low single digits.
Total expenses PMPM increased by 0.2% as-reported and declined by 1.4% when holding constant the product mix of the plans. Core costs, which exclude Sales and Marketing, increased by 3.2%, a modest but slightly higher growth than in 2012.
On a constant mix basis, total administrative costs declined by 1.4%, a precipitous fall from the 8.3% increase last year. Core costs increased by 1.6%, a decline from 4.4% last year.
Corporate Executive and Governance costs sharply declined. Information systems cost increases were responsible for most of the increase that occurred, as claim and encounter capture and adjudication fell. Medical Management costs accelerated and Sales declined.
Additional information was published yesterday in Plan Management Navigator, and is posted at: sherlockco.com/navigator.
We will discuss the results via a free web conference on Wednesday, October 8 from 2:00 PM to 3:00 PM Eastern Daylight Time. Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, please register at: gotomeeting.com/register/334820842. Once registered, dial-in information and a link to connect to the web conference will be provided in a confirmation email.
The Navigator analysis excerpts from the 2014 Medicaid edition of the Sherlock Expense Evaluation Report (SEER). This benchmarking study analyzes in-depth surveys of 9 Medicaid plans serving 3.8 million members. On average approximately 40% of their members are in Medicaid products. Several plans offer Medicare SNP which we believe to be primarily dual eligibles.
This universe is especially interesting considering encouraged expansion of Medicaid under the Affordable Care Act.
Besides the Medicaid universe, other universes include Blue Cross Blue Shield plans, Independent/Provider-Sponsored and Medicare plans. Collectively, these organizations serve over 38 million insured Americans.
This is the 17th consecutive year of the Sherlock Benchmarks. With cumulative experience of 660 health plan years, they are “the gold standard” of benchmarks used to measure and manage health plan administrative activities.
Sherlock Company (www.sherlockco.com), based in North Wales, 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.