PHILADELPHIA--(BUSINESS WIRE)--Medicaid-focused plans’ per member core administrative costs increased by 1.4% in 2016, up from a decline of 5.5% in 2015. A shift in mix to more expensive products meant that as-reported expenses appeared to increase by 3.9%, compared to the 10.3% decrease in the prior year. These changes exclude confounding effects of differences in the universe and the effects of ACA and other taxes.
After eliminating the effects of mix differences, Account and Membership Administration increased by 1.1% per member, which is slower than the increase in 2015. Provider and Medical Management continued its decline from 2015, but at a slower rate. Corporate Services rebounded from a steep decline of 9.2% to an increase of 2.1% in 2016.
Corporate Executive and Governance posted the largest variance overall, while Medical Management function’s increase was the most important source of growth for Medicaid plans.
The median core total costs for the universe were $29.56 per member per month, higher than last year’s $29.06. The median administrative expense ratio was 6.8%, was slightly higher than last year’s 6.6%.
Additional information was published recently in Plan Management Navigator, and is posted here.
We will discuss the results via free web conference on Thursday, November 9th from 2:00 PM to 3:00 PM Eastern Standard 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 Navigator analysis excerpts from the 2017 Medicaid edition of the Sherlock Benchmarks. This benchmarking study analyzes in-depth surveys of 10 health plans with a plurality of their business stemming from Medicaid and collectively served 8.8 million comprehensive members.
Planning under uncertainty entails strategies that are applicable under any scenario. Cost optimization has been called a “no-regret move” for this reason. After all, superior performance should be translatable into growth in market share or earnings under any environmental outcome, since optimal costs can be deployed to achieve low prices or superior quality. One tool to inform this “no-regret move” is the Sherlock Benchmarks.
Besides the Medicaid universe, other universes include Blue Cross Blue Shield Plans, Independent / Provider – Sponsored plans, and Medicare plans. Collectively, the approximately 40 participating plans serve 50 million insured Americans.
This is the 20th consecutive year of the Sherlock Benchmarks. With cumulative experience of 780 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.
