Independent/Provider-Sponsored Plan Administrative Costs Declined in 2020

PHILADELPHIA--()--In 2020, Independent/Provider-Sponsored plans’ costs decreased by 1.0% per member, down from a 7.6% increase in 2019. The comparison is of continuously reporting plans and eliminates the effect of product mix changes between comparison years.

The results are published in Plan Management Navigator and are posted at Navigator excerpts from the 2021 Independent/Provider-Sponsored edition of the Sherlock Benchmarks. This edition of the Sherlock Benchmarks analyzes and reports on the in-depth surveys of 19 IPS plans serving 9.6 million members. Surveyed plans serve the lion’s share of members served by independent or provider-sponsored health plans.

The cost decline in Account and Membership Administration was the chief driver of overall cost decline.

Membership increased. Medicaid and Medicare Advantage increased, as commercial overall declined as ASO share increased.

Staffing ratios decreased by 4% and the Enrollment and Claims functions were affected. Compensation increased by 1%. Outsourcing was relatively stable at 5% overall.

Within the functions, cost trends were consistent with adaptation to COVID-19, such as in Nurse Information and Member and Group Communication, and strengthening Plans’ longer term competitive position through higher Risk Adjustment and Medical Management.

We will discuss the results via free web conference on Wednesday, July 21st, 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 Once registered, dial-in information and a link to connect will be provided in a confirmation email.

The current operating environment is challenging for health plans. The Sherlock Benchmarks can assist in adapting to this environment and optimizing expenses.

The Sherlock Benchmarks for 2021 will reflect approximately 929 health plan years of experience spanning 24 consecutive years. They are the “gold standard” of benchmarks to measure and manage health plan administrative activities in health plans serving approximately 173 million members. Planning, budgeting and cost benefit analyses are credibly informed by the Sherlock Benchmarks.

Besides the Independent/Provider-Sponsored plans universe, other universes include Blue Cross Blue Shield, Medicare plans and Medicaid plans. Collectively, the 36 participating plans serve 54 million insured Americans.

Sherlock Company (, 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.


Douglas B. Sherlock, CFA

Release Summary

Health plan administrative costs declined in 2020, according to Sherlock Company survey.


Douglas B. Sherlock, CFA