Blue Cross Blue Shield Plans’ Administrative Costs Flat to Down in 2021

PHILADELPHIA--(BUSINESS WIRE)--In 2021, Blue Cross Blue Shield Plans’ costs declined by 0.4% per member compared with growth of 5.2% in 2020 and 6.6% in 2019. These comparisons are between continuously reporting Plans and eliminate the effect of product mix differences between comparison years. Median PMPM costs were $41.66.

The results are published in Plan Management Navigator and are posted at sherlockco.com/navigator. Navigator excerpts from the 2022 Blue Cross Blue Shield Plan edition of the Sherlock Benchmarks. This edition of the Sherlock Benchmarks analyzes and reports on the in-depth surveys of 16 Blue Plans serving 49 million members. Surveyed Plans serve 71% of the members of Blue Cross Blue Shield Plans excluding publicly-traded companies.

Corporate Services significantly declined as Sales and Marketing increased. Account and Membership grew modestly as Information Systems costs declined.

Commercial membership declined in 2021, especially for insured products. Membership in ASO/ASC, FEP, Medicaid and Medicare Advantage increased.

Staffing ratios decreased by 1.5% and compensation increased by 0.8%. Outsourcing edged up to 13.5%.

2021 costs reflected trends in membership, the effects of cost management and a redeployment of expenses. The growth in Product Development, Benefit Configuration, Credit Card Fees and Actuarial suggests vigorous adaptation in a competitive environment.

We will discuss the results via free web conference on Thursday, June 23^rd, 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 recent operating environment has been challenging for health plans. The Sherlock Benchmarks can assist in adapting to this environment and optimizing expenses.

The Sherlock Benchmarks for 2022 will reflect approximately 963 health plan years of experience spanning 25 consecutive years. They are the “gold standard” of benchmarks and are used to measure and manage health plan administrative activities in health plans serving over 210 million members. Planning, budgeting and cost benefit analyses are credibly informed by the Sherlock Benchmarks.

Besides the Blue Cross Blue Shield universe, other universes include Independent/Provider-Sponsored plans, Medicare plans and Medicaid plans. Collectively, the 34 participating plans serve 63 million insured Americans.

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.