Independent / Provider – Sponsored Plan Costs Accelerate in 2021

PHILADELPHIA--(BUSINESS WIRE)--In 2021, Independent / Provider – Sponsored plans’ costs grew by 4.2% per member compared with a decline of 1.0% in 2020 and growth of 7.6% in 2019. These comparisons are between continuously reporting plans and eliminate the effect of product mix differences between comparison years. Median PMPM costs were $45.65.

The results are published in Plan Management Navigator and are posted at sherlockco.com/navigator. Navigator excerpts from the 2022 Independent / Provider – Sponsored Plan edition of the Sherlock Benchmarks. This edition of the Sherlock Benchmarks analyzes and reports on the in-depth surveys of 15 Independent / Provider – Sponsored Plans serving 10.6 million members. Surveyed plans serve about 52% of all membership in plans served by non-staff model plans of the Alliance of Community Health Plans and 35% of all membership served by commercial members of the Health Plan Alliance. The plans were geographically disbursed, serving 24 states.

The cost growth in Account and Membership Administration was the key driver of overall cost growth. Information Systems and Corporate Executive and Governance were prominent in cost growth.

Commercial membership declined in 2021, both for insured and ASO products. Membership in Medicare Advantage also decreased, while Medicaid increased.

Staffing ratios increased by 3.1% and compensation levels were effectively unchanged. Outsourcing edged up to 5.0%.

2021 reflected growth in Medicaid which, because of its more modest distribution system and infrastructure requirements, obscured growth in advertising, information systems and claims, provider network, finance and corporate executive.

We will discuss the results via free web conference on Wednesday, July 20^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 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 Independent/Provider-Sponsored universe, other universes include Blue Cross Blue Shield 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.