Blue Cross Blue Shield Plans’ Administrative Expenses Accelerated in 2022

PHILADELPHIA--(BUSINESS WIRE)--In 2022, Blue Cross Blue Shield Plans’ costs increased by 7.2% per member compared with a decline of 0.4% in 2021. These comparisons are between continuously reporting Plans after eliminate the effect of product mix differences between the comparison years. Median PMPM costs were $45.36.

The results are published in Plan Management Navigator and are posted at sherlockco.com/navigator. Navigator excerpts from the 2023 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 17 Blue Plans serving 52.2 million members. Surveyed Plans serve 76% of the members of Blue Cross Blue Shield Plans excluding publicly-traded companies.

Account and Membership expenses surged 8.3% from 1.7% in 2021. The total cost increase is the highest since at least 2015, as is the sharpness of the change in trends for Account and Membership Administration. The fastest growing function was Customer Services, followed by Actuarial. Plan Staffing Ratios increased as did compensation.

Plans’ cost growth reflected changes in their product mix. The growth was the same for as-reported and constant-mix per member costs because commercial diminished as high-cost Medicare Advantage and low-cost Medicaid increased.

We will discuss the results via free web conference on Wednesday, June 21^st, 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 Sherlock Benchmarks are the health plan industry’s metrics informing the management of administrative activities. They are based on surveys of health plans serving 63 million Americans and provide costs and their drivers on key administrative activities. Health plans use them to determine whether their administrative costs are optimal and to prioritize improvements among numerous specific activities.

The Sherlock Benchmarks for 2023 will reflect 1,000 health plan years of experience spanning 26 consecutive years. They are the “gold standard” of benchmarks used to measure and manage health plan administrative activities in health plans serving over 208 million members. Planning, budgeting and cost benefit analyses are informed by the Sherlock Benchmarks.

Besides the Blue Cross Blue Shield universe, others include Independent/Provider-Sponsored plans, Medicare plans, Medicaid plans and TPAs. Collectively, the 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.