Independent/Provider-Sponsored Plans’ Administrative Expenses Accelerated in 2023

PHILADELPHIA--(BUSINESS WIRE)--In 2023, Independent/Provider-Sponsored plan per member costs grew by 8.7% compared to 7.5% in 2022. These comparisons hold constant the set of reporting plans and are reweighted to eliminate the effect of product mix differences. Median PMPM costs for all reporting plans were $45.70.

The results are published in Plan Management Navigator posted at sherlockco.com/navigator. The Navigator excerpts from the 2024 Independent/Provider-Sponsored Plan edition of the Sherlock Benchmarks. It summarizes in-depth surveys of 12 plans serving 9.9 million members.

Account and Membership Administration expenses accelerated to 11.0% from 7.4% in 2022. Customer Services and Information Systems grew most rapidly and were most important, respectfully. Sales and Marketing nearly matched its growth and also accelerated from 2022. Plan Staffing Ratios decreased.

Medicare Advantage and Commercial Insured products outstripped others, amplifying as-reported expense growth.

We will discuss the results via a free web conference on Thursday, July 18^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 Sherlock Benchmarks are the health plan industry’s “gold standard” metrics of administrative activities, costs and operational drivers. They reflect 27 consecutive years and more than 1,000 health plan years of experience. Health plans use the Sherlock Benchmarks to determine whether their administrative costs are optimal and to prioritize improvements among numerous specific activities. Other applications include informing strategic corporate planning and cost-benefit analyses.

This year, collectively, Benchmark participants serve 52 million Americans in Independent/Provider-Sponsored plans and other universes. Other universes include Blue Cross Blue Shield, Medicare plans and Medicaid plans. Health plan users of the Sherlock Benchmarks serve over 200 million members since June 2021.

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.