Plan Management Navigator
Navigator provides analytics for health plan administration. It comments and observes on the management of health plan expenses under the direct control of the management team.
Much of the content is derived from our surveys of numerous health plans participating in the Sherlock Benchmarks.
Topics addressed include the cost of administration in each functional area, drivers of administrative costs such as product mix and operational metrics, economics of scale and other important topics.
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Most recent Navigator:
Late January 2018: Best-in-Class Blue Cross Blue Shield Plans
Mid - January 2018: Best-in-Class Independent / Provider - Sponsored Plans
January 2018: Economies of Scale in Health Insurance
December 2017: CVS - Aetna: Comment on Vertical Integration
November 2017: Apparent Economies of Scale: Short Term Membership Changes and Health Plan Administrative Costs
October 2017: Medicaid Administrative Cost Trends: Core Expenses Rebound from Last Year, Increasing by 1.4%
Late September 2017: Medicare Advantage Plan Administrative Cost Trends: First Overall PMPM Cost Growth Since 2013
Early September 2017: Benchmarks for Accountable Care Organizations: Observations of the Trial Stage
Mid-August 2017: Sherlock Benchmarks "Test Drive"
Early August 2017: Sherlock Benchmark Administrative Cost Values of Larger Health Plans - 2016 Metrics
July 2017: Independent / Provider - Sponsored Plans: Optimizing Costs in an Uncertain Environment
Late June 2017: Blue Cross Blue Shield Plans: Optimizing Costs in an Uncertain Environment
Early June 2017: Market Segment Costs of Blue Cross Blue Shield Plans
May 2017: How Do Medicare Advantage Plans Benefit From Expenses For Medical Management?
Early May 2017: Medicaid and the Individual Market
Late March 2017: Right-sizing For Change
March 2017: Resolving the Paradox of Scale Among Blue Cross Blue Shield Plans
February 2017: IPS Plans - Best in Class
January 2017: BCBS Plans - Best in Class
December 2016: Economies of Scale in Health Insurance - Revised
November 2016: Larger Health Plans - Indications of Scale
November 2016: Apples to Apples, or How We Eliminate Mix Distortions
October 2016: Medicaid Administrative Cost Trends First Cost Decline Since 2009 - Revised
September 2016: Medicare Advantage Plan Administrative Cost Trends: Declines, Mostly
July 2016: Independent / Provider - Sponsored Administrative Cost Trends: Cost Optimization Continues
June 2016: Blue Cross Blue Shield Administrative Cost Trends: Cost Optimization Continues
Late May 2016: Nine Takeways: An Early Look at 2015 Independent / Provider - Sponsored and Blue Cross Blue Shield Administrative Cost Trends
May 2016: How Medicaid and Medicare Make You Different
March 2016: Sherlock Benchmark Meeting Resolutions
February 2016: Comparing "Best-in-Class" Independent / Provider - Sponsored Plans Against Their Peers
January 2016: Comparing "Best-in-Class" Blue Cross Blue Shield Plans Against Their Peers
December 2015: How Important are Economies of Scale in Health Insurance Companies?
Late October 2015: Medicare Advantage Plans' Benchmarks Per Member Administrative Costs Declined, Overall and Account and Membership Administration
October 2015: Medicaid Administrative Cost Trends: The Full Impact of the Affordable Care Act
Late July 2015: Independent/Provider-Sponsored Administrative Cost Trends: The Full Impact of The Affordable Care Act
July 2015: Blue Cross Blue Shield Administrative Cost Trends: The Full Impact of The Affordable Care Act
Fourth Week of April 2015: Why Scale Effects are Modest for Medicaid Plans
Late April 2015: Considering Demographics When Measuring Employee Productivity
Mid-April 2015: How Does Medicaid Affect Commercial Administrative Costs?
Early April 2015: The ROI on Medical Management for Medicaid Plans
Late February 2015: How do Best-in-Class Blue Cross Blue Shield Plans Achieve it?
February 2015: How do Best-in-Class Health Plans Achieve it?
January 2015: Analysis from Sherlock Benchmarks: The Account and Membership Administration Cluster
November 2014: Analysis from Sherlock Benchmarks: Does Organization Type Drive Administrative Costs
Late October 2014: Medicare Plans: 2013 is the Baseline Year
October 2014: Medicaid Plans: 2013 is the Baseline Year
September 2014: Summary of Sherlock Scale Study for Health Plans: They Exist but Should not be Overstated
August 2014: Larger Health Plans and Economies of Scale
Late July 2014: Independent/Provider-Sponsored Benchmarks: 2013 is the Baseline Year<
July 2014: Blue Cross Blue Shield Benchmarks: 2013 Is the Baseline Year
- Measuring the Efficacy of Medical Management in Medicare and Medicaid
- PULSE Refocused
- Medicare and Medicaid Benchmark Universes Being Formed
- TPAs and ASO: The Growth of Self-Insurance
- Forming TPA Benchmark Universe
- Decisions of Low Cost Independent / Provider - Sponsored Plans
- Dashboard Summary
- PULSE Refocused
- Sherlock Benchmarking Universes
- Decisions of Low Cost Blue Cross and Blue Shield Plans
- New Benchmark Universes Being Formed
- New Applications of Sherlock Benchmarks
January 2014: A Metric for the Payoff of Medical Management
- Measuring Performance Improvements of Long-Term Benchmarking Participants
Late October 2013
- Medicaid Plans’ Administrative Costs Decelerate in 2012
- Lean Six Sigma and Sherlock Benchmarks
- Health Plans Expect Premium Increase Acceleration: 9.6% in 2014, or 6.8% After Buydowns
- Administrative Expense Growth For Medicare Plans Accelerate in 2012
- Benchmarking, Simplified
August 2013: The Cost of Medicare STAR Ratings
Late July 2013: Independent/Provider-Sponsored Plans’ Administrative Costs Were 8.7% of Premiums in 2012
July 2013: Blue Cross Blue shield Plans’ Administrative Costs Were 8.9% of Premiums in 2012
May 2013: Estimating Administrative Costs’ Sensitivity to Group Size
April 2013: Could 72,000 Health Plan Employees Lose Their Jobs Under Health Care Reform?
March 2013: Sherlock Company Resources and Health Care Reform
January 2013: Decisions of Low Cost Independent / Provider - Sponsored Plans in 2011
December 2012: Decisions of Low Cost Blue Cross and Blue Shield Plans in 2011
November 2012: ACA and Cost Benchmarks For Three Emerging Markets
October 2012: Administrative Costs for Medicare Advantage Plans Soar in 2011
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