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Performance Benchmarks For Health Plans

Photograph by A. Aubrey Bodine
Copyright © Jennifer B. Bodine

Sherlock Benchmarks are often called the "gold standard" benchmarks for health plan performance. They are critical tools to enhance operational performance and competitive position. The benchmarks also support strategic initiatives ranging from management of the product portfolio, vendor negotiations, outsourcing and business combinations.

The highly valid, well-populated benchmarking reports provide an unbiased ranking and helps prioritize cost management activities to have the greatest impact on improving your health plan's overall operating performance. The combination of the current environment of the Affordable Care Act along with the distinct possibility of changes in law and regulation may make participation by your health plan an appropriate and necessary response to the strong incentives to cost efficiency.





Recent Announcements

The Sherlock Benchmarks' 20th annual survey supplies comprehensive and highly granular financial and operational metrics to help health plans identify whether they operate at best practice and what functional areas provide the highest returns on management efforts to enhance plan performance. The broad scope of the metrics facilitates drill-downs to identify specific operational issues that can be used to map solutions to performance variances. They represent the cumulative experience of more than 740 health plan years.

The Sherlock benchmarks are broadly accepted. Forty-four plans are participated in the most recent benchmarking study, collectively serving 59 million members. Health plans serving approximately 62% of the total insurance market are users of the of the Sherlock Benchmarks. Consulting firms use our benchmarks in service to their clients and our Benchmarks have been used for public policy purposes.

They are provided in hard copy and two electronic forms. The PDF version permits users to copy the reports for use throughout their organization in a form that is identical to the hard copies. The Microsoft Excel ® version allows desktop access to each analysis and value of the reports.

The Sherlock Benchmarks are produced in two volumes consisting of operational and financial metrics. While encyclopedic in scope, it is organized for ease of use. These analyses are supported by extensive documentation. Detailed definitions and calculation notes are included with the benchmarking reports.

Universe Volume I Volume II Free Summaries
Financial Metrics Staffing Metrics Operational Metrics Medical Management Metrics Utilization Metrics
 
Description of Metrics
See Operational
Description of Metrics
Description of Metrics
Description of Metrics
 
Blue Cross Blue Shield
Table of Contents
Table of Contents
Table of Contents
Includes All Universes
Includes All Universes
Summary Financial Metrics
Larger Plan
Table of Contents
Tables of Contents
Table of Contents
Includes All Universes
Includes All Universes
Summary Financial Metrics
Independent / Provider - Sponsored
Table of Contents
Table of Contents
Table of Contents
Includes All Universes
Includes All Universes
Summary Financial Metrics
Medicaid
Table of Contents
Table of Contents
Table of Contents
Includes All Universes
Includes All Universes
Summary Financial Metrics
Medicare
Table of Contents
Table of Contents
Table of Contents
Includes All Universes
Includes All Universes
Summary Financial Metrics

*Includes all Operational Metrics volumes

The financial metrics are highly granular so that they can be actionable. Costs are segmented into up to 60 functional areas and 12 products. In other words administrative expenses are segmented into up to 700 product expense cells. Operational metrics support the financial metrics. These are typically provided in three books consisting of metrics for all operational areas except for medical management, medical management metrics and utilization metrics. To assure that these benchmarks are as comparable as possible, we have several peer groups so your plan can be compared with closely similar organizations. Some results are reported in our Plan Management Navigator which you can access at the buttons on the far right of the matrix above. A description of the peer groups can be accessed at a button below. Also, since the products offered by peer group vary, those products are also identified at a link below.

We manage the quality of our metrics through detailed procedures and through our business model. Our participation is voluntary, and access to our benchmarks is limited to those who are committed to the effort: We are organized to eliminate the risk of Tragedy of the Commons. We are also independent: Sherlock Company offers no complementary products, such as business process outsourcing, that could create an appearance of conflicts of interest. Finally, we have extensive quality assurance procedures, as outlined at the link below.

Description of Peer Groups

Products Offered by Peer Group

Quality Assurance Procedures

Contact Us

Please contact us regarding the license or participation in our performance benchmarking studies.

Citations of Sherlock Benchmarks

We are gratified that many organizations are users of our benchmarks or derivative content. References include:

American Academy of Actuaries
American Enterprise Institute
Congressional Research Service
Woolhandler, Campbell and Himmelstein
World Health Organization
National Academy of Social Insurance
Scott Harrington, University of Pennsylvania
Paul Von Ebers, Health Affairs Blog