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Performance Benchmarks For Health Plans

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

Sherlock Expense Evaluation Reports are the definitive 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.

Now completing its twelfth annual survey, the Sherlock Expense Evaluation Reports (SEER) supply 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.

SEER is provided in hard copy and, using Microsoft Excel ®, in electronic forms. One of the electronic forms permits users to copy SEER for use throughout the user’s organization in a form that is similar to the style of the written document. A second version, sometimes called a “flat file” has similar contact to first electronic form of the document, but omits graphs for faster navigation.

SEER is 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 SEER reports.

Products Offered by Universe Description of Financial Metrics

The financial metrics are highly granular so that they can be actionable. Costs are segmented into up to 59 functional areas and 12 products. In other words administrative expenses are segmented into up to 708 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 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.

Our benchmarks help you achieve results. One Blue Cross Blue Shield Plan reported $10 million in savings from information systems decisions made using our benchmarks. An Independent / Provider-Sponsored plan achieved savings of $50 million using our benchmarks.

SEER benchmarks enjoy wide acceptance. Health plans serving one of every five insured Americans participated in 2009, and health plans serving at least one of every 2.7 insured Americans used the 2008 benchmarks.

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