You can compare your health plan, or any health plan you are interested in, to the Sherlock Benchmarks by applying the plan's values to this Calculator.
Populate the average members for each product in the appropriate box. Average members can be calculated as member months divided by months, with 12 months corresponding with annual results.
If you don't have direct access to membership values, the NAIC Exhibit of Premiums, Enrollment, and Utilization for the health plan
can be used for this purpose. The SEC Form 10-K can be helpful in the case of public companies.
Select the Universe that is most comparable to yours for each product offered by the health plan.
You may select products of universes individually or you may select only those products in a particular universe.
If you do not locate your universe here, choose the closest one. For instance, we have found that commercial plans may closely
resemble Blue Cross Blue Shield Plans. The universes are Blue Cross Blue Shield Plans, Larger plans, Independent/Provider-Sponsored plans, Medicaid plans, and Medicare plans.
If you are only interested in what the Benchmark is, this Value is now shown.
By "Benchmark Value," we mean the expected weighted PMPM costs based on your mix and the Sherlock Benchmarks.
If you are interested in comparisons, please insert your Total Annual Administrative Expenses for the health plan into the appropriate box.
The NAIC schedule, The Statement of Revenues and Expenses, is a possible source if you do not have access to administrative cost values.
Use the sum of "Claims Adjustment Expenses" and "General Administrative Expenses." For public companies, the SEC Form 10-K can be helpful.
This will provide you with the health plan's PMPM, the Benchmark Value PMPM, and percent difference.
Please note that the values in the Sherlock Benchmarks for the various universes exclude miscellaneous business taxes. These are generally impossible to manage and mostly stem from the Affordable Care Act.
The values that populate this calculator are from past editions of Plan Management Navigator, linked here.
Other information concerning our Sherlock Benchmarks can be found here.
Expected PMPM Costs, or Benchmark Value: N/A
Your Total Annual Administrative Expenses
Total Average Members
Your PMPM Administrative Expenses
Variance from Benchmark
Percent Variance from Benchmark
Commercial HMO Insured
Commercial HMO ASO/ASC
Commercial POS Insured
Commercial POS ASO/ASC
Indemnity & PPO Insured
Indemnity & PPO ASO/ASC
Commercial ASO Total
Stand-Alone Part D
Data is from calendar year 2016 for IPS, BCBS, and Larger plans. Other data is from 2015. Updated 08-04-2017.