Sherlock Company

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Description of our Metrics

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. Sample survey forms, detailed definitions and calculation notes are included with SEER reports. A sample page illustrating the format of the data is included here.

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.

Volume I: Financial Metrics includes analyses of administrative expenses through financial ratios such as percent of revenues and per member per month. Data is divided into up to eleven product lines, and up to 59 functions. In certain editions, an additional section addresses individual products, small groups and national accounts. This volume consists of more than 300 pages with thousands of statistical analyses. A sample Table of Contents is found here.

Volume II: Operational Metrics analyzes the sources of administrative expense variances for most of the key functional areas. In addition, for most universes, two separate volumes address medical management and health care utilization.
Operational metrics are arranged by functional area and are logically organized, as illustrated below, to highlight the effects of primary demand, productivity, unit costs, staffing ratios and costs per employee.

In addition, further drill-down information is also provided. For instance, Claims Capture and Adjudication includes rates of adjudicated claims (compared to receipts), autoadjudication rates, form of claim receipts, cost of processing by platform, claims inventory and accuracy statistics and more. This volume consists of approximately 300 pages with thousands of statistical analyses. A sample Table of Contents is found here.

Medical Management Metrics

In most universes, a separate volume analyses the  administrative expenses associated with medical management.  We provide detailed metrics concerning such activities as precertification, cased management, disease management, nurse-based counseling, utilization review and appeals and quality assurance and wellness. A table of contents for this volume is found here.

Health Care Utilizations and Cost Metrics

Also, in most universes, we provide comprehensive health care utilization and cost metrics. Health care services are segmented into 40 separate categories. They include costs and utilization rates of various types of inpatient and outpatient facilities, physician services, prescription drugs and other products. These utilization metrics are further segmented by the product to which the member belongs. A table of contents for this volume is found here.