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The Peer Groups in Our Universe of Participating Health Plans

While every health plan is different, our reports facilitate the closest comparisons to your plan and our metrics can quantify of any residual differences. Comparability is promoted by segmenting our 60 organization universe into peer groups closely matching size, product mix, or organizational characteristics of your health plan. We also segment administrative activities and costs into product areas to isolate the varying resource consumption of health coverage products.

Recent studies include separate universes of health plans, including Blue Cross Blue Shield Plans, Larger health plans, Provider-Sponsored health plans, Medicare-oriented and Medicaid-oriented health plans.

Selected Characteristics
of Universes

Blue Cross
Blue Shield

Larger
Plans

Provider-
Sponsored

Medicaid-
Oriented

Medicare
Advantage

TPA

 

 

 

 

 

 

 

Sample Size

 

 

 

 

 

 

Number of Participants
27
6
15
11
10
7
Participants' Members (000)
38,211
19,130
5,780
5,727
2,490
607
Median Membership (000)
757
2,956
316
194
221
99
Mean Membership(000)
1,415
3,188
385
521
249
87

 

Supplemental Content

           
Prod. Memb. from Other Universes
NA
NA
NA
950
1,116
18,015
Total Product Members
NA
NA
NA
5,670
2,155
18,622
             

Market Mix (Prem./Fees)

Commercial*

Median

67.7%
65.5%
66.6%
0.0%
32.1%
NA

Average

69.8%
64.4%
63.6%
15.5%
32.5%
NA

Medicare Advantage

Median

4.8%
8.9%
26.4%
3.6%
57.3%
NA

Average

8.7%
12.8%
25.1%
11.0%
67.2%
NA

Medicaid

Median

0.0%
0.0%
6.3%
96.4%
0.0%
NA

Average

2.2%
0.0%
11.0%
73.0%
4.1%
NA

 

Product Mix

Pct. Mgd Care (Prem./Fees)**

Median

12.1%
20.1%
82.2%
100.0%
95.3%
NA

Average

16.3%
27.8%
79.1%
93.7%
87.7%
NA

 

Percent ASO (Members)

Median

39.6%
50.3%
20.3%
0.0%
2.6%
100.0%

Average

39.5%
49.0%
17.0%
7.0%
9.7%
100.0%

 

States Served

30
8
15
23
19
11

 

 

 

 

 

 

As of 9-30-11. Subject to change.

* Commercial excludes FEP.  
** Managed Care is the sum of Medicare Advantage, Medicaid and Commercial HMO.    

Summary Results for Various Peer Groups

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