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Sherlock Company Publishes Administrative Expense Benchmarks

July 12, 2004

Sherlock Company's recently published benchmarks for health plans report median costs of $24.30 for all comprehensive products in 2003. The reporting firms, eighteen Blue Cross Blue Shield Plans, reported expenses which ranged from $18.80 for POS (ASO) to a high of $42.26 for Medicare Advantage. Expressed as a percent of premiums or equivalents, insured comprehensive products ranged from 7.41% for Medicare Advantage to a high of 16.52% for Medicare Supplemental. Account and membership administration comprised the largest component of health plan administrative expenses.

Marketing expenses included Rating and Underwriting, Product Development / Market Research, Sales and Marketing, Commissions and Advertising and Promotion. These expenses represented $5.83 of the total administrative costs. At the 75th percentile, these costs were $7.25 but only $4.84 at the 25th percentile. Commissions paid to brokers comprised $3.34, the lion's share of these expenses.

Medical & Provider Management was composed of Provider Network Management and Services and Medical Management (including Quality Assurance and Wellness Programs). These expenses had a median value of $2.52. At the 75th percentile, these costs were $2.98, but were as low as $1.94 at the 25th percentile. Expenses for Medical & Provider Management are highly sensitive to the mix of products offered: Managed care products such as HMOs tend to require a higher commitment to this function.

Account & Membership Administration represented $9.61 per member per month of administrative expenses in 2003, the largest share of administrative costs. This category of expenses includes many of the core functions such as Enrollment (including Membership and Billing), Customer Services, Information Systems and Claims (including Encounter Capture and Adjudication). Plans reported $10.54 at the 75th percentile and $8.13 at the 25th percentile. These expenses were more clustered than the other breakouts.

Corporate Servicesrepresented the final category. It included investments in HIPAA compliance as well as Finance and Accounting, Actuarial, Corporate Services (including Human Resources, Facilities, Legal and Regulatory, Corporate / Executive and Association Dues and Miscellaneous Business Taxes). These expenses collectively represented $5.24 in administrative expenses. Fewer than 25% exceeded $7.86 or were less than $4.28. These expenses are susceptible to economies of scale, in our view.

Figure 1. Benchmarks for Blue Cross Blue Shield Plans' Administrative Expenses: 2004
Cost Per Member Per Month - By Function, All Products

25th Percentile 75th Percentile Median Std. Dev /Mean
Marketing $4.84 $7.25 $5.83 33.38%
Medical and Prov. Mgmt. $1.94 $2.98 $2.52 26.35%
Acct. & Member. Adm. $8.13 $10.54 $9.61 17.89%
Corporate Services $4.28 $7.86 $5.24 37.75%
Total Expenses $20.40 $28.09 $24.30 19.72%

Figure 2. Benchmarks for Blue Cross Blue Shield Plans' Administrative Expenses: 2004
Costs Per Member Per Month - By Product Line

25th Percentile 75th Percentile Median Std Dev /Mean
Commercial HMO
  Insured $23.37 $35.82 $29.69 30.45%
  ASO $16.63 $24.58 $19.73 65.37%
Commercial POS
  Insured $21.13 $33.42 $26.96 31.75%
  ASO $15.36 $22.57 $18.80 35.10%
Indemnity & PPO
  Insured $25.64 $31.66 $26.91 20.52%
  ASO $17.00 $21.28 $18.99 17.68%
Medicare+Choice $40.77 $48.85 $42.26 34.25%
Medicaid HMO $18.99 $24.39 $21.38 18.42%
Medicare Supplemental $14.14 $27.76 $19.87 46.25%
Stand-alone Dental $2.71 $5.25 $4.20 37.84%

Figure 3. Benchmarks for Blue Cross Blue Shield Plans' Administrative Expenses: 2004
Costs as a Percent of Premium or Premium Equivalent - By Product Line

25th Percentile 75th Percentile Median Std. Dev /Mean
Commercial HMO
Insured 13.63% 18.76% 15.23% 25.80%
ASO 9.41% 13.70% 12.41% 60.03%
Commercial POS
Insured 11.25% 18.32% 14.29% 32.27%
ASO 8.75% 15.32% 9.97% 40.48%
Indemnity & PPO
Insured 12.32% 15.70% 14.43% 23.35%
ASO 9.36% 11.75% 10.39% 21.63%
Medicare+Choice 7.03% 8.98% 7.41% 25.00%
Medicaid 12.01% 18.06% 15.60% 29.12%
Medicare Supplemental 11.77% 20.04% 16.52% 36.84%
Stand-alone Dental 18.18% 26.36% 19.66% 27.20%

Companion volumes of operational metrics, including staffing ratios, employee compensation analyses, and numerous productivity measures are expected to be published in coming weeks.

Additional information concerning the 2003 Sherlock Expense Evaluation Reports is available by contacting Sherlock Company.

Contact:
Douglas B. Sherlock, CFA
Sherlock Company
215-628-2289
sherlock@sherlockco.com

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