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Description of Operational Metrics

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

We collectively refer to our operational metrics as Volume II, though this actually consists of three volumes. Volume II.A analyzes the sources of administrative expense variances for most of the key functional areas. In addition, for most universes, two separate volumes, II.B and II.C respectively address medical management and health care utilization. We discuss those separately.

Operational metrics provide in-depth analyses, facilitating drill downs in key functional areas. Those areas include Sales and Marketing, Enrollment / Membership / Billing, Customer Services, Provider Network Management & Service, Claims & Encounter Capture & Adjudication, Information Systems, Corporate Services and Human Resources.

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.


Transactions per Member

x

Members per FTE

=

Transactions per FTE per Year

x

Cost per Transaction

=

Cost per FTE 

x

FTEs per 10,000 Members

=

Cost PMPM

1.1

x

9,000

=

9,900

x

$7.50

=

$74,250

x

1.11

=

$0.69

Primary Demand

Staffing Ratio

Productivity

Unit Cost

Per FTE Cost

Staffing Ratio

Cost PMPM

While this taxonomy provides the frame of reference for these metrics, we provide the metrics that the functional areas themselves view as central to their performance. 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.  Since the metrics specific to each functional area cannot be readily summarized, we encourage you to download the Table of Contents.

Sample Table of Contents

We provide both staffing ratios and per FTE staffing costs for each functional areas with employees. (Broker commissions for instance normally has no employees.)  In addition, our metrics take into account the effect of outsourced arrangements on the per FTE costs and the staffing ratios. Depending on the universe, this volume consists of from 170 to 434 pages with thousands of statistical analyses.

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