How do you compare to the Sherlock Benchmarks?
|Your Total Annual Administrative Expenses||$ Optional|
|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|
|Medicare Cost||IPS Only|
|Stand-Alone Part D|
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 of your products 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 for 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. Cost values are from calendar year 2022 for Blue, IPS, Medicaid and Medicare. Larger cost values are from 2021. Updated October 4th, 2023.