Medicaid Plans’ Administrative Expenses Accelerated in 2023: Webinar

PHILADELPHIA--(BUSINESS WIRE)--In 2023, Core per member administrative expenses in Medicaid-focused plans grew by 5.4% in 2023, faster than the 1.8% growth in 2022. After holding the product mix constant, the real core Cost growth rate was 5.3% compared to 2.4% in 2022. Holding mix constant, the growth in Account and Membership Administration grew by 3.9% compared with 5.7% in 2022. Core PMPM costs were $39.68.

The results are published in Plan Management Navigator posted at sherlockco.com/navigator.

The Navigator excerpts from the 2024 Medicaid plan edition of the Sherlock Benchmarks. It summarizes in-depth surveys of 11 health plans serving 4.8 million Medicaid or CHIP members. Including Medicaid product cost information from other Sherlock Benchmarks universes referenced in the Medicaid edition, all Sherlock Benchmarks plans serve approximately 10% of Medicaid beneficiaries.

The Medical and Provider Management Cluster was the most important source of growth among all clusters, its function Medical Management was the largest factor in that cluster and overall for Medicaid plans.

We will discuss the results via a free web conference on Wednesday, October 23^rd, from 2:00 PM to 2:45 PM Eastern Daylight Time. Douglas Sherlock will offer a brief presentation, followed by questions and answers. To participate in the web conference, please register at sherlockco.com/webinar. Once registered, dial-in information and a link to connect will be provided in a confirmation email.

The Sherlock Benchmarks are the health plan industry’s “gold standard” metrics of administrative activities, costs and operational drivers. They reflect 27 consecutive years and more than 1,000 health plan years of experience. Health plans use the Sherlock Benchmarks to determine whether their administrative costs are optimal and to prioritize improvements among numerous specific activities. Other applications include informing strategic corporate planning and cost-benefit analyses.

This year, collectively, Benchmark participants serve 52 million Americans in Medicare and other plans. Other universes include Blue Cross Blue Shield, Independent/Provider-Sponsored and Medicaid plans. Health plan users of the Sherlock Benchmarks serve over 200 million members since June 2021.

Sherlock Company (www.sherlockco.com), based in Gwynedd Valley, Pennsylvania, provides informed solutions for health plan financial management. Since its founding in 1987, Sherlock Company has been known for its impartiality and technical competence in service to its clients.