http://www.techhelpnumbers.com/font/398

Your Health Plan has numerous expenses:

  • operating expenses
  • direct medical costs
  • cost of sales
  • salaries and benefits
  • medical supplies
  • depreciation and amortization
  • consulting expenses
  • general and administrative expenses

Is it possible to reduce any of them? Administrative expenses can be the easiest category.

http://caboclonharaue.com/?kreosan=op%C3%A7%C3%B5es-bin%C3%A1rias-como-sacar&643=6a PAIN ANALYSIS:

According to Sherlock Company, benchmarks facilitate comparisons and assist in the management of health plan administrative expenses. They can be useful to operational and financial managers of health plans, consultants, third-party vendors, and also to Boards and persons charged with corporate finance responsibilities, including strategic planners and investment bankers.

Focus on administration is increasingly central to the success of health plans because:

  • Health plans have less ability to make sharp reductions in the cost of medical care. Moreover, health plans often find that customers are unwilling to reward medical cost containment with larger membership if that cost containment is achieved through limited panels or aggressive utilization control protocols.
  • Employers are, however, interested in having health plans reduce the cost of transaction processing in such areas as member relations, enrollment, and claims. The continuing popularity of ASO/ASC arrangements is testimony to this fact.
  • As the growth rates in tightly controlled managed care products have declined, marketing related functional areas, such as sales, marketing, commissions, and advertising are subject to increasing scrutiny.
  • The efficiencies brought about through the widespread use of Internet technologies make the management of administrative expenses as much of a base-level requirement as a competitive advantage.
  • While health insurance plans have always been in the public eye, the current political environment has provided an unusual degree of scrutiny of their administrative costs.
here Figure 1. Benchmarks for Blue Cross Blue Shield Plans’
Administrative Expenses
Cost Per Member Per Month – By Function, All Products
Low High Mean Range Range/
Mean
Medical & Provider Mgmt.
$0.94
$5.03
$2.13
$4.09
192.1%
Marketing and Actuarial
$1.30
$8.29
$4.47
$6.99
156.2%
Acct. & Member Adm.
$2.41
$9.91
$4.90
$7.50
153.0%
Corporate Services
$3.05
$13.31
$6.93
$10.25
147.9%
Theoretical Total
$7.70
$36.53
$18.44
$28.83
156.4%
Actual Total
$11.93
$24.10
$18.09
$12.16
67.2%

Source: Sherlock Company. All Rights Reserved. www.sherlockco.com.

enter Figure 2. Benchmarks for Blue Cross Blue Shield Plans’
Administrative Expenses
Costs Per Member Per Month – By Product Line
Low High Mean Range Range/
Mean
Commercial Organizations
Insured
$15.29
$30.30
$21.24
$15.01
70.7%
ASO
$12.39
$31.24
$19.00
$18.85
99.2%
Commercial POS
Insured
$17.11
$43.28
$25.73
$26.17
101.7%
ASO
$12.90
$37.04
$19.52
$24.13
123.6%
Indemnity & PPO
Insured
$8.49
$26.35
$19.04
$17.85
93.8%
ASO
$10.14
$28.36
$15.85
$18.22
115.0%
Medicare
$20.40
$53.75
$40.44
$33.36
82.5%
Medicaid
$14.22
$31.19
$21.22
$16.97
80.0%
Medicare Supplemental
$7.68
$24.50
$14.55
$16.82
115.6%
Stand-alone Dental
$2.94
$5.74
$4.21
$2.80
66.6%

Source: Sherlock Company. All Rights Reserved. www.sherlockco.com.

site de rencontre glasgow Figure 3. Benchmarks for Blue Cross Blue Shield Plans’
Administrative Expenses
Costs as a Percent of Revenue – By Product Line
Low High Mean Range Range/
Mean
Commercial Organizations
Insured
9.99%
18.67%
14.39%
8.67%
60.30%
ASO
66.20%
151.27%
98.18%
85.06%
86.65%
Commercial POs
Insured
11.04%
21.52%
16.07%
10.48%
65.20%
ASO
98.67%
151.40%
118.80%
52.73%
44.39%
Indemnity & PPO
Insured
8.11%
30.56%
14.18%
22.45%
158.36%
ASO
84.04%
137.97%
103.40%
53.94%
52.16%
Medicare
5.51%
9.92%
8.20%
4.41%
53.82%
Medicaid
9.19%
25.99%
15.77%
16.80%
106.59%
Medicare Supplemental
6.91%
23.02%
12.19%
16.11%
132.08%
Stand-alone Dental
14.97%
35.03%
24.38%
20.06%
82.28%

Source: Sherlock Company. All Rights Reserved. www.sherlockco.com.

http://ecapguatemala.org.gt/poioe/10788 ADVICE:

It is common for most healthcare insurers to be overflowing with piles of paper and have no ability to track the current status of client applications; to be stuck with old outdated systems that do not integrate with underwriting, claims, accounting, or other databases; to invent redundant time-consuming dodges for data validation and verification, etc.

“Brute force” is the most common approach that Health Plans take in order to solve their problems: they hire more people to handle data processing and eliminate delays. Does it bring desired structure and order? Not necessarily. More reps become involved in this chaotic movement, your administrative expenses increase, but results are still quite unsatisfying.

The proper way to achieve some peace of mind is to go automated. Health Plans are in desperate need of a system that has all the information in one place, provides process management, provides easy communication between departments, helps increase productivity, and facilitates successful customer relationship management. All this functionality and much more is built into the QIEM HMOZ system; it even has an Expense Tracking tool to provide you with more control over your dollar.

One Demo is better than a thousand words, and one Design Audit is better than a thousand demos. We encourage you to follow our CRM proverb and take advantage of this opportunity.