Health Plan Members per Employee

Health Plan Members per Employee

KPI Details

Health Plan Members per Employee measures the number of policyholders, or members, managed per health insurance company employee. This metric is an approximate measures of staffing levels within any health insurance company. A relatively low (as compared to industry averages, or previously demonstrated levels) number of health plan members per employee suggests that the company may be overstaffed, or not operating efficiently. Areas within health insurance companies that typically hold the most potential for improvement and capacity reduction/re-allocation include claims processing, member services (particularly, the call center) and underwriting. Alternatively, improving marketing, sales and customer service effectiveness (i.e., attracting, converting and retaining more customers) can increase the number of health plan members, which will also lead to a higher number of members per employee.

KPI Definition

The total number of health plan members, or policyholders, covered by the health insurance provider divided by the total number of employees working for the insurer (company-wide) at the same point in time.

KPI Best Practices

• Proficiency in marketing, policy acquisition and customer retention
• Efficient and standardized processes in place for highly repetitive tasks
• Accurate and effective workflow forecasting to prevent overstaffing

KPI Calculation Instructions Health Plan Members per Employee?

Two numbers are used to calculate this KPI: (1) the total number of health plan policyholders, or members, covered under the insurance company’s health plans, and (2) the total number of employees working for the health insurance company at the same point in time. The total number of employees (in the denominator for this calculation) should include all individuals, part-time and full-time, employed by the company at the time of measurement across all lines of business and functions. The total number of health plan policyholders should include the total number of individual policyholders covered under any of the health insurance plans offered by the organization (including all customers holding individual, group or family insurance plans).

KPI Formula :

Total Number of Health Plan Policyholders / Total Number of Employees