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Sponsored by: Anthem Blue Cross and Blue Shield in Maine
Updated: September 10, 2024

How Your Health Plan Works With You to Lower Costs

Healthcare costs continue to rise, and 82 percent of employers surveyed by the National Alliance of Healthcare Purchaser Coalitions said high healthcare costs are affecting their ability to be competitive.

The prices health systems charge for services and the high cost of prescription drugs are the primary drivers of healthcare spending. If the cost of services continues to skyrocket, Mainers will pay more for healthcare through higher premiums and higher out-of-pocket costs. In fact, nearly two-thirds of Anthem Blue Cross and Blue Shield members in Maine are covered through self-insured health plans, meaning their employers are directly responsible for their claims costs. Higher prices can lead to some skipping treatments and procedures due to the cost, which leads to a vicious circle of inadequate preventive care, increased stress and sickness, and ultimately even higher costs.

That’s why your health plan is a key partner in helping you manage your organization’s healthcare costs. There are four main ways health plans do this. Combined, these strategies have a considerable effect on lowering costs and encouraging members to take a more active role in their health – which means a healthier and more productive workforce.

Network/benefit design can optimize costs through strategies such as value-based care arrangements with providers that pay for the quality of care delivered rather than the quantity; network discounts; high-performance and curated care provider networks; centers of excellence; and benefits tailored to your employee population’s health.

For instance, at Anthem we offer a plan design called site of service where member cost shares reflect the value of the service (i.e., lower cost shares when seeking care at high-quality, lower-cost facilities). Our SmartShopper program offers financial incentives to members when they voluntarily choose high-quality, lower-cost providers. These programs provide our members with transparency about their healthcare options and gives them a reason to care. Together, our site of service and SmartShopper programs drive considerable cost savings for our customers and results in a more engaged member population.

Clinical programs may lower overall employer costs through care management for people with chronic conditions, medical and pharmacy integration, and integrated physical and behavioral healthcare. With 90 percent of annual healthcare expenses attributed to people with chronic and mental health conditions, improved care management is a critical tool in supporting better health for your employees. At Anthem, we can identify at-risk employees and their gaps in care, and partner with them and their medical team to support their wellness journey. This approach can lead to fewer emergency room visits, lower hospitalization rates, increased preventive screenings, and employees receiving the right care at the right place at the right time.

In addition, a comprehensive network of behavioral healthcare options can provide members with a variety of innovative care options and help address mental health conditions and substance use disorder early in a diagnosis, before they potentially lead to a crisis.

Total cost of care is often affected by wasteful billing practices or inaccurate claims. Advanced data and analytics, pre- and post-payment reviews, and fraud prevention can help mitigate costs. For example, Anthem’s payment integrity team helps ensure proper provider billing through practices like claims editing, data mining, and clinical audits to validate that claims are paid accurately.

Members’ engagement with their benefits can be improved through personalized resources, digital tools, health advocacy and navigation support, and wellness programs. For example, tools such as telehealth can deliver convenient, 24/7 access to care. Remote patient monitoring can help employees manage chronic conditions at home. At Anthem, our health plans include a range of well-being tools and services through our mobile app Sydney Health, such as a nutrition tracker, symptom checker, and virtual care visits. Our app also makes it easier for members to budget their healthcare dollars and see spending through their health savings accounts or health reimbursement accounts. Through our digital capabilities we can provide a more personalized healthcare experience for members and help them become better healthcare consumers.

Your health plan is here to support your employees’ health needs and protect affordability. At Anthem, we will continue to advocate for greater access to high-quality, affordable healthcare in Maine for the people and businesses we serve. 

Denise McDonough is the president of Anthem Blue Cross and Blue Shield in Maine, based in South Portland.

Learn more about Anthem’s efforts to keep health care affordable in Maine at anthem.com/maine