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Sponsored by: Anthem Blue Cross and Blue Shield in Maine
Updated: September 16, 2022

Working together to address the cost of health care in Maine

It comes as no surprise to Maine employers and consumers that health care costs in our state are some of the highest in the country. A 2019 study by the University of Pennsylvania ranked Maine as having the fourth highest health care cost burden for working families in America. And 55% of Mainers faced one or more cost-related barriers to getting the care they needed last year, according to a survey by Altarum.

Skipping treatments and procedures due to the cost of health care leads to a vicious circle of inadequate preventive care, increased stress and sickness, and ultimately higher costs. For employers, it also leads to dissatisfied employees, a less productive workforce, and a negative impact to the bottom line.

So, what can we do about it? To achieve the collective goal of more affordable and higher quality health care, we must all do our part. Here’s how employers and their employees, health systems, and health plans can work collaboratively to keep health care affordable in Maine.

Employers

Until recently, employers have prioritized broad doctor and hospital networks when selecting health plans, which often had the unintended consequence of putting network size and breadth ahead of value and quality. That is changing, however, as more Maine employers are adopting more curated networks comprised of providers that prioritize value-based care. These models reward doctors and other providers for efficiency, coordination, health outcomes, and care experience rather than on the volume of care provided under the traditional fee-for-service system. With this shift, employers are giving employees access to health care delivery built around improving health in addition to treating illness and injury — which reduces medical costs and increases productivity and morale.

Employers can also encourage employees to regularly visit a primary care provider (PCP). This is key to heading off potential medical issues before they become severe — and costly. Alarmingly, studies show declining PCP use in recent years. Employers should work with us to educate employees about ways a PCP can help them achieve better health. At Anthem Blue Cross and Blue Shield, we’re working to expand the number of independent primary care practices in Maine so employees have more convenient options for care.

Employees

Choosing the right health care setting to receive care is the easiest way for consumers to reduce their costs. One of the most significant and most avoidable out-of-pocket expenses for individuals is an emergency room visit for a non-life-threatening issue like a minor cut, earache, or allergies. With ER visits costing nearly 10 times compared to urgent care treatment, they are an expensive place for non-emergency care. Employee education about when to use the ER and other lower-cost care settings, including 24/7 telehealth, can be powerful.

Providers

We are working to accelerate growth in value-based payment models, which are being embraced by Maine providers because it aligns financial incentives with their priority to provide better care, lower costs, and a better experience for their patients. The key to ensuring this model is successful is collaboration. Anthem, for example, has co-designed a portfolio of value-based care models with doctors and hospitals. This continuum ranges from straightforward payment incentives for preventive care delivery to sophisticated models in which providers financially share in the “health dividend” resulting from improved health within the patient population. In fact, more than 95% of PCPs in Anthem’s network in Maine are enrolled in these types of value-based care programs.

Health plans

A health plan’s primary role is to provide consumers with access to care that’s affordable. But how we do that is changing. We have evolved to become more active participants in advancing the health of those we serve, providing tools and data to help members live better lives, help employers access better care for their workforce, help doctors deliver better outcomes, and help communities address social drivers of health, like food insecurity.

We know health care needs to be a lot more personal for it to be effective. At Anthem, we leverage our data to provide personalized health care that will empower consumers to make more informed decisions about where to get cost-effective care. In addition, our Health OS platform reaches across millions of individual records to track patterns and detect trends that require redeployment of resources, changes in diagnostic practices, or targeted community interventions, all while preserving privacy and security of data. We can then help health care providers apply these insights to improve care overall.

To make health care simpler, more affordable, and more accessible, we must reinvent the way we approach health. Protecting affordability will take collaboration, innovation, and commitment by every Mainer.

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.