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Protecting Healthcare Affordability in Maine

September 21, 2022

Healthcare costs in Maine are some of the highest in the country. While there has been a lot of focus on provider workforce issues and inflationary costs for supplies, the high cost of health care services is an issue we’ve been addressing for some time in Maine. The combination of factors including an aging state, our largely rural landscape, higher costs for prescription and specialty drugs, and increased hospital consolidation all contribute to the high cost of care.

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 rise unchecked, Mainers will pay more for healthcare through higher premiums and higher out-of-pocket costs. This 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.

At Anthem Blue Cross and Blue Shield in Maine, our role is to address increasing costs and protect affordability for the businesses and people we serve. That’s the reason we contract with providers and health systems, so we can negotiate and advocate on behalf of our customers.

Some of the other things Anthem Blue Cross and Blue Shield is doing to protect healthcare affordability in Maine include:

  • Working with providers to diversify Maine’s healthcare delivery system so consumers have non-hospital based alternatives for outpatient care.
  • Partnering with Northern Light Health to add Inland Hospital in Waterville and Mercy Hospital in Portland as Tier 1 providers in Anthem’s Maine HMO Tiered Options Plans, giving members access to healthcare professionals and hospitals with lower-cost options and incentives. By selecting a healthcare professional or hospital in Tier 1, members could see significant savings in cost shares for healthcare services – such as lower copays for primary care physician and specialist office visits, lower coinsurance costs, and up to $3,000 in savings on deductibles, depending on the plan.
  • Growing value-based care models, which reward providers for efficiency, coordination, health outcomes, and care experience rather than on the volume of care provided under the traditional fee-for-service system. More than 95 percent of primary care providers in Anthem’s network in Maine are enrolled in value-based care programs.
  • Developing digital tools so members can access care on their own time and have information at their fingertips to make better decisions about where to get affordable care.
  • Leveraging our massive amounts of data 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 healthcare providers apply these insights to improve care overall.

As has been our mission for 84 years, we remain committed to ensuring Mainers have access to quality healthcare that is affordable.