Protecting Healthcare Affordability in Maine

Healthcare costs in Maine are some of the highest in the country. 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 and members.

Some of the efforts Anthem Blue Cross and Blue Shield is taking to protect healthcare affordability in Maine include:

• Working with providers to diversify Maine’s healthcare delivery system so consumers have independent alternatives for outpatient care and more options for behavioral healthcare.
   
  • Last year, we welcomed two outpatient infusion providers into our network: Novella Infusion, with locations in Augusta, Lewiston, Portland, and Rockport, and Local Infusion, with locations in Augusta, Bangor, South Portland, and Portsmouth, N.H. These are the among the first independent infusion centers in Maine, where costs are typically much lower than infusions administered in a hospital and the patient experience is often more convenient, private, and comfortable.
  • Anthem was the first carrier to contract with Aspire365 for its new in-home substance use disorder and mental health treatment program for teens and adults.
  • Earlier this year, Anthem welcomed InStride Health to its network. InStride Health treats all severity levels for anxiety and OCD for children and young adults ages 7 to 22.
  • Anthem also welcomed Lin Health, a virtual/in-person provider leveraging technology-focused approaches to pain management, to its network last year.

• Partnering with Northern Light Health and Central Maine Healthcare to add Inland Hospital in Waterville, Mercy Hospital in Portland, Bridgton Hospital in Bridgton, Central Maine Medical Center in Lewiston, and Rumford Hospital in Rumford, 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.
   
• Investing in primary care.We currently offer a benefit for Anthem members in certain employer plans with ConvenientMD’s primary care practices in Portland and Portsmouth, N.H., giving members who select a ConvenientMD primary care provider no-cost access to on-site labs, procedures, X-rays, and urgent care visits when they visit any ConvenientMD urgent care clinic in Maine or Portsmouth.
   
• Developing digital tools such as Anthem’s mobile app, Sydney Health, 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.
   
• Advocating for legislative proposals to improve healthcare affordability and ensure greater transparency and fairness in healthcare billing. For instance, Anthem supported passage of L.D. 1533, which helps to ensure patients are billed for health services based on where they are rendered and will ensure healthcare services are reimbursed appropriately.
   
• Keeping rates low by leveraging our size and scope to effectively manage administrative and medical costs for our customers and members. Anthem has the lowest overall price position in the individual and small group markets for 2025.

As has been our mission for 86 years, we remain committed to ensuring Mainers have access to quality healthcare that is affordable.