By Lou Gianquinto, President of Anthem Blue Cross and Blue Shield in Connecticut
Connecticut residents are facing unprecedented economic challenges – no one has been spared from a rising grocery bill, increased utility bills, or higher costs for healthcare. According to Healthcare Value Hub, nearly two in three Connecticut adults delayed or went without healthcare in the last year due to costs. This concerning trend impacts community health, workforce productivity, and the local economy. It’s time to address the healthcare affordability challenge head on.
Why healthcare costs keep climbing
Many factors are driving increases in healthcare costs, such as an aging population, chronic conditions, rising prescription and specialty drug costs, and fraud, waste, and abuse. Hospital consolidation also plays a role – when health providers merge, it often leads to higher prices and fewer choices. Additionally, federal and state legislation and mandates continue to add costs year after year.
Who can make a difference
Addressing healthcare affordability requires all members of the healthcare system to act. Health plans, hospitals and health systems, care providers, pharmaceutical companies, lawmakers, employers, and individuals all need to take a seat at the table.
Care providers must focus on value not volume, leaning into value-based care models that incentivize positive healthcare outcomes. Lawmakers must work to better understand the impact of legislation being proposed and passed, factoring in the true cost of the affordability crisis. Individuals must engage in their healthcare journey, investing time to understand their health benefits and use the tools, programs, and resources available to help navigate options and costs.
How we’re making healthcare more affordable
At Anthem Blue Cross and Blue Shield, we’re working to address affordability on behalf of employers and members in Connecticut to improve health outcomes and drive economic resilience. Rising costs ripple through businesses and communities, affecting productivity and long-term well-being. That’s why we are committed to solutions that go beyond traditional cost control measures, including:
- Helping seniors manage complex care so they avoid unnecessary hospital stays.
- Offering disease management programs that help members better control chronic conditions.
- Negotiating lower prices for prescription drugs, especially expensive specialty drugs. We also offer a unique drug list that focuses on chronic condition drugs with no cost shares, making them more accessible to members.
- Working with providers to pay them based on the quality of care they deliver, not the number of services they provide. In fact, 65 percent of what we spend on medical care in Connecticut goes toward these value-based care programs that reward quality care and better health results.
- Encouraging members to get the right care, at the right place, at the right time and save the emergency room for truly emergent needs. We also incentivize members to get their annual preventive/wellness exam to catch health issues early.
- Engaging members with tools and corresponding incentives to choose the highest quality and most affordable providers through our portfolio of alternative health plan solutions (Guided Advantage, Clear Choice, and Anthem powered by Coupe Health).
- Creating customized, integrated solutions that help employers save on healthcare costs while improving care for their employees.
- Using AI to find potentially fraudulent activity and improper claims.
- Advocating for policies at both the state and federal levels that support affordability and access.
Our strategy blends proven tools with fresh thinking: expanding access to high-quality care, simplifying benefit design, preventing fraud and waste, and addressing whole health – the physical, behavioral, and social drivers of health.Looking ahead
Most factors influencing health occur outside medical settings. Behavioral health and social drivers like housing and nutrition play a critical role and overlooking them only compounds costs higher. This is why it is so important that all stakeholders come together to address rising costs. Our team in Wallingford is committed to working with all stakeholders to improve healthcare affordability and advance better health for everyone in Connecticut.
Learn more about our efforts at https://www.anthem.com/update/affordability-in-connecticut
