The essential role of a health plan in Connecticut

When families face a cancer diagnosis, mental health crisis, or any unexpected change in their health, the last thing they should worry about is navigating a complicated healthcare system. But for many, that’s exactly what they face. Complex benefits, rising out-of-pocket costs, and uncertainty about where to turn add stress to already difficult moments. Families are frustrated by rising premiums and costs – and they want solutions. At Anthem Blue Cross and Blue Shield, we believe health plans have a responsibility to help keep coverage dependable and accessible when people need care.

People today expect more from their health plan – they want support that makes healthcare easier to understand, easier to afford, and easier to use. Our role is clear: we advocate on behalf of our members, help people navigate care with confidence, and ensure access to high-quality care when it matters most. These are the standards we are committed to delivering in Connecticut.

Simplifying the healthcare experience

Healthcare has become increasingly complex. Our job is to simplify it by helping members understand their coverage, what care will cost, and how to find the right provider. Without clarity, these factors often lead to confusion, delays, or unnecessary costs. 

Tools like Anthem’s Sydney Health app bring benefits, in-network providers, cost estimates, and care navigation together in one place. Its ease of use, combined with new AI-powered features, helps members save time, make informed decisions, and find the right care faster. Members who use the app save an average of $185 annually because they can compare care options.

Lowering the cost of care for families

The U.S. now spends more than $5 trillion a year on healthcare, and costs are accelerating. Hospital spending increased by nearly 10 percent in both 2023 and 2024 – the fastest growth in more than three decades, outpacing inflation and wage growth. Prescription drug spending rose nearly 8 percent in 2024 and now represents roughly one-quarter of what employers spend on healthcare.

It’s important to understand what drives those costs. Premium rates are based on the expected cost of medical and pharmacy care and how often services are used. In that sense, premiums aren’t a prepayment for routine care – they’re protection against large, unexpected medical bills when serious illness or injury occurs. Premiums are tied to the actual cost and amount of care people receive, and by law, 80-85 percent of every premium dollar must go directly toward medical care or be returned to consumers.

We’re also shifting care to more affordable settings, such as virtual visits and community-based providers, to reduce avoidable emergency room visits and hospitalizations. We work with providers to reward better health outcomes rather than more services. These approaches drive long-term improvements in quality care, patient experiences, and lower care costs.

Providing personal support when needs are complex

Quality healthcare requires more than coverage; it requires personal care. When someone is managing a chronic condition, juggling multiple appointments, or facing a new health concern, they often need help from someone who understands the system. 

Care managers help members understand their benefits, coordinate appointments, and connect with community resources. One member’s experience shows the impact: when a pregnant woman noticed a concerning lump, she contacted her care manager, who helped her understand her coverage, coordinated a biopsy, and connected her with local support for food, diapers, and other essentials. That’s the whole-person support families should expect. In Connecticut, our care managers also help members access available resources that support complex care, chronic condition management, prescription drug affordability, and more.

We work closely with high-quality care providers to ensure care is coordinated, evidence-based, and focused on better outcomes. Our Community Pharmacy Total Care program, for example, pairs members with more complex health needs with independent pharmacists who take the time to review medications, sync refills, arrange free home delivery, and prepare easy to follow packaging instructions. This hands-on approach makes staying healthy easier and helps members manage medications with confidence. 

The path forward

Healthcare will continue to evolve, and health plans must evolve with it. Our commitment is simple:

• Make healthcare easier to understand through clear information and easy-to-use tools that guide decision-making.
• Make healthcare more affordable by addressing the drivers of rising costs and supporting lower-cost, high-quality care.
• Make healthcare more personal by offering support that meets people where they are.

When health plans, providers, and policymakers work together, families can spend less time worrying about costs and more time focusing on their health. Our commitment is to keep coverage dependable, improve affordability over time, and help people get the care they need – when they need it – across Connecticut.

Learn more at anthem.com/affordabilityinconnecticut.