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Anthem reports small PMPM increase and flags high-cost claim concentration in State plan
Summary
Anthem briefed commissioners that total plan spend was $216.6 million and Per Member Per Month rose from $681 to $683, with 33.2% of spend attributed to high-cost claimants.
Anthem presented the March 2026 State of Maine dashboard for paid claims April 2025–March 2026 and reported total plan spend of $216.6 million and a Per Member Per Month (PMPM) increase from $681 to $683. Anthem said employees represented 56% of membership and 63% of paid amounts, while spouses and children accounted for the remainder.
Anthem identified the top three condition categories by spend as cancer, circulatory conditions and a category labeled ‘Health Status,’ which together comprised a significant share of plan costs. Anthem said 1.1% of members were high-cost claimants but that cohort represented 33.2% of plan spend. Management Member Cecile Champagne-Thompson asked whether direct-care plans were reflected in utilization figures; Anthem replied that the matter could be researched and an answer provided to the commission.
Anthem also reported behavioral-health prevalence and utilization trends, noting mixed changes across inpatient, residential and outpatient services and encouraging preventive screenings and primary-care relationships to improve outcomes.
