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Anthem: high‑cost claimants and behavioral‑health use are driving medical trend
Summary
Anthem reported that high‑cost medical claimants account for a large and growing share of paid costs (1.1% of members, 33.1% of spend) and that behavioral‑health prevalence and spend have increased; Anthem recommended primary‑care engagement and targeted outreach.
Anthem presented a medical update for the State of Maine Health Plan covering paid claims for Jan.–Dec. 2025. Anthem reported membership and demographic mix (employees 56% of members, employees account for 62% of paid amount) and noted that total medical per member per month rose by $31 (5%), driven largely by high‑cost claimants and digestive system conditions.
Anthem said high‑cost medical claimants (>$100K) represented 1.1% of members but 33.1% of spend; specialty medical drugs accounted for 15% of that spend. Behavioral health claimants numbered 7,247 with per‑member per‑month spend up 7.2%; telehealth accounted for 47.6% of behavioral health visits. Anthem recommended promoting Primary Care Provider relationships, correcting invalid contact information, and targeted nurse engagement and advocacy to drive preventive care and screening uptake.
