Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the State Health Plan topic
No spam. Unsubscribe anytime.
Anthem reports rising medical trend and concentration of costs in high-cost claimants
Summary
Anthem told commissioners the State of Maine Health Plan saw a 9% rise in total medical per member per month (about $55 PMPM) driven by unit cost and utilization, with 324 high-cost claimants accounting for a large share of spend; plan membership and setting-of-care details were provided.
Anthem presented the State of Maine Health Plan medical review (paid Sept. 2014 to Aug. 2025). The report noted 14,870 subscribers, 26,494 members, and $17.8M paid in August 2025. Anthem said total medical per member per month rose 9% (about $55 PMPM), with high-cost claimants driving 52% of that trend in the current period.
Anthem highlighted that 76.3% of members had a primary care visit and that preventive screenings and primary care relationships are key to controlling long-term costs. The insurer also provided a breakdown of place-of-service spending and identified potentially impactable chronic conditions, with obesity, hypertension and low back pain among the largest prevalence groups.
