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September 7, 2023

Getting Employees Engaged in Their Healthcare: Look at Your Care Options

Our team is often asked by employers how they can encourage their employees to be more engaged in their healthcare. Simplifying the healthcare experience for your employees and offering wellness programs and digital tools are the keys to making them more willing to access care, but there is another element to consider as well.

Access to the right care, at the right place, at the right time

Employee education about using the appropriate setting for care (i.e., when to use the emergency room vs. urgent care or telehealth) is an important part of the solution, but so too is ensuring employees have the right options to access care – options that are high-quality, convenient, and affordable. And here is where your health plan is a critical partner in your health by developing healthcare networks that work best for your employees.

At Anthem, we have been working to diversify the care delivery system in Maine, because while hospitals play a critically important role in patient care, it is essential that members have independent alternatives for outpatient services – alternatives that have historically been in short supply within our state. Services such as imaging, labs, or prescription drug infusion are now available at a number of independent facilities throughout the state that offer consumers convenient locations, lower costs, and equal, if not greater, quality.

For example, Anthem welcomed two new outpatient infusion providers into our network earlier this year: Novella Infusion, with locations in Augusta, Lewiston, and Portland, and Local Infusion, with locations in Augusta and South Portland. These are the first independent infusion centers in Maine, where costs are typically much lower than infusions administered in a hospital and the patient experience is often more convenient, private, and comfortable.

In addition, many health plans now offer both in-person and virtual behavioral healthcare options and encourage members to choose in-network providers for the lowest out-of-pocket costs. Here is where having access to a comprehensive network with a variety of care options is crucial because treatment is very individual and what works well for one employee may not work as well for another.

At Anthem, we have been working to expand provider capacity in the system and bring new types of providers into the state, including residential, outpatient, at-home, and virtual behavioral health providers. We were the first to work with Aware Recovery Care, a 52-week in-home substance use disorder (SUD) treatment program, and the first carrier to contract with Aspire365 for its new in-home SUD and mental health treatment program for teens and adults. We also recently welcomed Lin Health, a virtual/in-person provider leveraging technology-focused approaches to pain management, to our network. We continue to add new behavioral health providers to our network on a regular basis.

Optimizing plan design

Health plan design and member education are also important parts of the solution in directing employees to high-quality, affordable options for care.

For example, at Anthem we offer innovative plan designs called Site of Service where member cost shares reflect the value of the lab, imaging service, or elective procedure (i.e., lower cost shares when rendered at high-quality, lower-cost facilities). Our SmartShopper program offers financial incentives to members when they voluntarily choose high-quality, lower-cost providers. These programs provide our members with a way to know about their healthcare options and gives them a reason to care. Together, our Site of Service and SmartShopper programs drive considerable cost savings for our customers and results in a more engaged member population.

In addition, transforming the primary care experience by developing innovative payment models and benefit designs can deliver high-quality care to your employees at overall lower costs. We recently launched a new benefit for Anthem members in certain employer plans with ConvenientMD’s primary care practices in Portland and Portsmouth, N.H., giving members who select a ConvenientMD primary care provider no-cost access to on-site labs, procedures, X-rays, and urgent care visits when they visit any ConvenientMD urgent care clinic in Maine or Portsmouth.

Keeping your employees engaged in their overall health means a happier, stronger, and more productive workforce. Your health plan is here to support you through improved access to care, member education and engagement, and plan designs that work for you.

Denise McDonough is the president of Anthem Blue Cross and Blue Shield in Maine, based in South Portland. Learn more about Anthem’s efforts to keep healthcare affordable in Maine at