Anthem: Lowering Healthcare Costs: A Shared Responsibility

When the cost of care rises beyond what families and employers can reasonably manage, it creates real strain on household budgets, businesses, and on access to timely treatment. Today’s pressures reflect system-wide trends: rising hospital and physician prices, increased utilization, and growing prescription drug costs that are affecting every coverage market and every health plan.

No single organization can solve this alone. Lowering the cost of healthcare requires shared responsibility, practical reforms, and sustained collaboration across the healthcare system.

Anthem recognizes its responsibility and is actively taking steps to address healthcare costs. The following are several examples of Anthem's ongoing efforts.

Focusing on value, not volume

Aligning care provider incentives around outcomes is one of the most effective ways to lower costs over time. To that end, Anthem's value-based care arrangements reward providers for better outcomes, prevention, and coordination rather than the number of services delivered.

Reducing avoidable utilization

Through care management, advocacy, and navigation programs, Anthem supports more than seven million people in managing chronic conditions and closing gaps in care. This helps reduce preventable ER visits and hospitalizations as national utilization continues to rise.

Shifting care to appropriate, lower-cost settings

Anthem promotes care in the right setting at the right time, including virtual care and alternatives to hospital-based services when clinically appropriate.

Improving outcomes to lower long-term costs

Through a value-based cancer care program, Anthem decreased year-over-year inpatient utilization among members with cancer by over 14% and year-over-year emergency department visits by 8% compared to pre-program levels. *

Streamlining administration and reducing waste

Since January 1, 2024, Anthem has removed prior authorization requirements for more than 400 services and procedures, with prior authorization now applying to only about 3% of claims. Electronic prior authorization and automation have also expanded, reducing denials and administrative rework.

Supporting meaningful policy reform

Public policy plays an important role in healthcare costs. Anthem supports:

• Greater hospital price transparency and accurate site-of-care billing practices.
• Requirements for unique National Provider Identifiers tied to site of service.
• Improvements to the No Surprises Act IDR process, where case volumes have exceeded expectations and added cost pressures.
  • A Broker and Consultant webinar on IDR is available to show how Anthem is working to mitigate the impact the misuse of this process is having on healthcare costs.
• Continued expansion of telehealth.
• Policies that promote competition, innovation, and pricing tied to clinical value, especially for prescription drugs.

Lowering the total cost of healthcare will not be solved by one action or one group. But as plans, providers, employers, policymakers, and brokers work together, meaningful progress is being made.

* Carelon Insights Oncology TCOC Analytics Readout January 2026