By Kennan Wethington, Anthem Blue Cross and Blue Shield in Kentucky
The people of Kentucky are facing unprecedented economic challenges. Combined with rising health care costs in the Commonwealth, people are faced with tough decisions. Families delaying or skipping care because of cost concerns impacts community health, workforce productivity and the local economy. It’s time to address the healthcare affordability challenge head on.
Why Health Care Costs Keep Climbing
Many factors are driving increases in health care costs – these are some of the biggest factors:
- Aging population – More older adults need more complex and costly care.
- Chronic conditions – Obesity, diabetes, and heart disease are examples of conditions that are becoming more common AND more expensive to treat.
- Drug costs – They continue to rise, with prices of existing drugs increasing at rates faster than inflation and new drugs starting at record-high prices.
- Provider consolidation – When health care providers merge, it often leads to higher prices and fewer choices.
- Fraud, waste, and abuse – The complexity of our system makes it easier to abuse the system.
- Legislation – Recent federal and state changes continue to mean added costs in the system – year after year.
Who Can Make a Difference
Addressing health care affordability requires all members of the health care system to act. Health plans, hospitals and health systems, health care providers, pharmaceutical companies, employers, lawmakers and individuals all need to take a seat at the table.
Health care providers must focus on value not volume, leaning into value-based care models that incentivize positive health care outcomes. Lawmakers must work to better understand the impact of legislation being proposed and passed with each session. Individuals must engage in their healthcare journey, investing time to understand their coverage and benefits so they can use the available tools, knowing that there is support to help navigate options and costs.
How We’re Making Health Care More Affordable
At Anthem Blue Cross and Blue Shield, we’re working toward solutions to address affordability on behalf of our members and their employers. Affordability is central to improving health outcomes and driving economic resilience. Rising costs ripple through businesses and communities, affecting productivity and long-term well-being. That’s why we are committed to solutions that go beyond traditional cost control measures.
Here are a few things we’re doing to make health care more affordable in Kentucky:
- Helping seniors manage complex care so they avoid unnecessary hospital stays.
- Offering disease management programs that help members better control chronic conditions.
- Negotiating lower prices for prescription drugs, especially expensive specialty drugs.
- Working with providers to pay them based on the quality of care they deliver, not the number of services they provide.
- Giving members rewards through programs like SmartShopper when they use our tools to compare prices.
- Using AI to find potentially fraudulent activity and improper claims.
- Advocating for policies at both the state and federal levels that support affordability and access.
- Collaborating with health systems to achieve moderate and predictable cost trends for employers and individuals.
- Partnering with the Kentucky Chamber and 110 local chambers of commerce across the state to offer affordable health plans that have saved our state’s small employers more than $400 million over the last five years.
Our strategy expands access to high-quality care, simplifying benefit design, preventing fraud and waste, and addressing the full spectrum of health.
Looking Ahead
Historically, health plans focused on paying for care and controlling costs. Today, we recognize that most factors influencing health occur outside medical settings. Social drivers like housing, nutrition and behavioral health play a critical role – and overlooking them makes costs higher. By leveraging data and technology together, we take a more comprehensive approach to building a more affordable health care system for families in Kentucky.
Learn more about our efforts at https://www.anthem.com/update/affordability-in-kentucky.
Kennan Wethington is the President of Commercial Business at Anthem Blue Cross and Blue Shield of Kentucky.
