Total Cost Of Care And Employee Benefits

Jan 11,2024

Read Time 2 Minutes

Infographic: Total Cost Of Care And Employee Benefits


With the rising costs of healthcare, employers are increasingly searching for cost savings. Leaning on Anthem’s proven and best-in-class Total Cost of Care (TCOC) approach augments the value of investment in employee benefits by lowering costs and increasing quality of care. View or download the infographic below to learn more. 

How we lower total cost of care


There’s a reason Anthem has been a leader in the healthcare field for over 80 years. Our network is unmatched, giving us local density on a national scale. This saturation enables us to pass on superior financial results through industry-leading clinical programs, innovative digital tools, and seamless integration.



The support pillars: Anthem products and services




Clinical programs and guidelines

  • Program Integrity
  • Data and insights 
  • Operational solutions
  • Medical benefit management
  • Telehealth


Cost protection network and plan design

  • Chronic, complex, and palliative care
  • Pharmacy
  • Employee assistance programs
  • Behavioral health
  • Digital platforms


Expanded engagement

  • End-to-end advocacy/clinical support
  • Concierge care support
  • Pharmacy
  • Community resources
  • Virtual care

The foundation: Our network, Health OS, and our total cost of care advantage


PMPM savings

  • Blue Network Advantage $121
  • Program Integrity $43
  • Clinical management/ advocacy $20
  • Integration (pharmacy, dental, vision & behavioral) $20
  • Pharmacy cost management programs $11

 Anthem’s total cost of care value is $215+ PMPM1


Meet Mike2


Mike is experiencing low back pain after a bike accident. He contacts Anthem member support to ask about medication coverage.


Outreach When Mike calls, the member advocate sees an alert showing the use of opioids without any physical therapy. Mike is flagged as being a member who may be at risk for ongoing pain, hospitalization, and opioid dependency.


Intake The advocate learns that Mike recently lost his mother and is reluctant to miss work to attend physical therapy sessions. Mike admits to chronic pain and feeling isolated.


Action Mike is assigned to a care navigator who arranges physical therapy, connects with his doctor about pain management options, and schedules behavioral health counseling.


Follow-up Mike’s care navigator tells Mike about alternatives to emergency room care, including virtual care, our nurse line, and resources available through the SydneySM Health app. 


Mike is feeling better and on the path to recovery.


As a result of our connected care model, Mike receives stronger care collaboration between his doctors and pharmacist to help him manage his clinical and behavioral health conditions. 


Behind the scenes, utilization management experts analyze Mike’s claims to ensure the billing is accurate, making the experience seamless for Mike, his employer, and his providers.


 1 Internal data based on Anthem internal program studies and third-party consultant analysis. Please consult your Anthem sales representative for specific sourcing in each category.

2 The people and situation in this example are not real. They’re only used to show how the program works.