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Carrum Health Doubles Its Covered Lives

Carrum Health, a leading provider of value-based Centers of Excellence (COE), has recently reported a significant milestone: it has doubled its covered lives to 6.7 million, adding 3.6 million new lives in 2025 alone. This dramatic growth is in response to the overwhelming surge in healthcare costs, marking a transformative shift in how employers approach healthcare in the current climate.

The Rising Costs of Healthcare

According to the latest industry reports, healthcare costs are escalating at the fastest rate we've seen in 15 years, with projections estimating a 9-9.5% increase in 2026 following an 8% growth in 2025. Factors contributing to these rising costs include skyrocketing drug prices, particularly driven by GLP-1 weight loss drugs and advanced cancer therapies, alongside impending Medicaid budget cuts that will further transfer costs onto the commercial market.

Employers are responding to this financial crisis with decisive actions. Specialty care, which constitutes nearly half of employer medical expenditures, has become a focal point, especially as cancer treatment alone accounts for up to 16% of overall healthcare spending. As Sach Jain, Founder and CEO of Carrum Health, remarked, "Employers are beyond the breaking point...they've tried incremental fixes for years while costs kept climbing. What's evolving now is a shift towards models that fundamentally alter how specialty care is delivered and financed."

A Shift Toward Value-Based Care

In light of the healthcare crisis, the adoption of the COE model is gaining momentum, identified as one of the most effective strategies for cost containment. Recent surveys have shown that half of employers currently offer COE programs specifically for cancer care, with a staggering 73% planning to implement them by 2028. Furthermore, about 84% of employers have adopted COEs for one or more high-cost specialty care needs.

Carrum Health is uniquely positioned as it continues to witness impressive growth, setting itself apart as the only true value-based COE model. Its innovative approach extends coverage to high-cost conditions that were not traditionally included in value-based care frameworks. In 2021, the company launched the first value-based cancer care program in the commercial market, intended to tackle the complexities and price variability associated with cancer treatment. This comprehensive solution not only encompasses the expenses related to intricate cancer drugs and advanced therapies but also significantly cuts costs—offering savings of up to 30% for employers.

In an effort to expand its scope, Carrum embarked on a pioneering treatment model aimed at addressing substance use disorders. This initiative relies on the insights gained from its previous value-based projects and responses to the sharp rise in out-of-network spending, which has reached an alarming 25-30% across the behavioral health spectrum. Costs for substance use treatment facilities have sharply increased, with some reporting costs escalating by as much as 40% out-of-network, according to recent analyses from Harvard Medical School and Health Affairs. Notably, 73% of employers have reported increased utilization for substance use services, and 90% foresee a growing demand.

Accountability in Specialty Care

Jain emphasizes the necessity for accountability in specialty care, noting that historically, the fragmented fee-for-service PPO model left employers grappling with opaque pricing and varied outcomes. He asserts, "We're witnessing a fundamental reset in expectations, as employers now seek transparency in pricing and outcomes. Our growth reflects a movement toward demanding accountability from providers, who must share in the risk rather than passing it onto employers."

In recent trends, more than half of new employers aligning with Carrum require member engagement with Carrum to receive coverage for select services. Forward-thinking benefits leaders have recognized that the most sustainable way to mitigate costs lies in directing members towards high-quality, value-based networks where providers are answerable for both costs and outcomes. This strategic alignment with value-centric care sets the stage for preventing unnecessary procedures, reducing unexpected billing issues, and enhancing member experiences, all reflected in a high Net Promoter Score (NPS) of 80.

Industry Partnerships and Our Future

Carrum Health is proud to serve progressive employers across diverse industries, including major Fortune 10 and Fortune 50 companies, ensuring a commitment to offering high-quality, value-based care at affordable rates. The success of Carrum's model has led to the integration of its services into the offerings of five national and multi-state health plans, with numerous partnerships underway.

The company has secured its status as the exclusive COE partner for eleven industry-leading ecosystem partners specializing in critical areas such as behavioral health, oncology, and care navigation.

In summary, Carrum Health is not just transforming its business; it is playing a vital role in reshaping the entire landscape of specialty care in the U.S. Through its unique COE model, Carrum is proving that it is possible to deliver high-quality specialty care at reduced costs, ultimately benefiting employers and employees alike. To learn more about Carrum Health and its innovative approaches to specialty care, visit carrumhealth.com.