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Carrum Health Reaches Milestone of 10 Million Covered Lives

Carrum Health, an innovator in value-based specialty care, recently announced it has expanded its coverage to 10 million lives. This impressive figure represents an increase of 3.5 million new enrollments within a single year, highlighting Carrum's rapid growth and employers' increasing demand for accountable healthcare solutions amidst rising costs and arbitration challenges.

Understanding the Shift to Value-Based Care

Employers are increasingly moving away from the traditional fee-for-service model, which has long been criticized for incentivizing high volumes of care regardless of outcome. Instead, many are now embracing a value-based approach that holds healthcare providers accountable for both the cost and quality of care delivered. Carrum Health's expansion is indicative of this pivotal shift, as companies look for smarter healthcare solutions to manage escalating expenses effectively.

Rising Healthcare Costs

Healthcare costs continue to rise at unprecedented rates. Specialty care has been a driving force behind these increases, making up over half of all U.S. healthcare expenditures. According to reports, employers have consistently underestimated these costs; while they expected a 6.8% increase in 2025, they actually faced an 8.8% hike. Projections suggest that without significant changes, costs could climb by 9.2% or even higher in 2027.

This environment of skyrocketing costs is compounded by a surge in arbitration payouts related to out-of-network bills, which have reached nearly $15 billion and exceed what similar care costs under in-network pricing. With upcoming cuts to Medicare and the expiration of certain Affordable Care Act subsidies, hospitals are shifting the burden onto employer plans, exacerbating the challenges companies face.

Why Employers Choose Carrum Health

Facing this threefold squeeze—unpredictable cost increases, surging arbitration payouts, and rising employer liability—many businesses are turning to Carrum Health. With over 70 Fortune 500 companies currently utilizing their services, Carrum's approach provides a framework to manage these issues proactively.

Key Reasons for Carrum’s Success:
1. Network Expansion: Carrum's Centers of Excellence (COE) network has expanded to over 1,550 locations. This network not only meets the demand for various specialties, including musculoskeletal procedures, cancer care, and gastroenterology, but also maintains rigorous quality control standards.
2. Integrated Offering: Carrum partners with over 25 organizations, including major health plans and telehealth services, to bolster access for employers. This model allows them to integrate seamlessly into existing healthcare benefits, providing extensive access to multiple channels for care.
3. Financial Protection Against Unexpected Costs: The company’s all-inclusive pricing model for surgical episodes offers predictability and shields employers from the financial shocks synonymous with traditional models. Unlike typical COEs that may leave plans vulnerable to additional out-of-pocket expenses, Carrum ensures comprehensive pricing coverages, including for associated anesthesiology and radiology costs.

Real Support for Members

Around half of Carrum's clients require its services for specific procedures. The feedback from beneficiaries reflects satisfaction, with high Net Promoter Scores indicating that members value the support and resources provided. Depending on their plans, members may face minimal to no out-of-pocket costs for critical surgical or therapeutic episodes.

Support includes navigational assistance from oncology nurses, licensed counselors for mental health, and care coordinators who facilitate access to COEs. This level of service is particularly vital, as cancer has become the top healthcare expense for most employers.

About Carrum Health

Carrum Health is on a mission to reshape how specialty care is delivered and paid for. By offering self-insured employers a value-based solution that connects them with a carefully vetted network of specialists, Carrum enhances both the experience and outcomes for its members. Its unique pricing structure and technological innovations not only lower expenses but also have been shown to substantially reduce unnecessary procedures by as much as 30% and readmissions by 80%. Through these efforts, they strive to create a sustainable future for healthcare in America.