Carrum Health Doubles Covered Lives as Employers Confront Record Healthcare Costs

Cost crisis fuels unprecedented growth: 6.7M members now have access to Carrum's value-based Centers of Excellence model for specialty care

SAN FRANCISCO, Oct. 15, 2025 /PRNewswire/ -- Carrum Health, the leader in value-based Centers of Excellence (COE), today announced it has doubled its covered lives to 6.7M, adding 3.6M new lives in 2025 alone. The unprecedented growth reflects a fundamental market shift as employers face a perfect storm of healthcare costs.

The triple threat:

• Healthcare costs are surging at the fastest rate in 15 years, with a projected 9-9.5% increase in 2026 {Business Group on Health (BGH), Mercer, WTW, Aon, Segal}, following an estimated 8% growth in 2025
• Soaring drug costs driven by GLP-1 weight loss drugs and cancer therapies
• Looming Medicaid budget cuts that will further shift costs to the commercial market

With the need to curb healthcare spending quickly, employers are focusing on where the biggest dollars go. Specialty care represents nearly half of employer medical spend, with cancer care alone accounting for up to 16% of the spend.

"Employers are beyond the breaking point," said Sach Jain, Founder & CEO of Carrum Health. "They've tried incremental fixes for years while costs kept climbing. What we're seeing now is a decisive pivot to models that fundamentally change how specialty care is delivered and paid for. This isn't theory anymore — it's market reality. Employers are voting with their benefits dollars, and they're choosing value-based care models that tackle root causes."

High-cost areas requiring urgent action

Against this backdrop, industry reports confirm widespread adoption of the COE model as employers' most effective cost-containment strategy. Recent employer surveys reveal the scale of the shift to Centers of Excellence:

• Half of employers now offer COE programs for cancer care, a top cost driver, and 73% will have them in place by 2028
• The majority of employers (84%) have adopted COEs for one or more high-cost specialty care needs
• Adoption of non-carrier COE models is surging as employers turn to direct specialty care partnerships to augment their underlying health plans

Carrum Health in particular is witnessing dramatic growth because it is the only true value-based COE model and it has expanded its innovative approach to cover expensive conditions previously outside the scope of value-based care. Building on its long expertise with bundled payments and provider accountability for surgeries (where it delivers 45% savings), in 2021, the company launched the commercial market's first value-based cancer care program, where treatment complexity and cost variability are highest. Its solution includes the cost of comprehensive treatment, from expensive cancer drugs and advanced therapies to excision surgeries, and delivers up to 30% in savings.

Carrum built on this experience with a pioneering treatment model for substance use,  applying its value-based care learnings and insights to another high-cost, high-variation specialty where employers sought help. 

Behavioral health leads all specialties in out-of-network spending at 25-30%. Within that category, substance use treatment facilities have seen costs surge from 10% to 40% out-of-network, the steepest increase in any healthcare segment (Harvard Medical School study, Health Affairs). This aligns with employer experience: 73% report increased utilization, and 90% expect further demand (Business Group on Health).

"For too long, specialty care operated without meaningful accountability. The traditional fee-for-service PPO system told employers to accept opaque pricing and inconsistent outcomes as the cost of doing business," Jain said. "That chapter is coming to a close. We're seeing employers demand what should have been standard from the beginning: accountability for results, transparency in pricing, and providers who share risk instead of shifting it. Our growth reflects that fundamental reset in expectations."

Validation: Employers, health plans and partnerships

More than half of the new employers partnering with Carrum require members to engage with Carrum to receive coverage for select services. Savvy benefits leaders have recognized the most sustainable way to reduce costs is to steer members to a high-quality, value-based network where providers are accountable for cost and outcomes. This prevents unnecessary procedures, removes surprise bills and prior-authorization friction, and lowers unit costs, while delivering exceptional member experiences reflected in a consistently high NPS score of 80 (and an NPS of 90 for voluntary clients).

Carrum is proud to serve industry-leading, progressive employers across multiple sectors who share our vision for high-quality, value-based care at lower prices, including:

• Leading private sector employers across defense, financial services, food services, manufacturing, retail, tech, transportation etc, including many Fortune 10 and Fortune 50 employers
• Large public sector clients including several state governments

The company's proven results have led five national and multi-state health plans to formally integrate Carrum's solution into their offerings, with more partnerships underway. This trend reflects Carrum's transition from an alternative solution to a mainstream model that is reshaping how specialty care is purchased and delivered across the U.S.

Carrum has also been selected as the sole COE partner for 11 ecosystem partners that are leaders in their respective categories, such as behavioral health, oncology, virtual care, imaging, PBM and care navigation, among other areas.

About Carrum Health

Carrum Health's mission is to change how we pay for and deliver specialty care. We offer self-insured employers and plan sponsors a value-based Centers of Excellence (COE) solution that connects their members with a rigorously vetted network of specialty care providers. Carrum's upfront, all-inclusive bundled pricing, award-winning technology, and dedicated care navigation team help lower costs for both members and employers while delivering a superior member experience. Carrum is independently validated to reduce unnecessary procedures by as much as 30%, lower readmissions by 80%, and save employers up to 45% per episode of surgical care. Learn more at carrumhealth.com.

SOURCE Carrum Health