Unprecedented Growth: 6.7M Members Now Access Value-Based Centers of Excellence Model

As healthcare costs continue to surge at the fastest rate in 15 years, with a projected 9-9.5% increase in 2026, employers are facing a perfect storm of growing expenses. In response, companies like Carrum Health are witnessing unprecedented growth in their value-based Centers of Excellence (COE) model, with 6.7 million members now having access to the solution. This growth reflects a fundamental market shift as employers pivot towards models that fundamentally change how specialty care is delivered and paid for.

Key Takeaways:

• Carrum Health has doubled its covered lives to 6.7 million, adding 3.6 million new lives in 2025 alone, which is a testament to the growing demand for value-based care models.
• The triple threat of healthcare costs includes surging costs at 9-9.5% in 2026, soaring drug costs driven by GLP-1 weight loss drugs and cancer therapies, and looming Medicaid budget cuts that will shift costs to the commercial market.
• Specialty care represents nearly half of employer medical spend, with cancer care alone accounting for up to 16% of the spend.
• Employers are losing patience, with 84% of them having adopted COEs for one or more high-cost specialty care needs, and 73% expecting to have them in place by 2028.
• Adoption of non-carrier COE models is surging, with 73% of employers turning to direct specialty care partnerships to augment their underlying health plans.
• Carrum Health's value-based COE model has expanded to cover expensive conditions previously outside the scope of value-based care, including substance use treatment facilities, which have seen costs surge from 10% to 40% out-of-network.
• Employer experience confirms increased utilization in substance use treatment facilities, with 85% reporting increased demand for services (Business Group on Health).

Statistics:

• 6.7 million members now have access to Carrum Health's value-based COE model.
• 3.6 million new lives were added in 2025 alone, a doubling of the company's covered lives.
• Specialty care represents nearly half of employer medical spend, with cancer care alone accounting for up to 16% of the spend.
• 84% of employers have adopted COEs for one or more high-cost specialty care needs.
• 73% of employers expect to have COEs in place by 2028.
• 73% of employers are turning to direct specialty care partnerships to augment their underlying health plans.

Sources:

• Business Group on Health (BGH)
• Mercer
• WTW
• Aon
• Segal
• Carrum Health