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

Strategic Insights -

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