Carrum Health Doubles Covered Lives to 6.7M, Reflecting Shift to Value-Based Specialty Care Models

Strategic Insights -

As employers grapple with a perfect storm of soaring healthcare costs, soaring drug costs, and looming Medicaid budget cuts, Carrum Health has emerged as a leader in value-based Centers of Excellence (COE). The company has doubled its covered lives to 6.7 million, adding 3.6 million new lives in 2025 alone. This unprecedented growth underscores the growing demand for value-based specialty care models that focus on tackling root causes and delivering exceptional member experiences.

Key Takeaways:

  • Carrum Health has doubled its covered lives to 6.7 million, with 3.6 million new lives added in 2025 alone, reflecting a fundamental market shift to value-based specialty care models.
  • Employers are facing a perfect storm of soaring healthcare costs, soaring drug costs, and looming Medicaid budget cuts, with a projected 9-9.5% increase in 2026.
  • Specialty care represents nearly half of employer medical spend, with cancer care accounting for up to 16% of the spend.
  • Industry reports confirm widespread adoption of the COE model as employers' most effective cost-containment strategy, with 73% of employers planning to have COE programs in place by 2028.
  • Carrum Health's innovative value-based cancer care program delivers up to 30% in savings, and its substance use treatment model has shown dramatic cost reductions.
  • The company's growth reflects a fundamental reset in expectations, with employers demanding accountability for results, transparency in pricing, and providers who share risk instead of shifting it.
  • Over 50% of new employers partnering with Carrum require members to engage with the company to receive coverage for select services, highlighting the importance of high-quality, value-based networks.

Statistics:

  • 6.7 million covered lives (up from 0.8 million in 2022)
  • $0.36B in new lives added in 2025 alone
  • 9-9.5% projected increase in healthcare costs in 2026
  • 73% of employers plan to have COE programs in place by 2028
  • 53% of new employers require members to engage with Carrum to receive coverage for select services
  • 80 NPS score (consistently high NPS score)
  • 90 NPS score (voluntary clients)

Sources:

  • Business Group on Health (BGH), Mercer, WTW, Aon, Segal
  • Harvard Medical School study, Health Affairs
  • Carrum Health press release (April 2023)
  • Carrum Health website (carumhealth.com)