The first digital health company connecting employers to Centers of Excellence through a technology-powered platform for better, more cost-effective healthcare
The cost of healthcare in the US is rising at an alarming rate, and does not equate to better outcomes. Healthcare delivery and the payment structure is far too complex to expect price transparency initiatives or solutions that make care ‘shoppable’ for the patient to solve the cost equation. The economics of care must be restructured and incentives for patients and providers aligned. Carrum Health is on a mission to change how care is delivered and paid for to make high-quality healthcare more affordable and simpler to access for all. Carrum was founded in 2014 by former Booz consultants who helped large health plans adapt to health reform and roll out value-based care. They wanted to make the same Centers of Excellence (COE) and bundled payments model that large employers like Walmart were rolling out to their employees more accessible to all companies, and improve on the offering through economies of scale. The marketplace model was born. Carrum’s founders brought on a technology team as well as advisors like Sally Welborn (Walmart) and Dr. Dena Bravata (Lyra Health), and they began working with doctors at the leading hospitals to determine how to best measure a COE in a scalable way and roll out. Today, the Carrum benefit is nationally available across the US. For patients, using Carrum’s COE digital platform eliminates the complexities of co-pays, deductibles and coinsurance, with any travel costs fully covered, while ensuring that patients get exceptional care, leading to better outcomes, at a lower, predictable cost.
Carrum developed the first digital bundled healthcare marketplace and companion mobile app for patients. We've defined a new, simpler way to plan and pay for healthcare, improving the experience for everyone involved. We design surgical and other medical care bundles that package all of the services a patient needs for surgery--preoperative consultations, imaging, anesthesiology, the procedure, rehab. The bundle is one upfront payment, avoiding the complications and confusion that comes from traditional insurance and the outdated fee-for-service model. Then we negotiate directly with the top 10% of providers to contract with them for surgical services. The Carrum model incentivizes providers to deliver value-based care by connecting them directly to self-insured employers who are seeking higher quality, cost-effective care for their employees. According to the Health Care Cost Institute, as much as 49% of employers’ health spending goes towards paying for surgeries, yet digital health vendors have historically focused on chronic and primary care, overlooking surgical spend. Carrum is the first to tackle the complexities of bundling surgical services across MSK, bariatrics, cardiac, and oncology. At the heart of the platform is a layer of AI-powered analytics that integrates data from numerous sources, including claims, to monitor cost and quality and insights that identify members most at-risk of needing surgery. The platform is connected to the Carrum mobile app, which provides members with the power to manage their own health by guiding them through all aspects of their care journey. Members receive the best care with little to no out-of-pocket costs.
What we call ‘first generation’ COE solutions, like those developed by Walmart, require patients to travel long-distances and lack the negotiating muscle to drive down costs, which limits scale. Surgical care is complex, and that’s why no other vendor has touched it, but Carrum spent the last decade fine tuning the platform and proved the value. We use a proprietary 50-point+ evaluation process of both the provider and the surgeon, ensuring we partner with only the top 10% of providers. We monitor quality outcomes for all of our COEs, and as the RAND study in Health Affairs found, our COEs deliver 80% lower readmission and complications versus all providers. Providers recognize they’re in an elite position, that’s why they’re willing to take on the risk and offer a 30-day warranty on care. Our platform delivers significant financial impact - roughly half of self-insured employers' medical spend is driven by 5% of members for planned surgeries. Carrum reduces this spend by nearly half through avoiding a quarter of unnecessary surgeries and reducing unit cost by a third for surgeries that occur. We achieve these results across 120+ surgical bundles for MSK, Bariatrics, Cardiac and Oncology. Direct bundled payment programs are traditionally built from scratch with over two dozen integration costs, costing over $1M with no standardization. Carrum uses standard definitions for a simpler payment layer and a 4-6 week implementation process. Our COE platform is easily configurable, enabling us to tailor the solution to meet the specific needs of the employee population.
Unlike competitive solutions, Carrum’s platform has third-party validation. In a first-of-its-kind study of bundled payments for commercially insured populations published in Health Affairs, RAND Corporation found more than 45% per procedure savings using Carrum’s platform and Carrum COEs avoided 30% of unnecessary surgeries. RAND study in Health Affairs (not paid): https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01488 Patient App (Android and iOS) and is used by over 90% of our patients and has an NPS score of 96. Case studies: Harvard Business School: https://www.hbs.edu/faculty/Pages/item.aspx?num=51867 Catalyst Reform Payment: https://www.catalyze.org/product/prospective-bp-santa-barbara/ Members: Janet, Avoided knee replacement “My home surgeon told me I was ready for a total knee replacement. Thankfully, through Carrum Health, Dr. Rosen at Scripps gave me a few simple exercises to help me put off my surgery for possibly many years.” Employee from Fidelia, bilateral knee replacement “I received the best care imaginable while saving thousands of dollars. With Carrum Health, you don’t have to worry about anything. It has changed my life.” Stacey, Hip replacement “I couldn’t be happier with the exceptional service, care, and results I received. The coordination of my surgical experience was effortless.” Employers: Joe Toniolo, Senior Director, Health & Welfare Plans, US Foods “Carrum’s easy solution made it possible to deploy Centers of Excellence to our nationally distributed workforce in just 5-6 weeks. “Carrum continuously seeks to deliver the most innovative and high-quality programs.” Thomas Pela, Director of Employee Health and Wellness, Quest Diagnostics “Carrum's soup-to-nuts solution allowed Quest to rapidly deploy a national Centers of Excellence program with minimal implementation effort.”
We're the only COE program with third-party, published data on cost savings for the employee and employer and the first to integrate a technology platform with a patient app that is already proven effective in the market. Now, with $51M funding, we’re accelerating our national footprint and expanding service lines.