Taps Carrum Health of Tennessee Carrum Health for Network Excellence

Carrum announced Thursday that Tennessee has selected Carrum Health as its professional care center for its outstanding solutions. The company announced a massive expansion last week, putting 90% of Americans within 50 miles of the Carrum Center of Excellence.

By working with Tennessee, Carrum Health’s services are now available to all employees covered by the National Health Program. Its Center for Excellence connects employers members to a network of professional care providers reviewed, including musculoskeletal care, cardiac care, cancer care and medication use treatment.

Carrum uses an upfront, bundled payment model in which the provider provides a one-time payment for all services of the CARE episode. This provides a provider for each service and program payment in this model compared to the payment service model. Bundled payments are a value-based form of care, as providers receive rewards for providing efficient and high-quality care, but they must bear the loss if the cost exceeds the target price.

Sach Jain, founder and CEO of Carrum Health, said Tennessee has reviewed Carrum over the past nine to 12 months because it “focused on quality, value-based payment contracts with providers and local coverage,” so it chose the company. A RAND study of Carrum Health found that the company reduced costs per surgery by 45%, reduced readmissions by 80%, and reduced procedures by 30%.

Through this partnership, Karum's public sector footprint has now exceeded one million. Since 2019, the company has been working with Maine and Nevada since 2023.

Carrum Health also announced last week that it has expanded its network to more than 1,000 locations, which puts 90% of Americans within 50 miles of the Carrum location. It also expands its specialized care products including gastroenterology, general surgery, gynecology, pain management, urology, as well as ear, nose and throat surgery.

With the expansion of professional care products, Karum now accounts for 40% of employers’ medical expenses. This is a time when employers’ health care costs surge: health care costs are expected to increase by 8% this year. Professional care represents half of employers’ health care spending.

However, this kind of expansion would not occur without the challenge. The company must learn how to adopt its initial service line (musculoskeletal, cardiovascular, weight loss) model and adapt it to the new service line.

“Moving and taking the same model and applying it to cancer care or drug use disorders is not easy, because in our initial service line, the provider will provide us with a readmission warranty of about 30 days,” Jain said in an interview. “This is not effective for cancer because the length of this episode is years, not just weeks or months.

“As employers demand a broader solution, we have to roll up our sleeves and figure out a model that will deliver on one hand delivers our commitment to keep providers accountable for the cost of services and the quality of care they provide for these specialties, but can also be accepted by providers but also with the value and work we see.” He continued. ”

According to Chief Network Officer Christoph Dankert, the company has built the center of this network of excellence based on a four-part framework called Care:

• Top 10% of planning: The company evaluates providers based on 55 metrics to ensure contracts with only the top 10% of providers. For example, when watching the surgery, the company evaluates how many surgeries the provider has performed and how often the patients have complications.
• Suitability: Carrum motivates providers to focus on the care that is best suited to patients rather than the most profitable.
• Adventure Provider: The company connects payments to results, incentivizing providers to provide the highest quality of care.
• End-to-end transparency: Employers receive information about the Carrum provider network and price them in advance so they know what they are paying.

“If you are a current customer, there is a spreadsheet, all these locations, all prices and everything is transparent in advance,” Dankert said in an interview. “As an employer who pays for all these care, you know exactly which providers people are going to go to, you know exactly what to pay in advance.”

Going forward, Carrum aims to continue to expand its network, including pregnancy care. Ultimately, it expects 95% of Americans to be close to the Karum location.

“There is still a large portion of the market that has not yet adopted COE solutions and we want to ensure that we propose solutions for these employers in the coming years,” Jain said. “But at the same time, besides self-sufficiency employers, there are other buyers facing similar challenges in cost, quality and membership experience, whether it’s a full-insured health plan or a Medicare Advantage plan, to name just a few. We want to propose solutions for all these different stakeholders.”

Other specialized care companies include lanterns and perspectives.

Photo: natali_mis, Getty Images