In a strategic move designed to address the escalating costs of complex medical treatments, Included Health has announced a formal partnership with Carrum Health to integrate high-value specialty care into its alternative health plan offerings. This collaboration aims to create a seamless continuum of care by bridging the gap between primary care navigation and specialized surgical or oncological interventions. By embedding Carrum Health’s Centers of Excellence (COE) network into its ecosystem, Included Health seeks to provide its employer clients with a more sustainable model for managing high-cost medical claims while ensuring superior clinical outcomes for members.
The partnership represents a significant evolution in the digital health landscape, where the focus is shifting from standalone "point solutions" to integrated platforms that manage the entire patient journey. Under the terms of the agreement, Included Health will utilize its advanced data analytics and primary care infrastructure to identify members in need of specialized care—ranging from orthopedic surgeries and cardiac procedures to cancer treatment and substance use disorder support—and direct them toward Carrum’s curated network of high-performing providers.
Addressing the Crisis of Rising Healthcare Expenditures
The collaboration comes at a critical juncture for American employers, who are currently grappling with the steepest rise in healthcare costs in over a decade. According to industry data from Aon and Willis Towers Watson, employer-sponsored healthcare costs are projected to increase by 6% to 8% in 2024 and 2025. A primary driver of this trend is specialty care, which accounts for approximately 50% of total employer healthcare spending despite representing a small fraction of total claims.
Traditional fee-for-service models often incentivize volume over value, leading to unnecessary procedures, high complication rates, and fragmented post-operative care. By contrast, value-based models like those championed by Carrum Health utilize bundled payment arrangements. These arrangements provide a single, transparent price for an entire episode of care, covering everything from the initial consultation to the procedure and any related follow-up care or complications. This model shifts the financial risk from the employer to the provider, incentivizing the latter to prioritize quality and efficiency.
Matthew Eurey, Chief Commercial Officer at Carrum Health, highlighted the necessity of this integration, noting that patients often feel overwhelmed when faced with a serious diagnosis or the need for surgery. "What we see is that oftentimes, individuals, when they are touching the healthcare system, they just don’t know what to do," Eurey stated. He emphasized that while Included Health has built a robust solution for navigation, the addition of Carrum’s specialty care outlet provides the necessary support during "life’s trickiest moments," effectively bending the cost curve for employers.
The Mechanics of an Integrated Care Model
The operational core of this partnership lies in the "referral loop" created between the two organizations. Included Health serves as the digital front door for members, offering 24/7 support for clinical and administrative needs, virtual primary care, and care coordination. When a member engages with Included Health—whether through a routine primary care visit, an inquiry on the mobile app, or via automated triggers in claims data—the platform’s algorithms identify if a specialty intervention is warranted.
Once a need is identified, the member is seamlessly referred to Carrum Health’s Centers of Excellence. These centers are comprised of top-tier hospitals and surgical groups that have been rigorously vetted for clinical quality, lower-than-average complication rates, and adherence to evidence-based protocols. After the specialized treatment is completed, the member is transitioned back to Included Health’s care coordinators and primary care teams. This ensures that post-operative recovery, medication adherence, and long-term wellness are managed within a single, cohesive framework, preventing the "leakage" and fragmentation that typically drive up costs in traditional insurance models.
Dr. Ami Parekh, Chief Health Officer at Included Health, underscored the importance of this closed-loop system. She noted that the selection of Carrum Health was driven by their proven ability to deliver high-quality outcomes through a value-based framework. "We want to make sure that we’re bringing the best healthcare to our clients… making sure that we are bringing them partners who can both continue to increase that quality and those outcomes, but also really help on that total cost of care piece," Parekh said.
A Timeline of Strategic Expansion
This partnership is the latest in a series of aggressive moves by Included Health to redefine the employer-sponsored insurance market. The company was formed in 2021 through the high-profile merger of Grand Rounds, a leader in healthcare navigation and expert medical opinions, and Doctor On Demand, a pioneer in virtual urgent care and behavioral health. Since the merger, Included Health has worked to consolidate its disparate services into a unified "all-in-one" health platform.
In February 2024, Included Health officially launched its "alternative health plan." Unlike traditional PPO or HMO plans that often prioritize broad networks over cost transparency, this alternative plan is built around a primary-care-first model. It offers upfront cost predictability and a heavy emphasis on proactive health management.
Further accelerating this strategy, Included Health announced in July 2024 its intent to acquire Firefly Health. Firefly Health is known for its virtual-first primary care model and its own innovative health plan offerings for small and mid-sized employers. The acquisition of Firefly Health, combined with the Carrum Health partnership, positions Included Health as a formidable challenger to traditional "Big Five" insurers by offering a vertically integrated care delivery and navigation system.
Measuring Success through Data and Outcomes
The success of the Included Health and Carrum Health integration will be scrutinized through several key performance indicators. Dr. Parekh noted that the companies would be tracking patient engagement levels, clinical outcomes (such as readmission rates and recovery times), and the overall impact on the total cost of specialty care.
For employers, the "total cost of care" metric is paramount. In many cases, Carrum’s bundled payment model can save employers between 25% and 45% per procedure compared to traditional commercial insurance rates. When these savings are scaled across a large workforce, the financial impact is substantial. Furthermore, by ensuring that employees receive the right care the first time, employers see a secondary benefit in reduced absenteeism and higher productivity.
The partnership also addresses the issue of "point solution fatigue." Human Resources departments have historically been forced to manage dozens of individual contracts for different health needs—one for mental health, one for MSK, one for diabetes, and another for navigation. By embedding Carrum Health directly into the Included Health plan, the administrative burden on employers is significantly reduced, providing a single point of accountability for both primary and specialty care.
Broader Implications for the Healthcare Industry
The collaboration between Included Health and Carrum Health is indicative of a broader trend toward "platformization" in healthcare. As the industry moves away from the fragmented, fee-for-service architecture of the past, the winners are likely to be those who can provide a comprehensive, data-driven experience that follows the patient across the entire clinical spectrum.
Industry analysts suggest that this partnership may force traditional health insurers to accelerate their own value-based care initiatives. For years, major carriers have struggled to implement true bundled payments at scale due to legacy billing systems and entrenched provider relationships. Agile, tech-forward companies like Included Health and Carrum Health are demonstrating that it is possible to bypass these hurdles by building new networks from the ground up.
As the partnership rolls out, it is expected to set a new benchmark for how specialty care is delivered to large populations. "We think really highly of Carrum and what they built," Dr. Parekh concluded. "It is the start of bringing higher quality, more efficient specialty care to large populations… raising the standard of healthcare for everyone."
By focusing on high-acuity needs such as oncology and complex surgery—areas that have traditionally been the most difficult to manage in terms of both cost and quality—Included Health and Carrum Health are tackling the most significant pain points in the American healthcare system. If successful, this model could serve as a blueprint for the next generation of health benefits, where technology and value-based clinical excellence converge to create a more sustainable and patient-centric future.
