The concept of “centers of excellence” has been around for a few decades. Surely sending health plan members and self-insured employers’ employees to the best and most effective providers should improve health outcomes and save payers’ money? Sach Jain is CEO of Carrum which has been working on this problem, partnering with the best providers and aggregating that demand from employers…and putting it all on a state of the art platform. As you might suspect, it’s not as easy as it looks. Carrum raised $45m from Omers Ventures a few weeks back, on top of a decent raise from Tiger Global a couple of years back. So are they getting it right? Sach told Matthew Holt that they are for sure on their way….
Our Healthcare System Needs More Than Policy Overhaul: It’s Time for Private Sector Innovation to Kick into High Gear for Our Health’s Sake
By SACH JAIN
Last year I was heading to a meeting on a Fortune 500 business campus and stumbled upon a bake sale. It was odd to see someone selling cupcakes and breads on the grounds of a major corporation, so I inquired. As it turns out, Judy, an employee, was selling baked goods to finance her insurance deductible for spinal fusion surgery.
“Is this what our system has come to?” I asked myself, “Fundraisers for fusions?” If so, our health system is broken.
No matter how you slice it, Americans spend more on healthcare than any other advanced economy, with households responsible for 28% of that spend according to CMS. The Affordable Care Act (ACA) attempted to address long-standing deficiencies inherent in our fractured healthcare system. However, creating an insurance marketplace hasn’t solved the problem of affordability or the reality of limited access to quality providers. The concept is great, but without private sector buy-in it will never succeed.
President Biden is taking long-overdue steps to address some of the ACA’s shortcomings with Executive Orders. During his campaign, he suggested other actions, like capping marketplace premiums at 8.5% for all income levels with the goal of spurring enrollment and strengthening the ACA with an affordable public option. The recently passed $1.9 trillion stimulus package also incorporates an increase in government subsidies to health insurers for covering workers laid off due to COVID-19 and those purchasing their own coverage.
This is a start. But it’s not enough. We can’t afford to waste time waiting for policymakers to negotiate rules that may be overturned when a party majority flips.
Continue reading…One-Price, 30-Day Warranty, Payment at Discharge: Carrum Health’s CEO on Changing How We Buy Surgery
By JESSICA DaMASSA, WTF HEALTH
No copays. No coinsurance. No surprise out-of-network anesthesiologist fees or pre-op imaging bills. Just one, single price (that you see in advance) tells you EXACTLY what you’ll be paying for your surgical care on Carrum Health. Backed by the recent close of a $40M Series A funding round, the health tech startup’s CEO Sach Jain talks through all the ways his company is looking to disrupt how we buy surgical care. Standardized bundle pricing is just the beginning. Carrum requires its Centers of Excellence (and each of their docs) to pass a proprietary 50-point inspection before they can join the platform, AND every surgery must be backed by a 30-day Warranty! How have they convinced providers to jump through these kinds of hoops? With a growing client-base of self-insured employers (Sach says they have several Fortune 100 and Fortune 500 clients) and payment-in-full made to providers upon discharge, the case for additional revenue and zero A/R days is pretty compelling to a health system. And what about the other side of the business model? Tune in to find out why Sach believes Carrum Health’s “marketplace” approach will appeal to the growing base of “activist” employers whose HR benefits administrators are becoming more and more adept at building-their-own healthcare networks.
