Carum Health pitches broader cancer and substance‑use coverage, offers COE surgery network and travel support

Carum Health presented to the board on May 21 and proposed expanding services available to PEBB members beyond the existing bundled surgical and limited oncology offerings.

Alex Brochu described Carum’s center‑of‑excellence model: pre‑negotiated bundles for surgical episodes, local patient navigators, and 30‑day warranty coverage for complications. Carum reported low complication rates among members served to date and high satisfaction scores from patients who used the network.

Carum asked the board to consider two expansions: 1) broader oncology coverage that would allow pay‑for‑performance (P4P) contracts to include chemotherapy and radiation for more cancer types (not limited to initial diagnosis), and 2) a value‑based substance‑use disorder benefit providing coordinated detox, inpatient rehabilitation and longitudinal supports. Carum emphasized wraparound services (nutrition, behavioral health, caregiver support) and said negotiated bundled pricing and warranties would apply in the new lines.

Carum also described logistics for members who must travel to centers of excellence: travel stipends, hotel and meal allowances, and clinical follow‑up coordination. The company said 91% of PEBB members live within 50 miles of a Carum COE for the targeted procedures, and staff recommended considering a focused “preferred provider” model for select procedure lines to increase capture of elective surgeries into the bundled network.

What happens next: Carum and staff will return with expanded network details, proposed plan‑design options (including an exception process and potential mandatory‑preferred approach for a small set of procedures), and projected savings based on PEBB claims experience.