Sach Jain, founder and CEO of Carrum Health, is leading a platform that helps self-insured companies save on medical procedures by connecting them with high-quality specialists at reduced costs. Recently, the company expanded its substance use treatment offerings from opioid and alcohol use to a wide range of other drugs, including cannabis, cocaine, and methamphetamine.
The Centers of Excellence Model
Carrum Health has built its reputation on a “centers of excellence” model, which offers self-insured employers access to high-quality medical specialists in fields such as musculoskeletal care, cardiology, and oncology at lower cost. The approach negotiates discounts with providers through research-identified best-in-class medical facilities and doctors. Unlike traditional health maintenance organizations, which require primary care doctors to address symptoms before referring to specialists, Carrum takes a different approach by negotiating high-quality care at lower prices.
Jain, who moved to San Diego with his family in 2023, has a background in computer science from the Indian Institute of Technology in Delhi and earned an MBA from the University of Chicago Booth School of Business. Before founding Carrum, he worked in hospital revenue cycle management. “Not growing up in the U.S., I was just shocked at the level of abuse, the level of just, you know, singlemindedness on how to maximize the reimbursement as opposed to thinking about how to make sure a patient has a good outcome,” Jain said.
Quality-First Approach
Carrum’s approach begins with finding doctors who only perform procedures when necessary and achieve best-in-class outcomes. The company analyzes terabytes of clinical and claims data, starting with public Medicare data to identify providers demonstrating good quality work. Once identified, the company conducts site visits and interviews. Notably, top-tier doctors and health systems work with Carrum at risk, meaning if anything goes wrong with a procedure, they cover costs free of charge. Carrum also asks them to offer prices at which employers realize significant savings—usually about half of standard costs.
For substance use disorder treatment, Carrum shifted from fee-for-service payment to paying for entire treatment episodes, penalizing providers if patients relapse. “The reality is that roughly one out of six Americans has a substance use disorder,” Jain said. “Employers cannot afford to just leave such a large part of their workforce by the side of the road.”
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://us.headtopics.com/news/meet-sach-jain-the-entrepreneur-revolutionizing-american-80767497