Carrum Health launched a substance use disorder treatment program for employers a year ago and has now expanded it to include cannabis, cocaine and methamphetamine as employer demand surges.
It's estimated that 29 million U.S. employees—1 in 6 working adults—are struggling with substance use disorder. Approximately 6.5% of full-time U.S. employees met the criteria for a cannabis use disorder in a 2021-22 study. Another study found that workplace cannabis consumption was highest among workers in states with "recreational" cannabis laws.
This poses a major health challenge for employers, and there's a critical unmet need for cost-effective prevention and treatment strategies.
Carrum, a company that established value-based Centers of Excellence for employers, now offers members access to value-based bundled treatment for nearly all substances to include cannabis, sedatives and stimulants—including cocaine, methamphetamine and misused ADHD medications—in addition to alcohol and opioid use.
Since launching the value-based substance use disorder treatment model a year ago, Carrum has seen employer adoption rapidly grow from one Fortune 50 retail pilot partner in 2023 to more than 100 clients. The continued increase in demand has been fueled by rising substance use rates and growing recognition that most treatment expenses occur out-of-network.
Treating substance use disorders costs employer-sponsored insurance $35.3 billion a year, with alcohol and opioid misuse topping the list of what many working-age people struggle with, according to a study by researchers with the Centers for Disease Control and Prevention. These costs most likely grow significantly when factoring in residual effects such as presenteeism, absenteeism and job retention, according to the JAMA Network Open study.
There is a high relapse rate among individuals in substance use treatment, estimated to be 40% to 60%, per the National Institute of Drug Abuse. This adds up to lost productivity and ballooning costs for employers.
The landscape also has changed as more states legalize cannabis for medical and recreational use, making it more accessible. More than 15,000 cannabis dispensaries now operate across 41 states. About 8 in 10 Americans (79%) live in a county with at least one cannabis dispensary, according to the Pew Research Center. Cannabis potency also has strengthened over time, with cannabis flower and concentrates in dispensaries having THC (tetrahydrocannabinol) concentrations of more than 40%, one study found.
Carrum initially launched the program for alcohol and opioid misuse a year ago as that represents 70% to 75% of the employees who come forward for treatment, Christoph Dankert, Carrum’s chief network officer, told Fierce Healthcare. The company spent the past year fine-tuning its opioid and alcohol use program, but there were unmet needs for employees who have additional substance use disorders or require treatment beyond alcohol and opioids.
"Members started coming to us for cannabis, cocaine and other substances, and we realized we didn’t have an option for them that met Carrum’s high standards for care, and that didn’t sit right,” Dankert said. “So we did what we’ve always done: We listened to our employer partners’ needs, and we built a solution to address them using our considerable experience and proven model."
"In substance use, I tell the front-line team, you have one chance. Somebody makes a decision, it's time to make a change, and then they make a phone call to us, and the goal for that phone call is it ends with them talking to the provider for intake," Dankert said.
The company offers employers and their members access to top quality treatment centers nationwide with significant cost savings over traditional insurance—and zero out-of-pocket costs for employees.
Starting in 2023, Carrum piloted alcohol and opioid use treatment with a Fortune 50 retailer, which faced dual challenges: escalating out-of-network costs and concerns about treatment effectiveness for employees. The pilot's success, demonstrating both clinical outcomes and cost savings, provided the foundation for national expansion.
Within the first year, Carrum’s model demonstrated its effectiveness by reducing readmission rates to half of the industry average.
Fortune 50, 100 and 500 employers in retail, manufacturing, transportation and safety-sensitive industries are leading adoption, driven by workforce productivity concerns and the need for an accountable, high-quality treatment network, the company said.
"We have employers that work in safety-sensitive professions like transportations, airlines and law enforcement, and, for them, this is a big deal. It's heavily regulated. They need to get a handle on this," Dankert said.
Over the past 11 years, Carrum Health developed a service that enables employers to purchase healthcare services and specialist medical care directly from top providers for a bundled price. Utilizing a Centers of Excellence network, with an all-inclusive pricing model and 30-day warranty on surgery and two years on cancer care, Carrum members receive surgical and cancer treatment guidance and coordination through the entire care journey with upfront pricing, according to the company.
The company applied that same approach to develop a substance use treatment model using transparent, pre-negotiated, bundled payments. This approach makes employer costs predictably lower, eliminates predatory or out-of-network pricing and requires providers to take on risk for patient outcomes, which aligns incentives to reduce relapses and readmissions, executives said.
The company used the frameworks for its opioid and alcohol programs to build out cannabis, stimulant and sedative treatment bundles. Carrum's approach maximizes the outcomes that matter, namely, sobriety or reduction in problematic use, instead of just discharging patients as quickly as possible for the lowest cost per day.
Carrum’s nationwide network includes rigorously vetted Centers of Excellence such as Hazelden Betty Ford, Recovery Centers of America and The Meadows Behavioral Healthcare, evaluated for evidence-based treatments, readmission rates, sustained sobriety and continuity of support.
When a member seeks help, a licensed counselor conducts a confidential intake and connects them to the appropriate provider within one day. Each patient is matched to their needed level of care, whether it’s inpatient detox, residential treatment, intensive outpatient or partial hospitalization, following American Society of Addiction Medicine guidelines.
Carrum executives assert the company brings the provider accountability it pioneered for cancer care (30% savings) and the bundled payment approach proven in surgery (45% savings) to addiction treatment. The company reports up to 45% cost savings through fewer readmissions and appropriate care levels, addressing the arbitrary pricing and relapse cycles that have plagued the industry for decades.
The company's treatment model has demonstrated reduced readmission rates, Dankert noted. "It's a function of picking the centers that have demonstrated good outcomes, but the providers also have an incentive. If a patient has to come back, it stings financially for the provider."
The company's treatment bundle also help employers tackle rising out-of-network medical costs. Behavioral health leads all specialties in out-of-network spending at 25% to 30%, according to the company. Within that category, substance use treatment facilities have seen costs surge up to 40% out-of-network—the steepest increase in any healthcare segment, according to a Harvard Medical School study published in Health Affairs. This aligns with employer experience: 73% report increased utilization, and 90% expect further demand growth, according to Business Group on Health’s 2026 annual employer healthcare survey.
Carrum is expanding its services as employers are increasingly seeking solutions to curb high healthcare spending. The company has doubled its covered lives to 6.7 million. In 2025 alone, Carrum added 3.6 million new lives to its value-based Centers of Excellence model for specialty care.
More than half of the new employers partnering with Carrum require members to engage with Carrum to receive coverage for select services, executives said.
“Employers are beyond the breaking point,” said Sach Jain, founder and CEO of Carrum. “They’ve tried incremental fixes for years while costs kept climbing. What we’re seeing now is a decisive pivot to models that fundamentally change how specialty care is delivered and paid for. This isn’t theory anymore—it’s market reality. Employers are voting with their benefits dollars, and they’re choosing value-based care models that tackle root causes.”