Healthcare costs continue to rise, driven by chronic conditions, specialty therapies, and a system that too often works in silos. Many employers and plan sponsors adopt a pharmacy carve-out strategy in an effort to strengthen cost management. But when pharmacy and medical benefits operate separately, care becomes fragmented, opportunities to intervene are missed, and total cost of care can climb.
Data shows how connected care offers a stronger solution — an integrated model to support more effective management across the full spectrum of care. Pharmacy and medical integration brings together clinical data, advanced analytics, and evidence-based formulary strategies, so employers can move beyond short-term pharmacy savings toward sustainable healthcare savings, improved outcomes, and better member experiences.
The impact is measurable. In a multi-year analysis of a large commercial population1 (40,000 members with three years of continuous enrollment and matched populations), connected care delivered:
- $38 PMPM lower total medical cost
- 31% fewer inpatient admissions
- 16% fewer ER visits
Cost management goes beyond pharmacy savings
Connected care also reduced costs across chronic conditions that often drive long-term spend and productivity loss — including diabetes, hypertension, and obesity — translating to approximately $75 million less in monthly medical costs across the integrated population.
Why the difference? Integration activates three mechanisms that are harder to achieve in a carve-out environment, each reinforcing the others through a continuous loop:
- Member engagement turns data into action through proactive outreach.
- Value-based care aligns incentives across medical and pharmacy.
- Whole-person health support improves the member experience through more timely, personalized advocacy.
For employers, connected care means clearer oversight, better care coordination, and more predictable cost trends. For members, integration can simplify healthcare navigation, strengthen medication adherence, and reduce avoidable high-cost events.
Download the white paper to see the full results and explore how CarelonRx can help you evaluate your approach to enable more coordinated care, improved outcomes, and lower total cost of care.
1 CarelonRx Value of Integration Study, commercial book of business (Fl+ASO), 2024.
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