Digging into employers’ cardiovascular costs

Heart conditions are a top cost driver for employer health plans, but you’d probably never know it by looking at any single claim.

That’s because cardiovascular costs don’t usually show up in one big bill. Instead, they add up across a lot of smaller claims that seem insignificant on their own. But when you review your claims report at renewal time, you’re surprised by an eye-popping total.

Cardiovascular costs are real, but they’re also hard to see coming. Let’s take a closer look at why these costs seem to hide in plain sight, why they’re so hard to predict even when you can see them, and what employers can do to get ahead of them.

Why your claims data undercounts cardiovascular spend

You might hear people refer to cardiovascular claims as “silent,” which means they don’t show up clearly as one big number on a report. They’re split across many smaller events and categories, making them harder to notice—and harder to attribute to their actual source.

Much of this spread is because most people with cardiovascular disease aren’t managing just one condition alone. In a study of over 223,000 patients with atherosclerotic cardiovascular disease, 98.5% had at least one other chronic condition. And 80.2% had five or more other chronic conditions, such as hypertension, high cholesterol, pain disorders, diabetes, and obesity.

Why does this matter? Because standard employer claims reports sort spending by individual category. For example, a diabetes-related cost gets filed under diabetes, while a weight-management visit gets filed under obesity care. But none of them are automatically linked back to the cardiovascular risk that’s actually behind all that spending.

Put simply, a report that adds up spending by individual condition will consistently gloss over what cardiovascular risks are actually costing the plan—because many of the costs are lumped in with other line items.

Tracking cardiovascular costs doesn’t mean you can predict them

Once you know what to look for (and where to look), you’ll likely see that cardiovascular disease costs some major money. But figuring out how much any individual case will cost is more complicated. Here’s why:

• Compounding conditions: Comorbidities spread costs around, but they also make the costs themselves less predictable. That same study found that healthcare costs rose 6.3% with each comorbid condition a patient had, while the odds of heart failure hospitalization rose nearly 25% per additional condition. Since comorbidity combinations vary widely from one patient to the next, so does the total bill.
• Unpredictable timing: Roughly every 40 seconds, someone in the U.S. has a heart attack, and about 605,000 of those are first-time events each year. These events arrive suddenly and usually require emergency treatment rather than an expected admission an employer can see coming.
• Multiplying claims: The national 30-day readmission rate for heart failure patients was 21.3%, as of September 2026. Roughly one in five patients will generate a second hospitalization claim within a month of the first. That means more cost for employers.
• Varied procedure costs: Even the exact same procedure can cost wildly different amounts depending on where it happens. A 2024 study of 544 U.S. hospitals found the median commercial price for coronary bypass surgery was about $57,240. But the prices at the 90th percentile were nearly three times as high as those at the 10th percentile across hospitals. That didn’t mean people were paying for quality. Higher prices had zero association with better outcomes, including 30-day mortality or readmission rates.

Any of those variables can cause a claim to swing bigger or smaller than expected, making both individual and total cardiovascular costs hard to predict and plan for.

What employers can do to get ahead of cardiovascular costs

You won’t eliminate cardiovascular costs entirely, but there are a few steps you can take to make these unpredictable claims a little more manageable.

1. Catch problems before they become emergencies

Some cardiac events involve scheduled procedures, but many show up as emergencies. Catching warning signs early—like rising blood pressure or high cholesterol—gives employees a chance to address them before they turn into a middle-of-the-night ER visit.

The same is true after a procedure. People who get regular follow-up care are less likely to end up back in the hospital a second or third time.

But many patients put off preventive visits, cardiac screenings, and post-op appointments because of cost concerns. Waiving or covering those expenses makes people far more likely to get care.

If and when a doctor flags a potential cardiac issue, it’s also helpful to have someone coordinate the next steps and make sure that a warning sign turns into an actual appointment. Carrum’s care navigators guide patients from diagnosis through recovery, including arranging second opinions, communicating with specialists, and following up after surgery.

2. Steer employees toward vetted cardiac specialists

Directing employees to providers with strong, verified track records for cardiac procedures (rather than leaving their choice up to chance or convenience) takes a lot of price swings off the table without sacrificing quality.

Research consistently shows that facilities and physicians who perform a given procedure at high volume produce fewer complications and better outcomes than those who perform it occasionally.

Best-in-class Centers of Excellence programs (COEs) guide people toward those types of facilities and physicians by looking at actual performance data and proven outcomes rather than just whether or not they’re in-network.

3. Lock in a price before the procedure happens

Most claims get paid based on whatever the provider bills after the fact. But bundled pricing offers an alternative by setting a single flat rate for the procedure ahead of time. This rate covers the surgery along with any pre-op or post-op care.

Employers don’t have to negotiate these bundled rates themselves. A best-in-class COE program like Carrum has already done this work by agreeing on flat, all-in rates with their provider network.

So, when an employee needs a bypass or another cardiac procedure, both they and their employer can see the pre-set price—instead of negotiating from scratch.

4. Treat comorbidities (and not just the diagnosis)

Remember that most people with cardiovascular disease are also dealing with something else—diabetes, high cholesterol, obesity, or more.

But when those conditions are treated like separate, disconnected problems, care can end up working against itself. For example, managing blood sugar without also managing blood pressure still leaves someone with a lot of unaddressed cardiovascular risk.

Employers can encourage this kind of connected care through plan design, such as making sure cardiac benefits and diabetes or weight-management benefits aren’t siloed from each other, or by covering necessary visits and screenings, even if they aren’t directly tied to the primary diagnosis.

Cardiovascular claims might seem unwieldy, but you can control some of the costs by steering employees to vetted providers, locking in prices before claims happen, catching problems early, and treating the whole patient instead of just the diagnosis.

Ultimately, cardiovascular disease will always be expensive—but that expense doesn’t have to catch you off guard.