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Cricket Health launches new approach to kidney care for Medicare Advantage plans

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Cricket Health now managing 10,000 kidney patients and over $500 million in medical spend


San Francisco and Boston (March 31, 2021), PR Newswire Today, Cricket Health announced a new value-based kidney care offering specifically designed for Medicare Advantage (MA) plans. Recent regulatory shifts through the CURES Act, which became effective on January 1, 2021, removed the long-standing prohibition on End Stage Kidney Disease (ESKD) patient enrollment in MA plans. Cricket Health’s program helps MA plans address this change by providing care management services specifically tailored for both late-stage CKD and ESKD populations. Improved care management for kidney patients is critically important, as this patient population can cost up to nine times as much as the average MA beneficiary, often leading to significant losses for MA plans. 

Cricket Health launched its Medicare Advantage program in Texas to more than 4,500 people with kidney disease, bringing the total number of commercial and MA lives under Cricket Health management to 10,000 across the country and the total medical spend under Cricket Health management to over $500 million. Early results point to high levels of patient engagement among MA members, demonstrating that even older patient populations find great value from the Cricket Health care model. With an average age of 76, and services available in both English and Spanish, patients are engaging with Cricket Health clinicians an average of ten times per month, or once every two or three days.  

“The key to value-based kidney care is early intervention. We are able to help Medicare Advantage plans identify kidney disease earlier and focus on those who are most at risk for progressing to kidney failure,” said Robert Sepucha,  CEO of Cricket Health. “By managing kidney disease earlier, we can provide personalized care roadmaps and targeted interventions that keep people healthy, at home, and out of the hospital.” 

Cricket Health’s program uses its proprietary data analytics model to help MA plans identify and risk-stratify members with, or at-risk for, kidney disease. Cricket Health then provides each member with a dedicated multidisciplinary care team including a nurse, pharmacist, social worker, dietitian, and trained patient peer mentor to provide support at every stage of the kidney care journey. Patients can access their dedicated team in-person, over the phone, and via a virtual care platform to learn more about their disease and help them make decisions to manage disease progression resulting in improved health outcomes for them and lower costs for plans. For those who do progress to kidney failure, Cricket Health deploys an ESKD-specific program that increases transplant referrals, increases utilization of home dialysis, and reduces unnecessary utilization. Across the full continuum of care, Cricket Health’s care teams work in unison with the MA plans’ existing network of medical providers, including PCPs, nephrologists, and other specialists.  

“We’ve already seen a high engagement rate in our Texas patient population, which is exciting to see so early on with a program like this,” said David Spalding, Cricket Health’s General Manager for Texas and Arkansas. “Medicare Advantage plans support and promote proactive and preventative care, and Cricket Health’s platform helps their members understand their treatment options and make the best decisions about their care.” 

Late-stage kidney disease costs the U.S. health care system over $200 billion per year, with over $40 billion being managed by MA plans. However, research indicates that up to 50 percent of late-stage patients remain undiagnosed, suggesting an even larger opportunity given Cricket Health’s ability to identify them with its proprietary claims-based algorithms. Even when a plan member has been diagnosed, health plan data often inaccurately represents the true stage of disease, leading to financial and quality of care implications. With advanced data analytics and the proprietary Predictive Glomerular Filtration Rate (pGFR), Cricket Health helps plans accurately stage members’ kidney disease and provides a curated care plan based on the patient’s unique health needs. 

To learn more about how health plans work with Cricket Health, visit: 

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