Historically kidney care has meant having a singular focus on people needing dialysis, with companies trying to deliver this very expensive treatment for patients whose kidneys have failed and those nearing end-stage renal disease.

That’s where the system is all wrong, believe executives at a new company that wants to turn the idea of kidney care on its head. The new entity – InterWell Health — was launched Monday by the merging of three companies – InterWell, Fresenius Health Partners and Cricket Health.

“There are about 600,000 Americans on dialysis. But there’s 36 million Americans with kidney disease prior to kidney failure, and there has been precious little attention paid to (these) patients as they progress towards kidney failure,” said Robert Sepucha, CEO of Cricket Health in an interview Wednesday.

What the combination of Cricket, InterWell and Fresenius Health Partners does is to recognize that entire journey, Sepucha said.

InterWell is focused on providing value-based care for those with mid-stage and late-stage chronic kidney disease. The merged company is valued at $2.4 billion with a total addressable market of $170 billion and with more than $6 billion of medical costs under management, which is calculated by multiplying the number of members who are included in value-based reimbursement programs. By 2025, the company said it expects to engage and manage the care of more than 270,000 Americans living with kidney disease and increase its medical costs under management to $11 billion. 

The move to create a new company to look at kidney disease earlier in the continuum is significant given that Fresenius Medical Care is one of the dominant players in the dialysis market.

“This merger will enable us to comprehensively support patients across the continuum of kidney care,” said Bill Valle, CEO of Care Delivery for Fresenius Medical Care, in an email.

Even DaVita, the other big name in the dialysis care, has been emphasizing the the need to move from volume to value-based care. Patient-centric care improvements include not only making dialysis more convenient, by offering it in-home, but providing a whole person model of care that provides patient education for disease management and lifestyle changes.

And to do all this well likely requires bringing in different capabilities, something that the InterWell merger, on paper, appears to possess.

InterWell Health brings its network of more than 1,600 nephrologists, and Fresenius Health Partners—the value based care division of Fresenius Medical Care North America—adds its expertise in value-based kidney care contracting to the combined company. Meanwhile Cricket Health brings the technological platform and analytics capability to the mix.

“To have a real impact on improving patient outcomes and improving their quality of life all while delivering better cost outcomes for our payer partners, you need to address the full spectrum of the disease,” Sepucha said.

Cricket has been doing this by identifying patients earlier and giving them the support and resources they need to not just understand their disease but also take a more active role in their own care, Sepucha said. As a result, the company has been able to improve patient outcomes and reduce the cost of care for patients with commercial insurance and Medicare Advantage alike, he said.

Combining San Francisco-based Cricket’s capabilities with those of InterWell and Fresenius, will improve patients’ quality of life in a number of ways, believe Sepucha and George Hart, co-chief medical officer of Watham, Massachusetts-based InterWell Health. This could be achieved through reduced hospital admissions and readmissions, slower disease progression, increased transplant referrals and rates, accelerated transition to home dialysis, and improved health equity.

The holy grail, Sepucha and Hart said, would be to delay the onset of kidney failure.

“Nephrologists frequently find themselves now as a constant in what is an otherwise very fragmented healthcare delivery system,” Hart said. “We’re trying to take care of these patients who have these severe diseases. They’re very vulnerable, frequently socioeconomically disadvantaged.”

While there’s only so much a single health provider can do, the combined company brings together tools like Cricket’s predictive analytics to better anticipate patients’ care needs and human resources. Ultimately, that will improve patient education and support, such as social workers, dietitians and nurses to help them navigate this whole process, Hart said.

The goal is to provide the phenomenal care and superior disease management that patients deserve, he said, including slowing the progression of chronic kidney disease or, in some cases, stopping CKD before it starts. The new company will expand the support physicians need to elevate the way they practice medicine by closely aligning workflows and providing the data, education, and care management resources necessary to succeed in a value-based world, Hart said.

Photo: HYWARDS, Getty Images