Cricket Health

Cricket Health is a comprehensive kidney care provider with a personalized, evidence-based approach to managing chronic kidney disease and end-stage renal dialysis. Headquartered in San Francisco and Boston, Cricket works with payers and providers to identify patients who are at risk, acts early to slow progression of the disease, and delivers kidney care through a multidisciplinary care team. Pulse writer Jeremy Rubel sat down with COO and Co-Founder James Chaukos WG ‘16 to talk more about Cricket and his experiences.

The Pulse: Prior to co-founding Cricket, you worked at LinkedIn and J.P. Morgan and attended Wharton. What drove you to start a company in health care and kidney care in particular?

JC: In the early part of my career, I realized that the times when I did my best work, and when I had the most motivation, were when I was working on a problem that not only had a real business behind it but would also have a positive impact on people’s lives. At J.P. Morgan, I was most interested in cleantech, and at LinkedIn, I thought that our mission of bringing economic opportunity to people all over the world was a worthy cause. When I was at Wharton, those were the new opportunities that most interested me.

The first thing I did for Cricket was write the case for us to focus on kidney disease. This part of healthcare is one of the most heart-wrenching. It affects so many people, but doesn’t get a lot of attention. It’s one of the areas in the U.S. healthcare system where there are a number of ways to dramatically improve the patient experience. When we started the company in 2015, we realized that there wasn’t attention from payers and investors in kidney disease despite it being one of the most common and most costly chronic diseases. Thankfully, today we have the complete opposite. You have momentum from the government, motivation on the payer side, and you have patients asking for a new solution. It’s the impact and opportunity to improve patient’s lives though that has kept me motivated over the past five years.

The Pulse: How does Cricket improve the health outcomes of its patients?

JC: At Cricket, we’ve been patient-centered from the jump. We started by speaking to medical professionals that were at the frontlines of providing patient care and asked them, “If you had a blank piece of paper, what would you want to do differently in kidney care?”

What quickly surfaced was that one of the most painful parts of a kidney disease patient’s journey is the transition to dialysis. Many patients don’t know they have kidney disease and crash into dialysis in the ER. What we first focused on was improving that transition to dialysis: identifying people with or at risk for kidney disease early, understanding who is at the greatest risk for progression of the disease, and giving them the tools and the care team that can help them manage their condition early on. If they do need renal replacement therapy, we support them in understanding their options, making an informed decision, and then pursuing that treatment choice.

As we’ve grown the company, we’ve expanded our focus, which has helped us improve outcomes for more patients. We’re now managing patients that are earlier in their disease progression, we’ve invested in making sure our identification and risk-stratification of patients is more accurate, and we’re reaching these patients more quickly.

One of the things that a lot of people don’t talk about is that there are a lot of great interventions in the country and there are pockets of excellence, but there are very few companies that can actually extend those outcomes to communities that don’t have high-functioning healthcare systems. Part of what we aim for at Cricket is to improve access to high-quality kidney care, and our ability to identify and risk-stratify patients early on is an important part of that.

The Pulse: Kidney disease is a serious risk factor for COVID-19. How has Cricket worked to keep its patients safe during the pandemic?

JC: Unfortunately, COVID-19 has disproportionately impacted the kidney disease community in the U.S. Research suggests that patients with end-stage kidney disease are 11 times more likely to be admitted to the hospital for COVID-19 than patients without kidney disease. At Cricket, we’ve focused on building our company to support patients in their home and beyond the clinic setting. Our members are able to enroll remotely and get access to their care team in the safety of their home. We can give patients the high-quality kidney care that we believe they deserve and we can do it despite the pandemic. We see this as a shift in how healthcare is delivered that is going to extend long after the pandemic has passed.

One piece of good news is that providers across the healthcare system have been almost forced to embrace technology this year in a way that they never had to before, and we do think that is in the best interest of patients in the long-run.

The Pulse: Cricket has deals with several payers to provide coordinated kidney care, including Blue Shield of California and Cigna. As a new provider, how do you convince payers that Cricket is able to provide value?

JC: Our relationships with payers takes time and, candidly, requires close integration. When we first start talking to payers, often we help them understand the magnitude of the problem. Claims data in this space is imperfect, and part of what we help them do is sort through that data. For example, at Blue Shield of California, once they decided that Cricket was going to be their partner, we worked together to unpack their data, which they then used to build the business case and get approval to move forward to term sheet and eventually contracting. That first step is one that forward-thinking payers don’t skip – because they want to make sure that health outcomes will improve and that this is worth their time to implement. We are really proud to partner with folks like Blue Shield of California, Cigna, and Baylor Scott & White now in Texas because they understand the importance of improving the status quo for this population and their members benefit from that.

The Pulse: How does Cricket work with payers to identify eligible patients?

JC: Our work with payers on the identification front starts early. When they are building the business case, we start to understand their data team’s capabilities and their data structure itself; so once we move into the implementation phase, we can effectively work with the payer team to map their population and identify these members. We use data from three different sources: claims, labs, and other clinical data that is provided to us to identify who should be eligible for the Cricket Health program. Our data team can use all those different sources of data and create models that are better than any of those three sources alone, allowing us to predict patients’ kidney function, who is at highest risk, and their risk of hospitalization. That’s important because we can find those patients that are in the most need of intervention. We reach kidney disease patients that don’t have a nephrologist and that are misdiagnosed or undiagnosed in claims. We are really proud that we are able to do this and believe that our impact is outsized because we are reaching those patients that would otherwise be missed by the status quo in kidney care.

Cricket Health COO and Co-Founder James Chaukos

The Pulse: In the US, a large percentage of adults change insurance every year and when a patient’s kidney disease progresses to ESRD, they qualify for Medicare. This poses a challenge to Cricket and other value-based providers that contract with payers to keep patients healthier and reduce their medical expenses. How does Cricket manage this patient churn problem?

JC: This is a quality of the U.S. healthcare system that has existed for a while, and it’s one that is not going away. I grew up in Canada where there is a single-payer system but in the U.S. that’s just not the way the system works. The burden on innovative providers and value-based care providers like ourselves is showing improving outcomes month on month, so that when you go to a payer you can show them: while the patient is enrolled in our program, you are going to see improved outcomes in the months that they are enrolled. You aren’t going to have to wait 12-18 months to see outcomes improve, by which point they may have left the plan. That’s resonated with payers and that’s how we’ve built our business; such that by identifying patients that are truly in need of the service and that are at high-risk of hospitalizations or other adverse events, we actually improve outcomes in the near-term. So even though patients may move out of the plan eventually, for those months that they are part of the program, there is still value to the plan and value to their members to them being enrolled in Cricket Health.

The Pulse: In 2019, the Trump Administration announced the Advancing American Kidney Health initiative to increase the share of home-based dialysis and to shift towards a value-based payment model. Have these policy changes impacted Cricket’s business?

JC: Absolutely. The kidney care initiative that the Administration announced was for us a positive development, with increased focus on early detection and alternatives to in-center dialysis, including increased home therapies and transplants.
What this has meant for us is that more providers are looking for partners to help them better support home dialysis, deliver condition management and improve health outcomes as a result. We think that’s an important step: we need payers, existing providers and patients all focused on this, instead of on filling chairs in a dialysis center.

The Pulse: As co-founder and COO, you have seen the company grow to over 100 employees since its founding in 2015. What have you learned about how to effectively manage a large multi-layered team?

JC: First of all, there is a lot to be learned from peers of ours that have gone through this growth. We’re at a point now where there are a handful of companies that have implemented value-based care in other parts of the U.S. healthcare system. It’s important to have humility and a learning mindset. Make sure you are talking to those folks that have done this before and incorporate those learnings into what you are doing.

The second learning that I would mention is that structuring, separating responsibilities, deepening the bench, and adding depth and breadth to the team are all key during this phase of growth. What you could do in the early days just by picking up the phone and calling your colleagues now needs to have structure and systems behind it. And that’s what allows you to scale what worked in the early days to larger-scale, commercial deployments.

The Pulse: What are your goals for Cricket in 2021?

JC: 2021 is all about growth for us. We’ve now got a handful of big commercial contracts that are live and are growing within those accounts. We are also going to be launching a number more. I’m excited for our team members that are able to experience that rapid growth and excited about how that growth can build their networks and experience but am most excited about what that growth means for patients that have kidney disease.

One of our cultural values that I’m really proud of is “Everyone is worthy.” We think that every kidney disease patient in the United States is worthy of high-quality kidney care, and so right now I’m focused on our outreach and enrollment numbers, I’m excited to see those numbers continue to grow and for us to continue to build an organization that supports this change in how kidney care is delivered in the U.S.

Interviewed by Jeremy Rubel in December 2020