Blue Shield of California is teaming up with Cricket Health to offer coordinated care to members with late-stage and end-stage renal disease.
The long-term collaboration is part of Blue Shield's Health Reimagined initiative, which includes a slew of pilot programs targeting the unique needs of members in four communities across the state.
Cricket Health's platform provides a multidisciplinary care team including nurses, pharmacists, social workers and dieticians who will collaborate with the patient's care team to better manage chronic kidney disease.
Kidney disease and ESRD in particular is a common, costly condition that disproportionate impacts vulnerable communities, Seth Glickman, M.D., chief health officer at Blue Shield, told Fierce Healthcare. And, some 90% of patients with kidney disease aren't aware they have it.
"It really requires new solutions and new approaches to help people who are effected by chronic kidney disease," Glickman said.
Members enrolled in Blue Shield's fully insured PPO plans will have access to Cricket Health's services. The insurer will also provide claims data to Cricket Health's team to analyze and identify members who have or are at risk for kidney disease, who will be invited to join the program.
Members who enroll will have access to the care team and virtual programs that are designed to slow the progression of kidney disease and reduce complications and hospitalizations.
Arvind Rajan, CEO of Cricket Health, told Fierce Healthcare that members have access around the clock to the care team and a peer mentor who will help them in navigating their care. In addition, users have access to a supportive community of people who enrolled in the program at the same time.
He said the program is built to give patients greater control over their own care.
Glickman said that the coronavirus pandemic is making the case for this work even more clear, as home and digital care take center stage amid ongoing social distancing.
"We really need to ensure that we’re able to bring solutions to bear that allow members to take care of themselves in their own homes," he said.
But even before the pandemic, bringing more kidney care into the home was a focus from the federal level down, with the Trump administration rolling out a series of five new payment models that aim to boost the use of home dialysis and access to transplantation.
Rajan said moving away from clinic dialysis represents a massive paradigm shift in the industry, as it's been the focus for decades.
Home dialysis is less intensive and less costly than clinic dialysis for people who may be eligible, with patients reporting better quality of life and fewer hospitalizations than those undergoing clinic dialysis, he said
Home dialysis can also be conducted daily, even overnight, instead of several times a week, which is less exhausting.
"You basically are getting more of the bad stuff out of your system more frequently," Rajan said.