InterWell Health finalizes $2.4B kidney care merger to combine tech, value-based care capabilities

InterWell Health completed a three-way merger with Fresenius Health Partners and Cricket Health to create a kidney care powerhouse on track to have $11 billion in costs under management by 2025. 

The three big players in kidney care announced in March plans to form a new value-based care company focused on services for the earlier stages of kidney disease.

The deal creates a company valued at $2.4 billion, according to the companies.

The merger brings together the expertise in value-based kidney care contracting of Fresenius Health Partners, a division of Fresenius Medical Care North America, InterWell Health’s network of more than 1,600 nephrologists and startup Cricket Health’s technology-enabled care model and patient engagement platform. Fresenius Medical Care is the world's largest operator of dialysis centers.

The independent new company is valued at $2.4 billion and will operate under the InterWell Health brand. The deal increases Fresenius Medical Care's total addressable market in the U.S. from around $50 billion to around $170 billion, according to the company.

With the combined capabilities, InterWell Health executives said the company aims to set the standard in value-based kidney care by partnering with a patient's nephrologist, improving their care delivery throughout the entire spectrum of their journey with kidney disease.

“In a value-based world, it is no longer enough just to provide quality care—providers must help patients change behavior, and this requires a fundamental shift in how we engage patients,” said Robert Sepucha, InterWell Health CEO.

"Patients with kidney disease need constant support and guidance and the assets and capabilities that all three companies bring to bear enable us to do that," Sepucha said in an interview. "I don't think that there's any other entity or organization that brings together all of the things you need to do to support this patient population from virtual care teams to in-person clinicians to the data and analytics to identify high-risk patients and a network of 1,700 physicians around the country. So putting together the data, the clinical model, the care teams and the physicians, that's what this is all about."

InterWell Health has more than $6 billion of medical costs under management and over 100,000 covered lives.

The new company will accelerate growth in the mid- and late-stage chronic kidney disease value-based care population, according to company executives.

The company plans to leverage data analytics capabilities to identify high-risk patients and combine that with a patient engagement platform to deliver in-person and virtual clinical support. InterWell Health also offers real-time access to multidisciplinary care teams, patient peer mentors and a large network of nephrologists in the country, Sepucha noted.

"The challenge that we see in today's healthcare system is that the chronic kidney disease population prior to kidney failure has historically been wildly unmanaged," Sepucha said. "Now, for the first time, we have the analytics capabilities to identify patients sooner so we can work with them and help them understand they have the disease, educate them about what it takes to manage that disease and help them take a more active role in it. And we can provide care management support and a multidisciplinary care team combined with an online patient experience to serve as the eyes and ears for the physicians between office visits."

The company has set ambitious goals to reduce hospital admissions and readmissions, increase transplant referrals and rates, accelerate the transition to home dialysis and improve health equity.

Fresenius historically has focused on patients living with chronic kidney disease and renal failure and provides dialysis services throughout the country. Cricket Health, founded in 2015, focuses more "upstream" to try to intervene early and deliver stage-specific care to kidney disease patients. Cricket Health developed a predictive analytics model to risk-stratify patients and identify those with chronic kidney disease in stage 3b and beyond with 96% accuracy. Identified patients are then assigned a care team that includes a nurse, a pharmacist, a social worker, a dietitian and a trained patient peer mentor.

InterWell Health was formed in 2019 as a physician-centric joint venture between 1,100 physician investors and Fresenius Medical Care North America and has 1,600 nephrologists in its network.

The new InterWell Health puts nephrologists at the center of its efforts, according to George Hart, M.D., InterWell Health's chief medical officer.

"Until now, we only had bits and pieces of the tool chest but we're bringing all these companies together. Now, I think this really flushes things out in a way that's going to be most effective. Physicians will now have a complete repertoire of what they need to be successful," Hart said in an interview. 

InterWell Health will give doctors the resources they need to provide superior care, manage disease progression and improve outcomes, he said.

The company will utilize its StageSmart machine learning and predictive glomerular filtration rate model. This technology will enable the combined entity to identify and risk stratify patients with kidney disease prior to kidney failure with 96% accuracy, helping slow disease progression and giving patients the time necessary to choose a treatment option that is right for them, according to the company. 

"We need to lean into what happens between office visits and put our arms around these patients when they're dealing with the transition from kidney disease to dialysis and even first learning about the fact that they even have kidney failure," Hart said. "We're excited because we think we now have these capabilities with some of the telehealth strategies that Cricket Health brings and the scalability that Fresenius Health Partners brings. You kind of marry all that with physicians and it's the appropriate cocktail for success."

InterWell Health has the financial and strategic support of leading investors including Valtruis, Oak HC/FT, Cigna Ventures and Blue Shield of California, which all backed Cricket Health.