Editor's note: An earlier version of this story included data about member visits to nephrologists that was out of date. The story has been corrected.
In 2020, Blue Shield of California announced a new collaboration with Cricket Health as part of its Health Reimagined initiative to transform the healthcare system for individuals, families, and communities.
Together, we launched an innovative, personalized, and comprehensive care coordination program for Blue Shield fully insured commercial Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) members with late-stage chronic kidney disease (CKD) or end-stage kidney disease (ESKD) at no additional cost to them. Now that we have completed the program’s inaugural year, we have promising results based on Blue Shield‘s claims data: improved clinical outcomes, high satisfaction ratings from members, and fewer hospitalizations.
The strong engagement between Blue Shield members and the Cricket Health team is yielding positive results in key clinical measures for kidney disease:
- Reductions in hospitalizations: Preliminary data shows a 63% reduction in unnecessary hospitalizations among enrolled patients. This means that members were kept safe at home during the pandemic, and didn’t contribute to the already low hospital capacity due to COVID-19 cases. Additionally, hospital visits drive up the cost of health care, so keeping people healthy at home dramatically reduces overall costs to the system.
- Alternative dialysis choice: Allowing members choice in how they want care delivered – especially with chronic illness – is paramount. With the benefit of educational resources, 90% of Blue Shield of California members enrolled with Cricket Health made a choice other than in-center dialysis for ESKD treatment.
- Outpatient data on starts: According to preliminary results, 83% of Blue Shield of California members who started dialysis began this treatment outside of the hospital setting. Patients who participate in the Cricket Health program are four times more likely to start dialysis at home and two times more likely to start dialysis in an outpatient setting than the status quo. These early results show that a better-educated patient is empowered to make more informed modality decisions, resulting in greater utilization of home dialysis, which has been shown to have better clinical outcomes than in-center .
Cricket Health provides members with peer support, education, and advice to help them confidently navigate their personal kidney-care journey.
Blue Shield members are highly satisfied with the program, with a Net Promoter Score (NPS) of 53. The NPS indicates the level to which a current patient would recommend Cricket Health to a family member or friend. NPS scores range from -100 to 100, with anything above 50 considered excellent. Here’s one patient’s Cricket Health story.
- Rick was diagnosed with CKD during a routine appointment for his diabetes management. In addition to his kidney disease and diabetes, Rick also suffers from chronic heart problems.
“I was blown away,” Rick said of his first interactions with his Cricket Health team. “It was just the beginning of a very in-depth, detailed conversation about my kidney disease and how to make changes in my life that would make me feel so much better.”
Rick appreciates the regular, attentive care he receives from his Cricket Health team: “In almost all healthcare these days, you meet with a specialist, and they say, ‘Come back and see me in three months.’ The real benefit I found with Cricket Health was a lot more contact and help on dialing in things at a detailed level that I just wasn't aware of. Also, they teamed up with my regular nephrologist, who welcomed the help.”
Rick’s care team helped him create a daily management plan and diet. He has lost 50 pounds, which improved his diabetes control, kidney health, and blood pressure. Rick’s goal is to meet the eligibility requirements for a kidney transplant, and this mission drives him to stay engaged with his care team.
“Cricket Health was an absolute turnaround for me,” said Rick. “I'm pretty informed as a patient. But there was a time when I was very uninformed and somewhat cavalier about all this stuff and thought I had all the time in the world to deal with it. The important takeaway for anyone who has kidney problems -- or any other chronic problem -- should be if you're only seeing your specialists every few months, you need to find other resources. In the case of kidney disease, Cricket Health has modeled the way to help patients. And I really appreciate that. Do it now. Don't wait.”
How the Cricket Health program works
Cricket Health offers a multidisciplinary care team that includes nurses, pharmacists, social workers, dietitians, and trained peer mentors through a patient support program. The program is offered for Blue Shield members enrolled in Blue Shield’s fully insured commercial Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) benefit plans.
The team, available online and by phone, works closely with the participating member’s medical providers, including primary care physicians, nephrologists, and other specialists, to help ensure that the patient remains healthy, at home, and out of the hospital through an evidence-based approach to managing kidney disease. Members also have access to stage-specific educational resources, as well as a peer support network to share stories and ask questions.
Early identification and intervention
Cricket Health helps Blue Shield identify members with late-stage chronic kidney disease or end-stage kidney disease. Using a proprietary algorithm, the Cricket analytics platform uses Blue Shield claims data to identify kidney disease stages 3b and beyond with 96% accuracy, and to assess and predict clinical risk for informed outreach and interventions.
This predictive analytics platform allows Cricket Health providers to intervene well before kidney failure with a personalized care plan for each member, designed to slow disease progression. For members whose kidney disease does progress, Cricket Health helps them understand treatment options and empowers them to choose the right treatment for their unique situation.