The most expensive moment in kidney care can begin with a surprise. A patient arrives at a hospital, learns that the quiet deterioration of an organ has become an emergency, and starts dialysis through a temporary catheter. The medical system is now moving briskly. The patient, rather less so. There has been little time to learn the vocabulary, consider a transplant, arrange permanent access, or ask whether dialysis at home might suit the rest of one’s life.
The company in six beats
- Found risk early with claims, clinical data and predictive models.
- Put nurses, pharmacists, social workers, dietitians and peer mentors around the patient.
- Helped people slow disease progression and choose among transplant, home dialysis, conservative care or in-center treatment.
- Sold to health plans and other organizations responsible for medical costs.
- Reported fewer admissions and more planned, outpatient and home dialysis starts in selected partnerships.
- Merged into InterWell Health in August 2022; Cricket Health no longer operates as a standalone brand.
Cricket Health’s proposition was that this surprise was not inevitable. Founded in San Francisco in 2015 by Arvind Rajan, Vince Kim and James Chaukos, the company worked in the stretch before kidney failure became a crisis. Its software searched for risk. Its care teams called, taught, nudged and coordinated. The technology was clever; the purpose of the technology was to make an earlier human conversation possible.
The original failure was a calendar
Rajan and Kim had gone looking for what Rajan called a hard problem in healthcare, especially one where keeping people out of institutions could improve both life and cost. Chronic kidney disease supplied an almost impolite abundance of difficulty. It can advance without conspicuous symptoms. Education is inconsistent. Care is split among primary-care doctors, nephrologists, hospitals, insurers and dialysis providers. By the time the system becomes attentive, the range of humane choices may already have narrowed.
Cricket’s first offering, launched publicly in 2016, was HOPE - Health Options Patient Education. The name was cheerful; the job was sober. It connected people with advanced disease to treatment information, clinicians, peers and mentors. Rather than begin with a grand platform, Cricket began with a decision: if kidney failure came, what should happen next?
“We were looking for a hard problem to tackle in healthcare - one where, if we could help patients avoid institutional care settings, and instead remain at home, we could have the greatest impact.”Arvind Rajan, co-founder and CEO
The company’s thinking then widened. Education at the edge of kidney failure was valuable, but it arrived after much of the opportunity to slow disease had passed. Cricket built machine-learning systems to find people at risk earlier, including StageSmart and a predictive estimate of kidney function. MyCricket became the front door for an integrated service: personalized care plans, education, remote monitoring, peer support and access by web, telephone or, when needed, in person.
The software pointed; people cared
It is tempting to describe Cricket as a SaaS company because a platform sat in the middle. That misses the expensive and interesting part. A person with kidney disease did not merely receive a notification. The service could involve nurses, pharmacists, social workers, dietitians, care coordinators and trained patient mentors. It worked alongside the person’s physicians, filling the broad gaps between appointments.
The patient was the user, but usually not the buyer. Cricket sold a B2B2C service to health plans and other organizations carrying financial risk for medical care. Those organizations could supply claims data, Cricket could identify members likely to benefit, and the care team could attempt to prevent hospitalizations or badly planned dialysis starts. Public contract prices were not disclosed. Blue Shield of California said its eligible members received the 2020 program at no additional cost.
Health plans and risk-bearing partners bought a value-based care service. The exact commercial rates stayed private.
Members with chronic kidney disease received guidance through their health benefit, not as a retail app subscription.
This was the useful alignment. Cricket did not have to persuade a frightened patient to buy one more health app. It had to persuade the institution paying for admissions and dialysis that earlier, continuous care was worth funding. Cigna and Blue Shield went a step further: they became investors as well as customers.
The numbers that changed the scale
In healthcare, a pleasing interface is not an outcome. Cricket needed evidence that its interventions altered the events for which payers actually wrote checks. In 2021, Cigna published results from an internal study covering the first year of its collaboration. Enrolled customers generated more than 7,000 clinical interactions, 1,000 peer-mentor interactions and 2,250 views of educational material. Cigna reported a greater than 45 percent reduction in unnecessary hospitalizations.
These figures were reported by Cricket and its partners from selected populations. They were not presented as results from a randomized clinical trial.
Cricket separately said that across commercial and Medicare Advantage partnerships in Texas and California it saw more than 50 percent fewer hospital admissions than the status quo. It reported that 77 percent of people starting dialysis did so as outpatients, compared with a cited baseline of 40 percent, and 45 percent began dialysis at home, compared with 11 percent. The caveat matters. So does the direction: planned care had become measurable enough to attract serious capital.
In August 2021, Cricket raised an $83.5 million Series B led by Valtruis. Oak HC/FT, Cigna Ventures, K2 HealthVentures and Blue Shield of California joined. It followed a $2.5 million seed round, a $24 million Series A and debt financing. The company was no longer selling the romance of prevention. It was selling the arithmetic.
The competitor was the default
By then, Cricket occupied a busy field. Strive Health, Somatus, Monogram Health, REACH Kidney Care and others were also trying to bring value-based economics upstream. Traditional health-plan case management and the established nephrology and dialysis system remained alternatives. Cricket’s particular arrangement joined risk prediction, a patient-engagement platform, multidisciplinary clinical care and peer support around a person’s existing doctors.
Its sharpest competitive argument was not that every element was novel. It was that the elements arrived in sequence. Identify the person before the crisis. Earn attention with education and peers. Give the clinician a richer view. Make home dialysis or transplant more plausible. Measure the expensive events avoided. The choreography was the product.
The approach also had a brutal clock. Americans change insurers, and people who progress to end-stage kidney disease may move to Medicare. A health plan might fund prevention only to watch another payer collect the savings later. Chaukos said Cricket had to show better outcomes month by month, not after 12 or 18 months. Patient churn did not change the mission; it changed the proof.
“While the patient is enrolled in our program, you are going to see improved outcomes in the months that they are enrolled.”James Chaukos, co-founder and COO
A merger made the thesis larger
In August 2022, Cricket merged with two organizations that possessed what it did not. Fresenius Health Partners brought experience in value-based contracting. InterWell Health brought a large network of nephrologists. Cricket brought the analytics and patient-engagement machinery. The combined business adopted the InterWell Health name and was valued at $2.4 billion when the transaction was announced.
The brand disappeared, but the argument survived. At closing, the new company said it expected to engage more than 270,000 people with kidney disease and manage $11 billion in medical costs by 2025. Fresenius later disclosed that Cricket contributed its net assets for roughly 17 percent of the new entity. This was not a failure of nerve so much as a recognition of scale: prediction, care teams and software become more useful when connected to physicians and contracts.
What can another company copy? Pick a costly transition rather than a vague condition. Find the organization that bears the cost. Intervene while patients still possess meaningful choices. Let software route scarce expertise instead of impersonating it. Prove the result inside the customer’s real retention window. And notice where the recipe depends on ingredients you may not have: timely claims or clinical data, reachable patients, clinical staff, physician cooperation and enough lead time before the emergency. Without those, prediction is merely an elegant way to be late.
Cricket Health’s most persuasive invention was therefore not StageSmart, HOPE or MyCricket. It was a different unit of value. The old system counted sessions in a dialysis chair. Cricket counted the decisions made before anybody had to sit in one.