Startup Insider: 3 questions with Cricket Health CEO Arvind Rajan

Since 2016, Cricket Health has provided advanced stage chronic kidney disease patients with technology-enabled home care through its Health Options Patient Education program.

The San Francisco-based startup uses HOPE, its online education program, to guide CKD patients through the transition to kidney failure, or end-stage renal disease. The program connects patients to a remote clinical team, trained mentors and a peer community to help inform treatment decisions and reduce hospital admissions, in an effort to keep patients in outpatient dialysis.

"By shifting the patient mix away from in-center hemodialysis, and by providing integrated care when patients are most vulnerable, we can help reduce hospital utilizations and readmissions, which are central to the healthcare industry's shift toward value-based reimbursement," said Arvind Rajan, co-founder and CEO of Cricket Health.

 Mr. Rajan spoke with Becker's Hospital Review about existing barriers to high-quality CKD care and how technology can intervene in the healthcare landscape.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What prompted you to found Cricket Health?

Arvind Rajan: [Vince Kim, co-founder of Cricket Health] and I 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 in both patient outcomes and cost of care. That took us to CKD, which is kind of a microcosm of everything that is broken in the U.S. healthcare system.

Patients diagnosed with advanced stage CKD or ESRD are thrown into a management system with critical education and care coordination gaps. This population is often pipelined into narrow and expensive treatment options that fail to account for a patient's lifestyle and personal values. In addition, inconsistent patient education on the part of the provider and poor health literacy on the part of the patient often lead to a delayed or incomplete plan of action and tremendous cost burdens on the healthcare system.

Q: How does Cricket Health intervene in CKD care?

AR: The good news is most patients never progress to advanced stages of CKD or ESRD; but for the unfortunate percentage that do, it's a pretty depressing picture. If a patient is extremely lucky, he or she is treated in an environment setting with care providers — doctors, nurses, dieticians, pharmacists and social workers — who can deliver the integrated care and education necessary to manage successfully through the transition to ESRD. But the reality is that only a tiny fraction of patients get this kind of care.

As a result, patients frequently get hospitalized and are at high risk of death, and only 20 percent get an optimal start to ESRD. Close to 90 percent of dialysis patients get center-based hemodialysis, despite the fact CMS, the nephrology community and the dialysis providers all agree home dialysis is a better option for most patients, in addition to being less expensive. Most patients get remarkably poor education about their treatment options, if at all, and thus they end up on the default option — in-center hemodialysis.

Q: What advice do you have for other health IT companies focused on value-based care?

AR: I don't normally describe Cricket Health as a health IT company. Technology isn't the only way to deliver a value to patients, and we think of ourselves as a technology-enabled healthcare provider. I do think there is a tendency in some areas of healthcare to build a solution in search of a problem. I believe that healthcare shouldn't begin with the technology, but with the needs of patients, providers and payers. Then, once those needs are determined, uncover what roles technology and other solutions play.

At Cricket Health we put patients first, and the culture of our company flows from that mission. More specifically, we want to build a culture where we infuse strong clinical experience with the innovations of the technology world. As a healthcare startup, we have to demonstrate a willingness to tackle the hard problems in healthcare. We want a culture where the people who work here feel they can do their best possible work. We hire fundamentally decent people who also are incredibly talented and smart.

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