In 2022, Fresenius Health Partners, Cricket Health and Interwell Health merged to form an independent entity, operating under the Interwell Health name, that would serve patients with kidney disease. The company now has more than 100,000 patients under management and partners with more than 1,600 nephrologists and 2,600 dialysis clinics nationwide.
Interwell Health CEO Bobby Sepucha joins Modern Healthcare to discuss the future of value-based kidney care and the company's overall growth plan.
What approach does Interwell Health take to managing care for patients with kidney disease?
There are 36 million Americans who suffer from kidney disease. For the last 50 years, all of the focus and resources have been placed on the 600,000 Americans on dialysis. We’ve saved millions of lives. But those who have kidney disease prior to kidney failure have been largely unmanaged.
Far too often, patients will show up at the ER complaining of chest pain or blurred vision. The doctor will tell them their kidneys have failed, and they have to go on dialysis for the rest of their life. Because their disease hasn’t been managed, it leads to massive mortality in the early stages of dialysis. It’s incredibly expensive for the overall healthcare system.
Interwell exists to identify patients early to engage them with their care and hopefully slow progression. For those who do progress to kidney failure, we help them to get a preemptive transplant, or to pick the dialysis modality of their choice.
Where does the value-based care aspect come into play?
We help payers identify their kidney population, and then we’ll take on full clinical and financial accountability for [that population’s] care. We work closely with a network of nephrologists across the country. Many of them will share in either the savings or the losses. So from an economic perspective, as well as a clinical perspective, we’re all moving in the same direction.
What are some of the financial or operational challenges your company faces, particularly in the wake of COVID-19?
For Interwell and our constituent organizations, COVID has been a challenge. It’s really been about understanding the comorbidities, learning more as the rest of the healthcare system understood how to treat the disease, and then managing the interventions for COVID and the overall spend [in terms of population health].
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Interwell’s operational challenges include helping payers understand who their population is. We find payers underestimate their kidney population by about 50%.
We’ve developed predictive algorithms that mine claims to identify who patients are—not just if they have the disease, but what stage of the disease they’re at. From there, we can figure out who’s most at risk for progressing and who’s most at risk for hospitalization.
You’ve recently struck partnerships with big industry names like Providence and Oak Street Health. What is the status of those partnerships, and what are you hoping to accomplish through them?
We’ve signed six payer deals since last August. Oak Street is a very interesting partnership for us. It’s going to have its primary care physicians round our co-managed patients in the dialysis clinic. These people go to dialysis three times a week. It’s a four-hour treatment. It is grueling. It’s also a huge challenge for their caregivers. The last thing they want to do is try and schedule another appointment at a different physician office. By bringing the primary care physician to them in the clinic, we alleviate an awful lot of burden for them.
Are you seeking more partnerships like this in primary care?
I think that’s probably the future of value-based kidney care. We are in our nascent stages as an industry. We’re probably five to seven years behind primary care writ large in terms of moving toward value. We’re all trying to figure out where the right clinical partnerships are.
I think there’s a long way to go before we figure out what value-based care really means, not just in kidney care, but in the American healthcare system. I often say one of the hardest places to be must be at a payer, public or private, trying to make sense of all of these different point solutions and how they all stitch together. The worst thing that all these value-based care solutions could do is just reinforce the current silo-ization of American healthcare. If we do that, we haven’t moved the ball forward at all.
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What is Interwell’s growth plan over the next three to five years?
We focus on later-stage chronic kidney disease, Stage 4 and Stage 5—which is 18 to 24 months prior to kidney failure—plus the end stage, patients who are actually on dialysis post-kidney failure. The other [strategy] is to engage earlier in Stage 3B, 3A, perhaps even Stage 2, with tens of millions of Americans who may not know they’re sick, may not know they have kidney disease, but are getting progressively worse with each passing month or year. I think that’s an interesting path here—certainly an enormous untapped market, but more importantly, an untapped need for patients.
This interview has been edited for length and clarity.
