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All aboard the insurer investment train to end-stage renal disease

What's the deal with insurers' sudden investment spree in kidney disease companies?

We’re hearing a bit more than crickets from Cigna.

According to a Modern Healthcare article, Cigna and Blue Shield of California participated in a $83.5M funding round for Cricket Health, a software analytics company that improves care through artificial intelligence. The company detects and anticipates early complications of kidney failure.

Cool, that sounds useful, right?

So why are we still hesitant to hop onboard this investment train?

Well, not only are both insurers Cricket Health customers, Cigna was already a Cricket Health investor, and earlier this year, Cigna partnered with a similar company managing kidney care called Monogram Health. We’re curious – why is Cigna so (literally) invested in ESRD?

Two factors are at play here: 1) one little congressional action and 2) insurers who, you know, don’t want to pay. No surprise there.

Let’s back up. In addition to Americans 65+, Medicare covers anyone, of any age, with ESRD, which occurs when an individual’s kidneys permanently stop functioning. Unless they can receive a kidney transplant, people with ESRD typically undergo dialysis several times a week. In 2019, over 520,000 people were treated for ESRD through renal dialysis, and an additional 220,000 individuals received a kidney transplant. It’s an expensive condition, no doubt about it. But if Medicare covers these folks, why the sudden interest from private payors? Could it be the congressional decision to allow folks with ESRD to sign up for Medicare Advantage (plans operated by private carriers), beginning in 2021?

Modern Healthcare seems to think so: “Health insurers have been rushing to offload the risk of patients suffering from permanent kidney failure as end-stage renal disease patients became eligible to enroll in Medicare Advantage plans for the first time this year.” The companies seem to have great results. They are decreasing hospitalizations and improving quality of life for patients. But we can’t help questioning the sudden interest in these companies coinciding with financial incentive. We also can’t help but notice the irony of increased opportunities for insurers to profit from these new investments in patient care, while insurers nationwide enact policies seemingly focused on making care harder to access.

Will we now see other insurers hop onboard this train? Conductor, pull stop!

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