1 00:00:15,076 --> 00:00:25,756 Speaker 1: Pushkin, this is solvable. I'm Ronald Young Jr. If you're 2 00:00:25,756 --> 00:00:28,156 Speaker 1: anything like me, As you get older, you begin to 3 00:00:28,196 --> 00:00:31,876 Speaker 1: think about your general health and wellness, being more active, 4 00:00:32,436 --> 00:00:36,076 Speaker 1: my blood pressure, my cholesterol, trying to eat more vegetables, 5 00:00:36,516 --> 00:00:39,916 Speaker 1: making the appointment for my annual physical. But even if 6 00:00:39,916 --> 00:00:42,276 Speaker 1: I take the time to tend to my lifestyle choices 7 00:00:42,316 --> 00:00:46,476 Speaker 1: and overall health, some preventative care measures may still slip 8 00:00:46,516 --> 00:00:49,716 Speaker 1: through the cracks, just because I don't know all the 9 00:00:49,836 --> 00:00:53,796 Speaker 1: questions to ask. Patients are going into their doctor asking 10 00:00:53,836 --> 00:00:56,636 Speaker 1: to get their cholesterol checked. I mean, how many people 11 00:00:56,636 --> 00:00:58,236 Speaker 1: do you know they're going to their doctor and say, 12 00:00:58,436 --> 00:01:00,876 Speaker 1: can I have my kidney's checked? I certainly don't think 13 00:01:00,876 --> 00:01:03,356 Speaker 1: about my kidneys on a regular basis, But one in 14 00:01:03,396 --> 00:01:07,316 Speaker 1: seven adults has chronic kidney disease or CKD, and because 15 00:01:07,316 --> 00:01:10,836 Speaker 1: it's asymptomatic in the early stages, nine people with the 16 00:01:10,916 --> 00:01:14,636 Speaker 1: disease have no idea they've got it. And today we're 17 00:01:14,636 --> 00:01:18,956 Speaker 1: phased with the situation where a wonderful policy has created 18 00:01:19,156 --> 00:01:22,036 Speaker 1: an incentive where we put a lot of resources in 19 00:01:22,116 --> 00:01:24,836 Speaker 1: the end stage of a disease and nothing on prevention 20 00:01:25,716 --> 00:01:29,236 Speaker 1: for end stage renal disease. Also known as kidney failure. 21 00:01:29,596 --> 00:01:33,036 Speaker 1: Patients are often treated with dialysis. It's a very time 22 00:01:33,076 --> 00:01:36,716 Speaker 1: consuming and exhaustive treatment that can save lives, but can 23 00:01:36,756 --> 00:01:41,636 Speaker 1: also be extremely disruptive. Doctor Carmen Peralta co founded the 24 00:01:41,716 --> 00:01:45,316 Speaker 1: Kidney Health Research Collaborative at the University of California, San 25 00:01:45,356 --> 00:01:48,716 Speaker 1: Francisco to change all that. Some of the first obstacles 26 00:01:48,756 --> 00:01:53,916 Speaker 1: were information really understanding the epidemiology of disease, what populations 27 00:01:53,916 --> 00:01:57,396 Speaker 1: are affected, what are the risk factors for disease, why 28 00:01:57,516 --> 00:02:01,036 Speaker 1: it happens. Doctor Peralta is also the chief medical officer 29 00:02:01,076 --> 00:02:04,436 Speaker 1: at Cricket Health, a for profit company that specializes in 30 00:02:04,476 --> 00:02:08,276 Speaker 1: helping people with kidney disease by supporting early detection programs 31 00:02:08,316 --> 00:02:13,676 Speaker 1: and providing risk assessments. A big, important, gigantic reason to 32 00:02:14,036 --> 00:02:17,516 Speaker 1: detect the disease early. The earlier you detected, the more 33 00:02:17,556 --> 00:02:20,996 Speaker 1: chances you have to prevent it from progressing. Nearly thirty 34 00:02:21,036 --> 00:02:25,196 Speaker 1: seven million Americans lived with chronic kidney disease. Getting an 35 00:02:25,196 --> 00:02:28,396 Speaker 1: early diagnosis could improve the quality of life for many 36 00:02:28,556 --> 00:02:33,036 Speaker 1: and even prevent the necessity of in stage treatment. Chronic 37 00:02:33,076 --> 00:02:43,276 Speaker 1: kidney disease is solvable. How did you get interested in 38 00:02:43,316 --> 00:02:48,716 Speaker 1: kidneys specifically, my grandfather, who I never met, was a physician, 39 00:02:49,036 --> 00:02:52,836 Speaker 1: and so I grew up in em Barranquia, Colombia, and 40 00:02:53,156 --> 00:02:56,116 Speaker 1: he was one of those physicians that would just do 41 00:02:56,356 --> 00:02:59,716 Speaker 1: anything for his patience. And my mother always talked about 42 00:02:59,836 --> 00:03:02,076 Speaker 1: him and the way people loved him and all the 43 00:03:02,116 --> 00:03:04,996 Speaker 1: things that he did, and so that was an inspiration. 44 00:03:05,596 --> 00:03:09,276 Speaker 1: My uncle was also a doctor, and I love the 45 00:03:09,276 --> 00:03:11,996 Speaker 1: physiology of the kidney. I mean, when you probably talk 46 00:03:12,076 --> 00:03:14,636 Speaker 1: to people about kidneys, they think, oh, they filter your blood, 47 00:03:14,636 --> 00:03:16,676 Speaker 1: which is true, but the kidney has a ton of 48 00:03:16,716 --> 00:03:20,636 Speaker 1: other functions, regulating the water content in your body, blood pressure, 49 00:03:21,156 --> 00:03:23,156 Speaker 1: helping make red blood cells, and all these things that 50 00:03:23,156 --> 00:03:26,796 Speaker 1: I found it to be absolutely fascinating. And I was 51 00:03:26,836 --> 00:03:31,516 Speaker 1: struck by several things that happened during my training. One 52 00:03:31,956 --> 00:03:36,036 Speaker 1: was meeting patients that would arrive in an emergency room 53 00:03:36,076 --> 00:03:38,356 Speaker 1: just sort of saying that they didn't feel well or 54 00:03:38,396 --> 00:03:40,956 Speaker 1: maybe they were swollen, or they were having trouble breathing, 55 00:03:41,596 --> 00:03:44,116 Speaker 1: and then they were diagnosed with kidney failure what we 56 00:03:44,156 --> 00:03:46,876 Speaker 1: call end stage renal disease or end stage kidney disease, 57 00:03:47,476 --> 00:03:51,156 Speaker 1: and told that they needed dialysis. I also was struck 58 00:03:51,196 --> 00:03:54,876 Speaker 1: by the reports that we were having in those times. 59 00:03:54,876 --> 00:03:58,156 Speaker 1: And remember this is the early nineteen nineties, thinking about 60 00:03:58,156 --> 00:04:00,956 Speaker 1: the race disparities and SoC economic disparities that we saw 61 00:04:00,996 --> 00:04:05,076 Speaker 1: in the disease, and that truly marked me because I 62 00:04:05,156 --> 00:04:09,276 Speaker 1: was thinking, why is this disease devastating this community is 63 00:04:09,316 --> 00:04:12,396 Speaker 1: in this way, and why are people showing up at 64 00:04:12,396 --> 00:04:15,276 Speaker 1: the very end stage of a disease? How is the 65 00:04:15,276 --> 00:04:18,436 Speaker 1: treatment for kidney disease changed over the years? Has the 66 00:04:18,556 --> 00:04:21,556 Speaker 1: medical establishment shifted the way it responds to the disease 67 00:04:21,956 --> 00:04:24,116 Speaker 1: as the number of cases in the US has grown 68 00:04:24,756 --> 00:04:26,956 Speaker 1: a lot of people don't know this. So in nineteen 69 00:04:27,036 --> 00:04:30,036 Speaker 1: sixty five, we had the Medicare Medicaid Act right that 70 00:04:30,196 --> 00:04:32,756 Speaker 1: now allowed us to provide care for seniors or in 71 00:04:32,796 --> 00:04:36,356 Speaker 1: persons with disabilities or low income right. And one of 72 00:04:36,356 --> 00:04:39,116 Speaker 1: the things people don't realize is that in nineteen seventy 73 00:04:39,116 --> 00:04:42,316 Speaker 1: two there was an amendment that was done to the 74 00:04:42,356 --> 00:04:45,596 Speaker 1: Medicare where people with end stage kidney failure would qualify 75 00:04:45,676 --> 00:04:50,156 Speaker 1: for services through Medicare regardless of age. And the reason 76 00:04:50,276 --> 00:04:53,316 Speaker 1: is because right around in the sixties and late sixties, 77 00:04:53,636 --> 00:04:56,796 Speaker 1: the technology both for the dialysis machine and what we 78 00:04:56,836 --> 00:04:58,916 Speaker 1: call vascular access, which means the way that we can 79 00:04:58,956 --> 00:05:01,396 Speaker 1: access the blood to clean it had improved in a 80 00:05:01,436 --> 00:05:05,476 Speaker 1: way that allowed people to get dialysis in a chronic fashion. 81 00:05:05,836 --> 00:05:08,236 Speaker 1: So it became a life saving treatment, but it was 82 00:05:08,356 --> 00:05:11,436 Speaker 1: really expensed and only very very few people could actually 83 00:05:11,436 --> 00:05:15,596 Speaker 1: get the treatment, and in order to reduce those disparities 84 00:05:15,596 --> 00:05:18,356 Speaker 1: and make it available to every American, there was a 85 00:05:18,356 --> 00:05:21,716 Speaker 1: decision to cover the service. But at the time, the 86 00:05:21,796 --> 00:05:24,676 Speaker 1: projections were that maybe there would be a you know, 87 00:05:24,716 --> 00:05:28,116 Speaker 1: maybe twenty thirty thousand people on dialysis, you know, maybe 88 00:05:28,156 --> 00:05:31,196 Speaker 1: would cost a billion dollars or something of the sort. 89 00:05:31,676 --> 00:05:35,676 Speaker 1: And today we're faced with a situation where a wonderful 90 00:05:35,716 --> 00:05:39,356 Speaker 1: policy has created an incentive where we put a lot 91 00:05:39,396 --> 00:05:41,956 Speaker 1: of resources in the end stage of a disease and 92 00:05:42,076 --> 00:05:45,476 Speaker 1: nothing on prevention. We couldn't have anticipated that. Now we 93 00:05:45,556 --> 00:05:48,836 Speaker 1: have over half a million persons undergoing dialysis treatment in 94 00:05:48,876 --> 00:05:52,476 Speaker 1: the US, and so it's incredibly expensive, causes a lot 95 00:05:52,476 --> 00:05:55,956 Speaker 1: of suffering, and naively, you know, as a trainee and 96 00:05:56,116 --> 00:05:58,636 Speaker 1: thinking that that I could solve it, I thought it's 97 00:05:58,636 --> 00:06:00,836 Speaker 1: so easy. All we need to do is test people 98 00:06:01,556 --> 00:06:05,636 Speaker 1: who have respectors for the kidney disease, detect the disease early, 99 00:06:05,716 --> 00:06:08,756 Speaker 1: so we can manage it early, educate people on physicians, 100 00:06:09,396 --> 00:06:12,036 Speaker 1: put in all the management strategies, and then this won't happen. 101 00:06:12,276 --> 00:06:15,036 Speaker 1: I thought, this is solvable because what we need is 102 00:06:15,076 --> 00:06:17,796 Speaker 1: to invest in the early stages. Little did I know 103 00:06:17,916 --> 00:06:21,276 Speaker 1: then that there were so many questions to be answered. 104 00:06:21,396 --> 00:06:24,156 Speaker 1: Can you give me some examples, meaning what test should 105 00:06:24,196 --> 00:06:28,316 Speaker 1: we order, who should we test, what populations? Understanding why 106 00:06:28,356 --> 00:06:31,476 Speaker 1: the race hathing differences that we see in outcomes where 107 00:06:31,916 --> 00:06:34,676 Speaker 1: people who self identifies African Americans have under order of 108 00:06:35,236 --> 00:06:37,996 Speaker 1: two point seven times more likely to start dialysis than 109 00:06:38,116 --> 00:06:40,956 Speaker 1: compare the white persons, for example, Hispanics about one point 110 00:06:40,996 --> 00:06:44,276 Speaker 1: three times. So I was very curious to understand those 111 00:06:44,636 --> 00:06:46,476 Speaker 1: because if you don't know the causes of those things, 112 00:06:46,476 --> 00:06:50,756 Speaker 1: that you can't solve them. So what happens at Cricket Health? 113 00:06:50,756 --> 00:06:53,876 Speaker 1: How do you address these problems? So at Cricket Health, 114 00:06:53,916 --> 00:06:57,196 Speaker 1: we partner with payers and health systems to care for 115 00:06:57,236 --> 00:07:01,156 Speaker 1: people with kidney disease. We then use laboratory data or 116 00:07:01,196 --> 00:07:04,916 Speaker 1: algorithms to identify persons who might be at risk for 117 00:07:04,956 --> 00:07:07,236 Speaker 1: having kidney disease or who we know have kidney disease. 118 00:07:07,756 --> 00:07:10,716 Speaker 1: So we provide a multiary care team that includes nurse, 119 00:07:10,796 --> 00:07:15,796 Speaker 1: social worker, dietitian, pharmacist, care navigator, and a peer mentor 120 00:07:16,236 --> 00:07:18,196 Speaker 1: because it is another patient that has gone through the 121 00:07:18,276 --> 00:07:21,396 Speaker 1: journey of kidney disease that I cannot concially help someone 122 00:07:21,436 --> 00:07:24,076 Speaker 1: that's just starting. And then what we do is we 123 00:07:24,276 --> 00:07:28,436 Speaker 1: essentially number one, put in evidence based measures to slow 124 00:07:28,476 --> 00:07:31,796 Speaker 1: the progression of disease for those who we can't despite 125 00:07:31,796 --> 00:07:35,236 Speaker 1: the best of our abilities, we prepare them and give 126 00:07:35,276 --> 00:07:37,636 Speaker 1: them a lot of education around both kidneys, how to 127 00:07:37,676 --> 00:07:40,756 Speaker 1: keep the kidney healthy, but also what potential therapies they 128 00:07:40,756 --> 00:07:44,156 Speaker 1: could use to treat their kidney disease, whether it's a transplantation, dialysis, 129 00:07:44,236 --> 00:07:48,156 Speaker 1: or medical management without dialysis. We then work with the 130 00:07:48,756 --> 00:07:51,636 Speaker 1: patient doctors and we are the eyes andeers in between 131 00:07:51,676 --> 00:07:55,236 Speaker 1: appointments for the providers. They don't have the time to 132 00:07:55,236 --> 00:07:58,436 Speaker 1: see people as often as they need care, and so 133 00:07:58,476 --> 00:08:01,236 Speaker 1: we are the service that is there to be able 134 00:08:01,236 --> 00:08:04,316 Speaker 1: to give this entire support through the kidney journey. You're 135 00:08:04,316 --> 00:08:07,956 Speaker 1: saying that we are being more reactive than proactive, and 136 00:08:08,396 --> 00:08:13,436 Speaker 1: yours to do early testing are more proactive efforts. What 137 00:08:13,596 --> 00:08:16,036 Speaker 1: happens after catching it early. We're not putting people on 138 00:08:16,076 --> 00:08:19,756 Speaker 1: dialysis necessarily early, but I'm assuming that there are treatments 139 00:08:19,796 --> 00:08:23,356 Speaker 1: for people who do detect chronic kidney disease as early 140 00:08:23,396 --> 00:08:26,876 Speaker 1: as possible. Absolutely. One thing to know is that typically 141 00:08:26,916 --> 00:08:30,356 Speaker 1: kidney disease doesn't really have a lot of symptoms until 142 00:08:30,396 --> 00:08:33,916 Speaker 1: it's very advanced. And also the symptoms tend to be 143 00:08:34,116 --> 00:08:38,396 Speaker 1: not very specific, meaning it's just maybe tired, maybe a 144 00:08:38,396 --> 00:08:43,076 Speaker 1: little bit of swollen legs, or difficulty breathing. The only 145 00:08:43,116 --> 00:08:44,716 Speaker 1: way to know that something might be going on with 146 00:08:44,756 --> 00:08:47,116 Speaker 1: the kidneys is to test the blood or the urine 147 00:08:47,636 --> 00:08:50,076 Speaker 1: in the United States, as high blood pressure and diabetes 148 00:08:50,116 --> 00:08:54,116 Speaker 1: are the typical factors that are associated with kidney disease, 149 00:08:54,636 --> 00:08:58,156 Speaker 1: and so the mainstay of the treatment is controlling the 150 00:08:58,236 --> 00:09:01,916 Speaker 1: typical risk factors. They lose weight, stop smoking, the typical 151 00:09:01,956 --> 00:09:05,036 Speaker 1: things to keep health. In addition, there are certain medications 152 00:09:05,036 --> 00:09:09,436 Speaker 1: that are crucially important to consider impatience with kidney disease. 153 00:09:09,956 --> 00:09:12,036 Speaker 1: Classes of medications that have been on the market for 154 00:09:12,156 --> 00:09:16,156 Speaker 1: decades called ACE inhibitor or JE tensing converting hiber flock 155 00:09:16,276 --> 00:09:19,956 Speaker 1: so as or ARBs. Those are the pills that people 156 00:09:20,036 --> 00:09:23,916 Speaker 1: might recognize that are also used for blood pressure treatment. 157 00:09:24,236 --> 00:09:27,836 Speaker 1: So those have shown to potentially reduce the progression of 158 00:09:27,916 --> 00:09:31,516 Speaker 1: kidney disease and reduce some of the complications. The other 159 00:09:31,556 --> 00:09:33,916 Speaker 1: thing that we have to think about is even as 160 00:09:33,916 --> 00:09:37,316 Speaker 1: people are progressing, and let's say that, Okay, no matter 161 00:09:37,356 --> 00:09:39,876 Speaker 1: what you do, we do everything perfectly, you know, do 162 00:09:39,876 --> 00:09:43,396 Speaker 1: you take every right pill, you do all the right treatments, 163 00:09:43,436 --> 00:09:46,396 Speaker 1: everything is perfect, But some people will progress. And the 164 00:09:46,436 --> 00:09:49,116 Speaker 1: truth is that sometimes we don't know why despite our 165 00:09:49,156 --> 00:09:52,796 Speaker 1: best treatments. Still the best treatments for kidney failures that transplant, 166 00:09:53,476 --> 00:09:57,996 Speaker 1: and so a big, important, gigantic reason to detect the 167 00:09:58,076 --> 00:10:01,436 Speaker 1: disease early. The earlier you detect it, the more chances 168 00:10:01,436 --> 00:10:04,596 Speaker 1: you have to prevent it from progressing. But also it 169 00:10:04,596 --> 00:10:07,916 Speaker 1: gives an opportunity for you to actually be in control 170 00:10:07,956 --> 00:10:10,596 Speaker 1: and have the possibility of having a transplant before you 171 00:10:10,636 --> 00:10:13,956 Speaker 1: even need dialysis. So that's another reason rather than waiting 172 00:10:13,996 --> 00:10:19,476 Speaker 1: until somebody needs dialysis. When you're trying to do preventative care, 173 00:10:19,676 --> 00:10:22,396 Speaker 1: trying to do early detection, what types of obstacles do 174 00:10:22,436 --> 00:10:24,676 Speaker 1: you run into when you're trying to implement those plans. 175 00:10:25,476 --> 00:10:29,036 Speaker 1: Some of the first obstacles were information really understanding the 176 00:10:29,116 --> 00:10:33,316 Speaker 1: epidemiology of disease. What populations are affected, what are the 177 00:10:33,396 --> 00:10:37,436 Speaker 1: risk factors for disease, why it happens. There's also a 178 00:10:37,476 --> 00:10:40,396 Speaker 1: lot of research going on really around just how can 179 00:10:40,396 --> 00:10:43,636 Speaker 1: a disease happens, like at the tissue level, of the 180 00:10:43,676 --> 00:10:47,116 Speaker 1: molecular level, at the mechanistic level of really understanding that 181 00:10:47,196 --> 00:10:50,636 Speaker 1: in order to develop new targets. Then the next implementation, 182 00:10:50,716 --> 00:10:52,996 Speaker 1: which I worked on, is to say, Okay, now we 183 00:10:53,036 --> 00:10:55,556 Speaker 1: need to educate the patient about kidney health, and we 184 00:10:55,596 --> 00:10:58,956 Speaker 1: also need to educate primary providers. And when you think 185 00:10:58,956 --> 00:11:03,076 Speaker 1: about it, in the United States, primary care providers are 186 00:11:03,676 --> 00:11:06,956 Speaker 1: very busy, and they have to deal with many things, 187 00:11:07,516 --> 00:11:10,276 Speaker 1: you know, and sometimes they have list that is so 188 00:11:10,356 --> 00:11:12,116 Speaker 1: long of the things that they have to address for 189 00:11:12,116 --> 00:11:15,156 Speaker 1: our patient. The patienter might have a different list. A 190 00:11:15,316 --> 00:11:17,356 Speaker 1: primarycare provider might say, oh, we're going to talk about 191 00:11:17,356 --> 00:11:19,716 Speaker 1: your blood person and your diabetes, but the patient wants 192 00:11:19,716 --> 00:11:22,476 Speaker 1: to talk about their headache. Now you're adding another disease 193 00:11:22,476 --> 00:11:24,956 Speaker 1: that they have to worry about. So a big part 194 00:11:24,996 --> 00:11:27,876 Speaker 1: of it has been how do we then provide tools 195 00:11:28,236 --> 00:11:30,476 Speaker 1: so that we can help the primary care provider be 196 00:11:30,516 --> 00:11:35,356 Speaker 1: efficient and actually understand how to test for kidney disease 197 00:11:35,796 --> 00:11:38,436 Speaker 1: flag When a patient has kidney disease. So we did 198 00:11:38,476 --> 00:11:40,636 Speaker 1: a couple of projects where we did that, where we 199 00:11:40,676 --> 00:11:44,476 Speaker 1: actually tested some tools to improve recognition of kidney disease 200 00:11:44,516 --> 00:11:47,276 Speaker 1: early with the hope that the end the management would improve. 201 00:11:54,236 --> 00:11:56,876 Speaker 1: How do you recomcile the work that you're doing being 202 00:11:56,996 --> 00:12:01,076 Speaker 1: very specific about kidneys, but also probably being something that 203 00:12:01,116 --> 00:12:04,116 Speaker 1: could be applied universally when it comes to healthcare. Do 204 00:12:04,156 --> 00:12:07,636 Speaker 1: you ever struggle with kind of the existential nature of saying, like, hey, 205 00:12:08,036 --> 00:12:10,036 Speaker 1: you know, I'll try to fix the kidneys, but this 206 00:12:10,116 --> 00:12:11,916 Speaker 1: is probably something that needs to be applied probably in 207 00:12:11,956 --> 00:12:15,916 Speaker 1: our hearts, probably you know, all kinds of other transplants 208 00:12:15,956 --> 00:12:19,516 Speaker 1: as well, when we're talking about prevention versus of reactive treatment. 209 00:12:19,916 --> 00:12:24,436 Speaker 1: Oh yeah, Well, but I can tell you is I 210 00:12:24,436 --> 00:12:27,476 Speaker 1: would love to just change the world right for everybody. 211 00:12:27,956 --> 00:12:31,476 Speaker 1: I think the thing that grabs me about kidney disease 212 00:12:32,316 --> 00:12:36,516 Speaker 1: is that it is so stark how much we invest 213 00:12:36,556 --> 00:12:39,316 Speaker 1: at the end of the disease compared to others. Now, 214 00:12:39,396 --> 00:12:41,676 Speaker 1: I'm not saying there's not a lot that we need 215 00:12:41,716 --> 00:12:45,116 Speaker 1: to do in diabetes and heart disease and high cholesterol 216 00:12:45,156 --> 00:12:47,276 Speaker 1: and all of these kinds of things, But when you 217 00:12:47,316 --> 00:12:50,956 Speaker 1: think about it, let's say, for example, heart disease. There's 218 00:12:50,956 --> 00:12:53,716 Speaker 1: a lot more knowledge out there, and primary care providers 219 00:12:53,716 --> 00:12:56,876 Speaker 1: are more aware. Patients are going into their doctor asking 220 00:12:56,916 --> 00:12:59,676 Speaker 1: to get their cholesterol checked. I mean, how many people 221 00:12:59,716 --> 00:13:01,316 Speaker 1: do you know they're going to their doctor and say, 222 00:13:01,516 --> 00:13:03,956 Speaker 1: can I have my kidneys checked? Right? And so I 223 00:13:03,996 --> 00:13:07,116 Speaker 1: think we've done a little bit better in the healthcare 224 00:13:07,156 --> 00:13:10,716 Speaker 1: system to talk about prevention when it comes to kidney health. 225 00:13:11,436 --> 00:13:14,316 Speaker 1: There's actually an executive order that was signed a couple 226 00:13:14,316 --> 00:13:17,556 Speaker 1: of years ago under the Trump administration, and in fact, 227 00:13:17,596 --> 00:13:22,876 Speaker 1: they are testing specifically models that promote early detection of 228 00:13:22,916 --> 00:13:27,516 Speaker 1: disease management early because they're realizing that the cost of 229 00:13:27,556 --> 00:13:29,716 Speaker 1: just putting all the efforts at the end of the 230 00:13:29,796 --> 00:13:31,956 Speaker 1: disease costs a lot of money and cause a lot 231 00:13:31,956 --> 00:13:34,156 Speaker 1: of suffering. So we are seeing a little bit of 232 00:13:34,196 --> 00:13:37,876 Speaker 1: a move. What I hope is that when we move 233 00:13:37,956 --> 00:13:40,956 Speaker 1: to paying for value and good outcomes, is that this 234 00:13:41,076 --> 00:13:44,036 Speaker 1: actually does that for all chronic diseases. And I think 235 00:13:44,036 --> 00:13:46,476 Speaker 1: we're seeing some of that shift in other chronic diseases 236 00:13:46,516 --> 00:13:52,116 Speaker 1: as well. It's testing expensive, Nope, it's actually quite cheap. 237 00:13:52,356 --> 00:13:54,276 Speaker 1: So if you just do you know, the blood and 238 00:13:54,316 --> 00:13:57,676 Speaker 1: the urine test can be pretty cheap. Why wouldn't this 239 00:13:57,756 --> 00:14:00,876 Speaker 1: just be a posture The doctors more widely take to say, hey, 240 00:14:00,876 --> 00:14:05,396 Speaker 1: why don't we just test this to make sure you're good? Yeah? Yeah, 241 00:14:05,476 --> 00:14:08,076 Speaker 1: So the funny thing is that the blood test is 242 00:14:08,116 --> 00:14:11,596 Speaker 1: often included in the physical but typically the urins not tested. 243 00:14:11,636 --> 00:14:14,276 Speaker 1: It's just a blood and you need really both tests. 244 00:14:14,596 --> 00:14:16,556 Speaker 1: I think it's a couple of things. One is lack 245 00:14:16,596 --> 00:14:21,836 Speaker 1: of education, both for patients and providers. I think it's 246 00:14:22,116 --> 00:14:25,876 Speaker 1: inaccurate perception by providers that if you find kidney disease 247 00:14:25,956 --> 00:14:27,476 Speaker 1: or a leader, that there's nothing to do. And I 248 00:14:27,476 --> 00:14:30,876 Speaker 1: think I've already hopefully convinced people that there is a 249 00:14:30,916 --> 00:14:33,916 Speaker 1: lot to do. And number three again is just not 250 00:14:33,956 --> 00:14:36,676 Speaker 1: having the time, you right to deal with so many 251 00:14:36,756 --> 00:14:39,876 Speaker 1: of the issues that our prima care providers have to 252 00:14:39,916 --> 00:14:43,556 Speaker 1: deal with, and frankly like a lack of support. You know, 253 00:14:43,596 --> 00:14:46,356 Speaker 1: the job of US special is actually to support the 254 00:14:46,436 --> 00:14:50,436 Speaker 1: Prima care community in handling all the competing, you know, 255 00:14:50,596 --> 00:15:01,236 Speaker 1: diseases that they have to they have to handle. Doctor praulta, 256 00:15:01,516 --> 00:15:03,956 Speaker 1: is there a way in which we perpetuate the brokenness 257 00:15:04,076 --> 00:15:06,476 Speaker 1: of the American healthcare system? And when I say that 258 00:15:06,556 --> 00:15:09,396 Speaker 1: I guess I'm asking in whose interest is it to 259 00:15:09,476 --> 00:15:13,956 Speaker 1: work from the reactive stance rather than the proactive stance. Well, 260 00:15:13,996 --> 00:15:16,476 Speaker 1: I think if you think about it, the healthcare system 261 00:15:17,036 --> 00:15:22,916 Speaker 1: in America rewards for procedures, for visits, for volume. So 262 00:15:23,036 --> 00:15:25,636 Speaker 1: the more patients to see, the more procedures that you do, 263 00:15:26,156 --> 00:15:29,116 Speaker 1: the more money a system will make. Right, And that 264 00:15:29,196 --> 00:15:31,356 Speaker 1: is what we call quote unquote fee for service, which 265 00:15:31,396 --> 00:15:33,356 Speaker 1: means that you get paid a fee for a service 266 00:15:33,356 --> 00:15:36,316 Speaker 1: that you do. But we are seeing a transformation into 267 00:15:36,356 --> 00:15:40,276 Speaker 1: what we call value based care, which is actually let's 268 00:15:40,356 --> 00:15:43,956 Speaker 1: pay for keeping people healthy, for keeping people out of 269 00:15:43,996 --> 00:15:46,556 Speaker 1: the hospital. And let's say five to ten years. What 270 00:15:46,556 --> 00:15:48,516 Speaker 1: does this look like or do you have a timeline 271 00:15:48,796 --> 00:15:51,196 Speaker 1: for when you say, hey, you know what we've done, 272 00:15:51,196 --> 00:15:54,916 Speaker 1: it solved, We're good. Yeah. Well I'm ready to change 273 00:15:54,916 --> 00:15:58,276 Speaker 1: the world today. Right. So I wish I could tell 274 00:15:58,316 --> 00:16:00,836 Speaker 1: you that in five years from now, we have touched 275 00:16:01,076 --> 00:16:04,516 Speaker 1: hundreds of thousands of lives and that barely any of 276 00:16:04,516 --> 00:16:07,596 Speaker 1: these people on dialysis, that the majority of our at home, 277 00:16:07,676 --> 00:16:10,396 Speaker 1: the majority have gotten a transplant, and that people are 278 00:16:10,396 --> 00:16:14,476 Speaker 1: living a full life even with kidney disease. So I 279 00:16:14,596 --> 00:16:19,476 Speaker 1: am still part of UCSF in a smaller capacity, but 280 00:16:19,676 --> 00:16:22,996 Speaker 1: being the chief medical officer Cricket has really allowed me 281 00:16:23,396 --> 00:16:26,756 Speaker 1: to take everything from my clinical experience, from what I know, 282 00:16:26,876 --> 00:16:29,476 Speaker 1: from what we know about the disease, and implemented and 283 00:16:29,556 --> 00:16:34,476 Speaker 1: actually make it a viable and incredibly successful program that 284 00:16:34,516 --> 00:16:37,276 Speaker 1: we are implementing nationwide. I said to me, this is 285 00:16:37,316 --> 00:16:41,596 Speaker 1: an accelerator and the final part is again a value 286 00:16:41,596 --> 00:16:44,436 Speaker 1: based program where we are rewarded for keeping people healthy. 287 00:16:44,716 --> 00:16:47,596 Speaker 1: Do you guys take insurance, Yeah, we work with insurance companies, 288 00:16:47,636 --> 00:16:50,956 Speaker 1: health systems and so forth. Yet do you ever have 289 00:16:51,036 --> 00:16:54,236 Speaker 1: concerned that being a part of a for profit company 290 00:16:54,316 --> 00:16:58,556 Speaker 1: with albeit an altruistic mission, that you'll ever be beholden 291 00:16:58,636 --> 00:17:02,036 Speaker 1: to the bottom line, to stakeholders, to the shareholders, to 292 00:17:02,116 --> 00:17:05,196 Speaker 1: the folks that really need the business to make money, 293 00:17:05,436 --> 00:17:08,796 Speaker 1: even if that runs a skew of the mission. I mean, 294 00:17:08,836 --> 00:17:11,636 Speaker 1: there's always going to be, you know, a business that 295 00:17:11,636 --> 00:17:14,436 Speaker 1: you're building. But the one thing about Cricket Health that 296 00:17:14,596 --> 00:17:17,876 Speaker 1: makes me very product that we are changing the way 297 00:17:18,356 --> 00:17:21,276 Speaker 1: even that reimbursement happens. So pretty much everything that we 298 00:17:21,316 --> 00:17:24,556 Speaker 1: are doing is value based. Once you change the incentive, 299 00:17:25,276 --> 00:17:28,516 Speaker 1: then it's a whole different way that you're thinking about 300 00:17:28,636 --> 00:17:31,276 Speaker 1: how you're going to build your business, and so that's 301 00:17:31,356 --> 00:17:47,076 Speaker 1: really what we're trying to do. What can listeners do 302 00:17:47,116 --> 00:17:50,196 Speaker 1: if they're interested in learning more about chronic kidney disease 303 00:17:50,356 --> 00:17:52,476 Speaker 1: or even the research that you're doing, or if they 304 00:17:52,516 --> 00:17:55,836 Speaker 1: want to get involved, What can listeners do? First of all, 305 00:17:55,956 --> 00:18:00,716 Speaker 1: get informed. The CDC has an incredible website that talks 306 00:18:00,716 --> 00:18:03,556 Speaker 1: about kidney disease. I would say, you know, talk to 307 00:18:03,596 --> 00:18:06,356 Speaker 1: your family members and community, because when you talk about it, 308 00:18:06,396 --> 00:18:08,476 Speaker 1: you'll discover that there's more people you know that have 309 00:18:08,556 --> 00:18:11,596 Speaker 1: kidneys than you ever imagined. You know. The other thing 310 00:18:11,676 --> 00:18:13,996 Speaker 1: is talk to your doctor, talk and say, okay, should 311 00:18:13,996 --> 00:18:16,076 Speaker 1: I be tested? And then what would we do about it? 312 00:18:16,116 --> 00:18:19,676 Speaker 1: I think that's important. I think people should also if 313 00:18:19,716 --> 00:18:21,716 Speaker 1: they have loved ones who are affected with kiddings, he 314 00:18:21,796 --> 00:18:26,276 Speaker 1: should learn about transplantation and living donation, for example. But 315 00:18:26,356 --> 00:18:32,036 Speaker 1: I certainly urged people to go get informed. Doctor Parlta, 316 00:18:32,116 --> 00:18:34,356 Speaker 1: thank you so much for being with us today. Oh 317 00:18:34,396 --> 00:18:36,436 Speaker 1: it's been so fun to talk to you. And I 318 00:18:36,556 --> 00:18:39,116 Speaker 1: tell you that we must have hope and when we 319 00:18:39,156 --> 00:18:42,116 Speaker 1: think about our healthcare system, understand that compassion is a 320 00:18:42,116 --> 00:18:47,036 Speaker 1: big part of what we need. To build. Doctor Carmen 321 00:18:47,116 --> 00:18:49,916 Speaker 1: Parlta is the chief medical Officer at Cricket Health. She 322 00:18:50,036 --> 00:18:53,476 Speaker 1: co founded the Kidney Health Research Collaborative at University of California, 323 00:18:53,516 --> 00:18:57,276 Speaker 1: San Francisco and the San Francisco VA. If you'd like 324 00:18:57,316 --> 00:19:00,076 Speaker 1: to learn more about kidney health and preventative medicine, we'll 325 00:19:00,116 --> 00:19:03,236 Speaker 1: include a link to the CDC page Doctor Barlta recommended 326 00:19:03,396 --> 00:19:06,796 Speaker 1: in our show notes. Solvable is produced by Jocelyn Frank, 327 00:19:07,396 --> 00:19:11,596 Speaker 1: research by David Jack, booking by Lisa Dunn, editing help 328 00:19:11,636 --> 00:19:15,636 Speaker 1: from Keyshell Williams. Our managing producer is Sasha Matthias. Our 329 00:19:15,676 --> 00:19:20,076 Speaker 1: executive producer is Mio LaBelle. I'm Ronald Young Junior. Thanks 330 00:19:20,076 --> 00:19:20,596 Speaker 1: for listening.