WEBVTT - Kidney Failure is Solvable 0:00:15.076 --> 0:00:25.756 Pushkin, this is solvable. I'm Ronald Young Jr. If you're 0:00:25.756 --> 0:00:28.156 anything like me, As you get older, you begin to 0:00:28.196 --> 0:00:31.876 think about your general health and wellness, being more active, 0:00:32.436 --> 0:00:36.076 my blood pressure, my cholesterol, trying to eat more vegetables, 0:00:36.516 --> 0:00:39.916 making the appointment for my annual physical. But even if 0:00:39.916 --> 0:00:42.276 I take the time to tend to my lifestyle choices 0:00:42.316 --> 0:00:46.476 and overall health, some preventative care measures may still slip 0:00:46.516 --> 0:00:49.716 through the cracks, just because I don't know all the 0:00:49.836 --> 0:00:53.796 questions to ask. Patients are going into their doctor asking 0:00:53.836 --> 0:00:56.636 to get their cholesterol checked. I mean, how many people 0:00:56.636 --> 0:00:58.236 do you know they're going to their doctor and say, 0:00:58.436 --> 0:01:00.876 can I have my kidney's checked? I certainly don't think 0:01:00.876 --> 0:01:03.356 about my kidneys on a regular basis, But one in 0:01:03.396 --> 0:01:07.316 seven adults has chronic kidney disease or CKD, and because 0:01:07.316 --> 0:01:10.836 it's asymptomatic in the early stages, nine people with the 0:01:10.916 --> 0:01:14.636 disease have no idea they've got it. And today we're 0:01:14.636 --> 0:01:18.956 phased with the situation where a wonderful policy has created 0:01:19.156 --> 0:01:22.036 an incentive where we put a lot of resources in 0:01:22.116 --> 0:01:24.836 the end stage of a disease and nothing on prevention 0:01:25.716 --> 0:01:29.236 for end stage renal disease. Also known as kidney failure. 0:01:29.596 --> 0:01:33.036 Patients are often treated with dialysis. It's a very time 0:01:33.076 --> 0:01:36.716 consuming and exhaustive treatment that can save lives, but can 0:01:36.756 --> 0:01:41.636 also be extremely disruptive. Doctor Carmen Peralta co founded the 0:01:41.716 --> 0:01:45.316 Kidney Health Research Collaborative at the University of California, San 0:01:45.356 --> 0:01:48.716 Francisco to change all that. Some of the first obstacles 0:01:48.756 --> 0:01:53.916 were information really understanding the epidemiology of disease, what populations 0:01:53.916 --> 0:01:57.396 are affected, what are the risk factors for disease, why 0:01:57.516 --> 0:02:01.036 it happens. Doctor Peralta is also the chief medical officer 0:02:01.076 --> 0:02:04.436 at Cricket Health, a for profit company that specializes in 0:02:04.476 --> 0:02:08.276 helping people with kidney disease by supporting early detection programs 0:02:08.316 --> 0:02:13.676 and providing risk assessments. A big, important, gigantic reason to 0:02:14.036 --> 0:02:17.516 detect the disease early. The earlier you detected, the more 0:02:17.556 --> 0:02:20.996 chances you have to prevent it from progressing. Nearly thirty 0:02:21.036 --> 0:02:25.196 seven million Americans lived with chronic kidney disease. Getting an 0:02:25.196 --> 0:02:28.396 early diagnosis could improve the quality of life for many 0:02:28.556 --> 0:02:33.036 and even prevent the necessity of in stage treatment. Chronic 0:02:33.076 --> 0:02:43.276 kidney disease is solvable. How did you get interested in 0:02:43.316 --> 0:02:48.716 kidneys specifically, my grandfather, who I never met, was a physician, 0:02:49.036 --> 0:02:52.836 and so I grew up in em Barranquia, Colombia, and 0:02:53.156 --> 0:02:56.116 he was one of those physicians that would just do 0:02:56.356 --> 0:02:59.716 anything for his patience. And my mother always talked about 0:02:59.836 --> 0:03:02.076 him and the way people loved him and all the 0:03:02.116 --> 0:03:04.996 things that he did, and so that was an inspiration. 0:03:05.596 --> 0:03:09.276 My uncle was also a doctor, and I love the 0:03:09.276 --> 0:03:11.996 physiology of the kidney. I mean, when you probably talk 0:03:12.076 --> 0:03:14.636 to people about kidneys, they think, oh, they filter your blood, 0:03:14.636 --> 0:03:16.676 which is true, but the kidney has a ton of 0:03:16.716 --> 0:03:20.636 other functions, regulating the water content in your body, blood pressure, 0:03:21.156 --> 0:03:23.156 helping make red blood cells, and all these things that 0:03:23.156 --> 0:03:26.796 I found it to be absolutely fascinating. And I was 0:03:26.836 --> 0:03:31.516 struck by several things that happened during my training. One 0:03:31.956 --> 0:03:36.036 was meeting patients that would arrive in an emergency room 0:03:36.076 --> 0:03:38.356 just sort of saying that they didn't feel well or 0:03:38.396 --> 0:03:40.956 maybe they were swollen, or they were having trouble breathing, 0:03:41.596 --> 0:03:44.116 and then they were diagnosed with kidney failure what we 0:03:44.156 --> 0:03:46.876 call end stage renal disease or end stage kidney disease, 0:03:47.476 --> 0:03:51.156 and told that they needed dialysis. I also was struck 0:03:51.196 --> 0:03:54.876 by the reports that we were having in those times. 0:03:54.876 --> 0:03:58.156 And remember this is the early nineteen nineties, thinking about 0:03:58.156 --> 0:04:00.956 the race disparities and SoC economic disparities that we saw 0:04:00.996 --> 0:04:05.076 in the disease, and that truly marked me because I 0:04:05.156 --> 0:04:09.276 was thinking, why is this disease devastating this community is 0:04:09.316 --> 0:04:12.396 in this way, and why are people showing up at 0:04:12.396 --> 0:04:15.276 the very end stage of a disease? How is the 0:04:15.276 --> 0:04:18.436 treatment for kidney disease changed over the years? Has the 0:04:18.556 --> 0:04:21.556 medical establishment shifted the way it responds to the disease 0:04:21.956 --> 0:04:24.116 as the number of cases in the US has grown 0:04:24.756 --> 0:04:26.956 a lot of people don't know this. So in nineteen 0:04:27.036 --> 0:04:30.036 sixty five, we had the Medicare Medicaid Act right that 0:04:30.196 --> 0:04:32.756 now allowed us to provide care for seniors or in 0:04:32.796 --> 0:04:36.356 persons with disabilities or low income right. And one of 0:04:36.356 --> 0:04:39.116 the things people don't realize is that in nineteen seventy 0:04:39.116 --> 0:04:42.316 two there was an amendment that was done to the 0:04:42.356 --> 0:04:45.596 Medicare where people with end stage kidney failure would qualify 0:04:45.676 --> 0:04:50.156 for services through Medicare regardless of age. And the reason 0:04:50.276 --> 0:04:53.316 is because right around in the sixties and late sixties, 0:04:53.636 --> 0:04:56.796 the technology both for the dialysis machine and what we 0:04:56.836 --> 0:04:58.916 call vascular access, which means the way that we can 0:04:58.956 --> 0:05:01.396 access the blood to clean it had improved in a 0:05:01.436 --> 0:05:05.476 way that allowed people to get dialysis in a chronic fashion. 0:05:05.836 --> 0:05:08.236 So it became a life saving treatment, but it was 0:05:08.356 --> 0:05:11.436 really expensed and only very very few people could actually 0:05:11.436 --> 0:05:15.596 get the treatment, and in order to reduce those disparities 0:05:15.596 --> 0:05:18.356 and make it available to every American, there was a 0:05:18.356 --> 0:05:21.716 decision to cover the service. But at the time, the 0:05:21.796 --> 0:05:24.676 projections were that maybe there would be a you know, 0:05:24.716 --> 0:05:28.116 maybe twenty thirty thousand people on dialysis, you know, maybe 0:05:28.156 --> 0:05:31.196 would cost a billion dollars or something of the sort. 0:05:31.676 --> 0:05:35.676 And today we're faced with a situation where a wonderful 0:05:35.716 --> 0:05:39.356 policy has created an incentive where we put a lot 0:05:39.396 --> 0:05:41.956 of resources in the end stage of a disease and 0:05:42.076 --> 0:05:45.476 nothing on prevention. We couldn't have anticipated that. Now we 0:05:45.556 --> 0:05:48.836 have over half a million persons undergoing dialysis treatment in 0:05:48.876 --> 0:05:52.476 the US, and so it's incredibly expensive, causes a lot 0:05:52.476 --> 0:05:55.956 of suffering, and naively, you know, as a trainee and 0:05:56.116 --> 0:05:58.636 thinking that that I could solve it, I thought it's 0:05:58.636 --> 0:06:00.836 so easy. All we need to do is test people 0:06:01.556 --> 0:06:05.636 who have respectors for the kidney disease, detect the disease early, 0:06:05.716 --> 0:06:08.756 so we can manage it early, educate people on physicians, 0:06:09.396 --> 0:06:12.036 put in all the management strategies, and then this won't happen. 0:06:12.276 --> 0:06:15.036 I thought, this is solvable because what we need is 0:06:15.076 --> 0:06:17.796 to invest in the early stages. Little did I know 0:06:17.916 --> 0:06:21.276 then that there were so many questions to be answered. 0:06:21.396 --> 0:06:24.156 Can you give me some examples, meaning what test should 0:06:24.196 --> 0:06:28.316 we order, who should we test, what populations? Understanding why 0:06:28.356 --> 0:06:31.476 the race hathing differences that we see in outcomes where 0:06:31.916 --> 0:06:34.676 people who self identifies African Americans have under order of 0:06:35.236 --> 0:06:37.996 two point seven times more likely to start dialysis than 0:06:38.116 --> 0:06:40.956 compare the white persons, for example, Hispanics about one point 0:06:40.996 --> 0:06:44.276 three times. So I was very curious to understand those 0:06:44.636 --> 0:06:46.476 because if you don't know the causes of those things, 0:06:46.476 --> 0:06:50.756 that you can't solve them. So what happens at Cricket Health? 0:06:50.756 --> 0:06:53.876 How do you address these problems? So at Cricket Health, 0:06:53.916 --> 0:06:57.196 we partner with payers and health systems to care for 0:06:57.236 --> 0:07:01.156 people with kidney disease. We then use laboratory data or 0:07:01.196 --> 0:07:04.916 algorithms to identify persons who might be at risk for 0:07:04.956 --> 0:07:07.236 having kidney disease or who we know have kidney disease. 0:07:07.756 --> 0:07:10.716 So we provide a multiary care team that includes nurse, 0:07:10.796 --> 0:07:15.796 social worker, dietitian, pharmacist, care navigator, and a peer mentor 0:07:16.236 --> 0:07:18.196 because it is another patient that has gone through the 0:07:18.276 --> 0:07:21.396 journey of kidney disease that I cannot concially help someone 0:07:21.436 --> 0:07:24.076 that's just starting. And then what we do is we 0:07:24.276 --> 0:07:28.436 essentially number one, put in evidence based measures to slow 0:07:28.476 --> 0:07:31.796 the progression of disease for those who we can't despite 0:07:31.796 --> 0:07:35.236 the best of our abilities, we prepare them and give 0:07:35.276 --> 0:07:37.636 them a lot of education around both kidneys, how to 0:07:37.676 --> 0:07:40.756 keep the kidney healthy, but also what potential therapies they 0:07:40.756 --> 0:07:44.156 could use to treat their kidney disease, whether it's a transplantation, dialysis, 0:07:44.236 --> 0:07:48.156 or medical management without dialysis. We then work with the 0:07:48.756 --> 0:07:51.636 patient doctors and we are the eyes andeers in between 0:07:51.676 --> 0:07:55.236 appointments for the providers. They don't have the time to 0:07:55.236 --> 0:07:58.436 see people as often as they need care, and so 0:07:58.476 --> 0:08:01.236 we are the service that is there to be able 0:08:01.236 --> 0:08:04.316 to give this entire support through the kidney journey. You're 0:08:04.316 --> 0:08:07.956 saying that we are being more reactive than proactive, and 0:08:08.396 --> 0:08:13.436 yours to do early testing are more proactive efforts. What 0:08:13.596 --> 0:08:16.036 happens after catching it early. We're not putting people on 0:08:16.076 --> 0:08:19.756 dialysis necessarily early, but I'm assuming that there are treatments 0:08:19.796 --> 0:08:23.356 for people who do detect chronic kidney disease as early 0:08:23.396 --> 0:08:26.876 as possible. Absolutely. One thing to know is that typically 0:08:26.916 --> 0:08:30.356 kidney disease doesn't really have a lot of symptoms until 0:08:30.396 --> 0:08:33.916 it's very advanced. And also the symptoms tend to be 0:08:34.116 --> 0:08:38.396 not very specific, meaning it's just maybe tired, maybe a 0:08:38.396 --> 0:08:43.076 little bit of swollen legs, or difficulty breathing. The only 0:08:43.116 --> 0:08:44.716 way to know that something might be going on with 0:08:44.756 --> 0:08:47.116 the kidneys is to test the blood or the urine 0:08:47.636 --> 0:08:50.076 in the United States, as high blood pressure and diabetes 0:08:50.116 --> 0:08:54.116 are the typical factors that are associated with kidney disease, 0:08:54.636 --> 0:08:58.156 and so the mainstay of the treatment is controlling the 0:08:58.236 --> 0:09:01.916 typical risk factors. They lose weight, stop smoking, the typical 0:09:01.956 --> 0:09:05.036 things to keep health. In addition, there are certain medications 0:09:05.036 --> 0:09:09.436 that are crucially important to consider impatience with kidney disease. 0:09:09.956 --> 0:09:12.036 Classes of medications that have been on the market for 0:09:12.156 --> 0:09:16.156 decades called ACE inhibitor or JE tensing converting hiber flock 0:09:16.276 --> 0:09:19.956 so as or ARBs. Those are the pills that people 0:09:20.036 --> 0:09:23.916 might recognize that are also used for blood pressure treatment. 0:09:24.236 --> 0:09:27.836 So those have shown to potentially reduce the progression of 0:09:27.916 --> 0:09:31.516 kidney disease and reduce some of the complications. The other 0:09:31.556 --> 0:09:33.916 thing that we have to think about is even as 0:09:33.916 --> 0:09:37.316 people are progressing, and let's say that, Okay, no matter 0:09:37.356 --> 0:09:39.876 what you do, we do everything perfectly, you know, do 0:09:39.876 --> 0:09:43.396 you take every right pill, you do all the right treatments, 0:09:43.436 --> 0:09:46.396 everything is perfect, But some people will progress. And the 0:09:46.436 --> 0:09:49.116 truth is that sometimes we don't know why despite our 0:09:49.156 --> 0:09:52.796 best treatments. Still the best treatments for kidney failures that transplant, 0:09:53.476 --> 0:09:57.996 and so a big, important, gigantic reason to detect the 0:09:58.076 --> 0:10:01.436 disease early. The earlier you detect it, the more chances 0:10:01.436 --> 0:10:04.596 you have to prevent it from progressing. But also it 0:10:04.596 --> 0:10:07.916 gives an opportunity for you to actually be in control 0:10:07.956 --> 0:10:10.596 and have the possibility of having a transplant before you 0:10:10.636 --> 0:10:13.956 even need dialysis. So that's another reason rather than waiting 0:10:13.996 --> 0:10:19.476 until somebody needs dialysis. When you're trying to do preventative care, 0:10:19.676 --> 0:10:22.396 trying to do early detection, what types of obstacles do 0:10:22.436 --> 0:10:24.676 you run into when you're trying to implement those plans. 0:10:25.476 --> 0:10:29.036 Some of the first obstacles were information really understanding the 0:10:29.116 --> 0:10:33.316 epidemiology of disease. What populations are affected, what are the 0:10:33.396 --> 0:10:37.436 risk factors for disease, why it happens. There's also a 0:10:37.476 --> 0:10:40.396 lot of research going on really around just how can 0:10:40.396 --> 0:10:43.636 a disease happens, like at the tissue level, of the 0:10:43.676 --> 0:10:47.116 molecular level, at the mechanistic level of really understanding that 0:10:47.196 --> 0:10:50.636 in order to develop new targets. Then the next implementation, 0:10:50.716 --> 0:10:52.996 which I worked on, is to say, Okay, now we 0:10:53.036 --> 0:10:55.556 need to educate the patient about kidney health, and we 0:10:55.596 --> 0:10:58.956 also need to educate primary providers. And when you think 0:10:58.956 --> 0:11:03.076 about it, in the United States, primary care providers are 0:11:03.676 --> 0:11:06.956 very busy, and they have to deal with many things, 0:11:07.516 --> 0:11:10.276 you know, and sometimes they have list that is so 0:11:10.356 --> 0:11:12.116 long of the things that they have to address for 0:11:12.116 --> 0:11:15.156 our patient. The patienter might have a different list. A 0:11:15.316 --> 0:11:17.356 primarycare provider might say, oh, we're going to talk about 0:11:17.356 --> 0:11:19.716 your blood person and your diabetes, but the patient wants 0:11:19.716 --> 0:11:22.476 to talk about their headache. Now you're adding another disease 0:11:22.476 --> 0:11:24.956 that they have to worry about. So a big part 0:11:24.996 --> 0:11:27.876 of it has been how do we then provide tools 0:11:28.236 --> 0:11:30.476 so that we can help the primary care provider be 0:11:30.516 --> 0:11:35.356 efficient and actually understand how to test for kidney disease 0:11:35.796 --> 0:11:38.436 flag When a patient has kidney disease. So we did 0:11:38.476 --> 0:11:40.636 a couple of projects where we did that, where we 0:11:40.676 --> 0:11:44.476 actually tested some tools to improve recognition of kidney disease 0:11:44.516 --> 0:11:47.276 early with the hope that the end the management would improve. 0:11:54.236 --> 0:11:56.876 How do you recomcile the work that you're doing being 0:11:56.996 --> 0:12:01.076 very specific about kidneys, but also probably being something that 0:12:01.116 --> 0:12:04.116 could be applied universally when it comes to healthcare. Do 0:12:04.156 --> 0:12:07.636 you ever struggle with kind of the existential nature of saying, like, hey, 0:12:08.036 --> 0:12:10.036 you know, I'll try to fix the kidneys, but this 0:12:10.116 --> 0:12:11.916 is probably something that needs to be applied probably in 0:12:11.956 --> 0:12:15.916 our hearts, probably you know, all kinds of other transplants 0:12:15.956 --> 0:12:19.516 as well, when we're talking about prevention versus of reactive treatment. 0:12:19.916 --> 0:12:24.436 Oh yeah, Well, but I can tell you is I 0:12:24.436 --> 0:12:27.476 would love to just change the world right for everybody. 0:12:27.956 --> 0:12:31.476 I think the thing that grabs me about kidney disease 0:12:32.316 --> 0:12:36.516 is that it is so stark how much we invest 0:12:36.556 --> 0:12:39.316 at the end of the disease compared to others. Now, 0:12:39.396 --> 0:12:41.676 I'm not saying there's not a lot that we need 0:12:41.716 --> 0:12:45.116 to do in diabetes and heart disease and high cholesterol 0:12:45.156 --> 0:12:47.276 and all of these kinds of things, But when you 0:12:47.316 --> 0:12:50.956 think about it, let's say, for example, heart disease. There's 0:12:50.956 --> 0:12:53.716 a lot more knowledge out there, and primary care providers 0:12:53.716 --> 0:12:56.876 are more aware. Patients are going into their doctor asking 0:12:56.916 --> 0:12:59.676 to get their cholesterol checked. I mean, how many people 0:12:59.716 --> 0:13:01.316 do you know they're going to their doctor and say, 0:13:01.516 --> 0:13:03.956 can I have my kidneys checked? Right? And so I 0:13:03.996 --> 0:13:07.116 think we've done a little bit better in the healthcare 0:13:07.156 --> 0:13:10.716 system to talk about prevention when it comes to kidney health. 0:13:11.436 --> 0:13:14.316 There's actually an executive order that was signed a couple 0:13:14.316 --> 0:13:17.556 of years ago under the Trump administration, and in fact, 0:13:17.596 --> 0:13:22.876 they are testing specifically models that promote early detection of 0:13:22.916 --> 0:13:27.516 disease management early because they're realizing that the cost of 0:13:27.556 --> 0:13:29.716 just putting all the efforts at the end of the 0:13:29.796 --> 0:13:31.956 disease costs a lot of money and cause a lot 0:13:31.956 --> 0:13:34.156 of suffering. So we are seeing a little bit of 0:13:34.196 --> 0:13:37.876 a move. What I hope is that when we move 0:13:37.956 --> 0:13:40.956 to paying for value and good outcomes, is that this 0:13:41.076 --> 0:13:44.036 actually does that for all chronic diseases. And I think 0:13:44.036 --> 0:13:46.476 we're seeing some of that shift in other chronic diseases 0:13:46.516 --> 0:13:52.116 as well. It's testing expensive, Nope, it's actually quite cheap. 0:13:52.356 --> 0:13:54.276 So if you just do you know, the blood and 0:13:54.316 --> 0:13:57.676 the urine test can be pretty cheap. Why wouldn't this 0:13:57.756 --> 0:14:00.876 just be a posture The doctors more widely take to say, hey, 0:14:00.876 --> 0:14:05.396 why don't we just test this to make sure you're good? Yeah? Yeah, 0:14:05.476 --> 0:14:08.076 So the funny thing is that the blood test is 0:14:08.116 --> 0:14:11.596 often included in the physical but typically the urins not tested. 0:14:11.636 --> 0:14:14.276 It's just a blood and you need really both tests. 0:14:14.596 --> 0:14:16.556 I think it's a couple of things. One is lack 0:14:16.596 --> 0:14:21.836 of education, both for patients and providers. I think it's 0:14:22.116 --> 0:14:25.876 inaccurate perception by providers that if you find kidney disease 0:14:25.956 --> 0:14:27.476 or a leader, that there's nothing to do. And I 0:14:27.476 --> 0:14:30.876 think I've already hopefully convinced people that there is a 0:14:30.916 --> 0:14:33.916 lot to do. And number three again is just not 0:14:33.956 --> 0:14:36.676 having the time, you right to deal with so many 0:14:36.756 --> 0:14:39.876 of the issues that our prima care providers have to 0:14:39.916 --> 0:14:43.556 deal with, and frankly like a lack of support. You know, 0:14:43.596 --> 0:14:46.356 the job of US special is actually to support the 0:14:46.436 --> 0:14:50.436 Prima care community in handling all the competing, you know, 0:14:50.596 --> 0:15:01.236 diseases that they have to they have to handle. Doctor praulta, 0:15:01.516 --> 0:15:03.956 is there a way in which we perpetuate the brokenness 0:15:04.076 --> 0:15:06.476 of the American healthcare system? And when I say that 0:15:06.556 --> 0:15:09.396 I guess I'm asking in whose interest is it to 0:15:09.476 --> 0:15:13.956 work from the reactive stance rather than the proactive stance. Well, 0:15:13.996 --> 0:15:16.476 I think if you think about it, the healthcare system 0:15:17.036 --> 0:15:22.916 in America rewards for procedures, for visits, for volume. So 0:15:23.036 --> 0:15:25.636 the more patients to see, the more procedures that you do, 0:15:26.156 --> 0:15:29.116 the more money a system will make. Right, And that 0:15:29.196 --> 0:15:31.356 is what we call quote unquote fee for service, which 0:15:31.396 --> 0:15:33.356 means that you get paid a fee for a service 0:15:33.356 --> 0:15:36.316 that you do. But we are seeing a transformation into 0:15:36.356 --> 0:15:40.276 what we call value based care, which is actually let's 0:15:40.356 --> 0:15:43.956 pay for keeping people healthy, for keeping people out of 0:15:43.996 --> 0:15:46.556 the hospital. And let's say five to ten years. What 0:15:46.556 --> 0:15:48.516 does this look like or do you have a timeline 0:15:48.796 --> 0:15:51.196 for when you say, hey, you know what we've done, 0:15:51.196 --> 0:15:54.916 it solved, We're good. Yeah. Well I'm ready to change 0:15:54.916 --> 0:15:58.276 the world today. Right. So I wish I could tell 0:15:58.316 --> 0:16:00.836 you that in five years from now, we have touched 0:16:01.076 --> 0:16:04.516 hundreds of thousands of lives and that barely any of 0:16:04.516 --> 0:16:07.596 these people on dialysis, that the majority of our at home, 0:16:07.676 --> 0:16:10.396 the majority have gotten a transplant, and that people are 0:16:10.396 --> 0:16:14.476 living a full life even with kidney disease. So I 0:16:14.596 --> 0:16:19.476 am still part of UCSF in a smaller capacity, but 0:16:19.676 --> 0:16:22.996 being the chief medical officer Cricket has really allowed me 0:16:23.396 --> 0:16:26.756 to take everything from my clinical experience, from what I know, 0:16:26.876 --> 0:16:29.476 from what we know about the disease, and implemented and 0:16:29.556 --> 0:16:34.476 actually make it a viable and incredibly successful program that 0:16:34.516 --> 0:16:37.276 we are implementing nationwide. I said to me, this is 0:16:37.316 --> 0:16:41.596 an accelerator and the final part is again a value 0:16:41.596 --> 0:16:44.436 based program where we are rewarded for keeping people healthy. 0:16:44.716 --> 0:16:47.596 Do you guys take insurance, Yeah, we work with insurance companies, 0:16:47.636 --> 0:16:50.956 health systems and so forth. Yet do you ever have 0:16:51.036 --> 0:16:54.236 concerned that being a part of a for profit company 0:16:54.316 --> 0:16:58.556 with albeit an altruistic mission, that you'll ever be beholden 0:16:58.636 --> 0:17:02.036 to the bottom line, to stakeholders, to the shareholders, to 0:17:02.116 --> 0:17:05.196 the folks that really need the business to make money, 0:17:05.436 --> 0:17:08.796 even if that runs a skew of the mission. I mean, 0:17:08.836 --> 0:17:11.636 there's always going to be, you know, a business that 0:17:11.636 --> 0:17:14.436 you're building. But the one thing about Cricket Health that 0:17:14.596 --> 0:17:17.876 makes me very product that we are changing the way 0:17:18.356 --> 0:17:21.276 even that reimbursement happens. So pretty much everything that we 0:17:21.316 --> 0:17:24.556 are doing is value based. Once you change the incentive, 0:17:25.276 --> 0:17:28.516 then it's a whole different way that you're thinking about 0:17:28.636 --> 0:17:31.276 how you're going to build your business, and so that's 0:17:31.356 --> 0:17:47.076 really what we're trying to do. What can listeners do 0:17:47.116 --> 0:17:50.196 if they're interested in learning more about chronic kidney disease 0:17:50.356 --> 0:17:52.476 or even the research that you're doing, or if they 0:17:52.516 --> 0:17:55.836 want to get involved, What can listeners do? First of all, 0:17:55.956 --> 0:18:00.716 get informed. The CDC has an incredible website that talks 0:18:00.716 --> 0:18:03.556 about kidney disease. I would say, you know, talk to 0:18:03.596 --> 0:18:06.356 your family members and community, because when you talk about it, 0:18:06.396 --> 0:18:08.476 you'll discover that there's more people you know that have 0:18:08.556 --> 0:18:11.596 kidneys than you ever imagined. You know. The other thing 0:18:11.676 --> 0:18:13.996 is talk to your doctor, talk and say, okay, should 0:18:13.996 --> 0:18:16.076 I be tested? And then what would we do about it? 0:18:16.116 --> 0:18:19.676 I think that's important. I think people should also if 0:18:19.716 --> 0:18:21.716 they have loved ones who are affected with kiddings, he 0:18:21.796 --> 0:18:26.276 should learn about transplantation and living donation, for example. But 0:18:26.356 --> 0:18:32.036 I certainly urged people to go get informed. Doctor Parlta, 0:18:32.116 --> 0:18:34.356 thank you so much for being with us today. Oh 0:18:34.396 --> 0:18:36.436 it's been so fun to talk to you. And I 0:18:36.556 --> 0:18:39.116 tell you that we must have hope and when we 0:18:39.156 --> 0:18:42.116 think about our healthcare system, understand that compassion is a 0:18:42.116 --> 0:18:47.036 big part of what we need. To build. Doctor Carmen 0:18:47.116 --> 0:18:49.916 Parlta is the chief medical Officer at Cricket Health. She 0:18:50.036 --> 0:18:53.476 co founded the Kidney Health Research Collaborative at University of California, 0:18:53.516 --> 0:18:57.276 San Francisco and the San Francisco VA. If you'd like 0:18:57.316 --> 0:19:00.076 to learn more about kidney health and preventative medicine, we'll 0:19:00.116 --> 0:19:03.236 include a link to the CDC page Doctor Barlta recommended 0:19:03.396 --> 0:19:06.796 in our show notes. Solvable is produced by Jocelyn Frank, 0:19:07.396 --> 0:19:11.596 research by David Jack, booking by Lisa Dunn, editing help 0:19:11.636 --> 0:19:15.636 from Keyshell Williams. Our managing producer is Sasha Matthias. Our 0:19:15.676 --> 0:19:20.076 executive producer is Mio LaBelle. I'm Ronald Young Junior. Thanks 0:19:20.076 --> 0:19:20.596 for listening.