December 8, 2021 • 19 mins
Dr. Carmen Peralta is the Chief Medical Officer at Cricket Health. She co-founded the Kidney Health Research Collaborative at University of California San Francisco and the San Francisco Veterans Affairs Medical Center. She works to provide support to patients, doctors and all the steps in between to improve kidney health outcomes.
Dr. Peralta recommends these sites to learn more:
CDC Chronic Kidney Disease Initiative
https://www.cdc.gov/kidneydisease/index.html
UCSF Kidney Health Research Collaborative
https://khrc.ucsf.edu/
Solvable is produced by Jocelyn Frank, David Zha, Lisa Dunn and Keishel Wiliams. The managing producer is Sachar Mathias and our executive producer is Mia Lobel.
Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Pushkin, this is solvable. I'm Ronald Young Jr. If you're
anything like me, As you get older, you begin to
think about your general health and wellness, being more active,
my blood pressure, my cholesterol, trying to eat more vegetables,
(00:36):
making the appointment for my annual physical. But even if
I take the time to tend to my lifestyle choices
and overall health, some preventative care measures may still slip
through the cracks, just because I don't know all the
questions to ask. Patients are going into their doctor asking
to get their cholesterol checked. I mean, how many people
(00:56):
do you know they're going to their doctor and say,
can I have my kidney's checked? I certainly don't think
about my kidneys on a regular basis, But one in
seven adults has chronic kidney disease or CKD, and because
it's asymptomatic in the early stages, nine people with the
disease have no idea they've got it. And today we're
phased with the situation where a wonderful policy has created
(01:19):
an incentive where we put a lot of resources in
the end stage of a disease and nothing on prevention
for end stage renal disease. Also known as kidney failure.
Patients are often treated with dialysis. It's a very time
consuming and exhaustive treatment that can save lives, but can
also be extremely disruptive. Doctor Carmen Peralta co founded the
(01:41):
Kidney Health Research Collaborative at the University of California, San
Francisco to change all that. Some of the first obstacles
were information really understanding the epidemiology of disease, what populations
are affected, what are the risk factors for disease, why
it happens. Doctor Peralta is also the chief medical officer
at Cricket Health, a for profit company that specializes in
(02:04):
helping people with kidney disease by supporting early detection programs
and providing risk assessments. A big, important, gigantic reason to
detect the disease early. The earlier you detected, the more
chances you have to prevent it from progressing. Nearly thirty
seven million Americans lived with chronic kidney disease. Getting an
(02:25):
early diagnosis could improve the quality of life for many
and even prevent the necessity of in stage treatment. Chronic
kidney disease is solvable. How did you get interested in
kidneys specifically, my grandfather, who I never met, was a physician,
(02:49):
and so I grew up in em Barranquia, Colombia, and
he was one of those physicians that would just do
anything for his patience. And my mother always talked about
him and the way people loved him and all the
things that he did, and so that was an inspiration.
My uncle was also a doctor, and I love the
(03:09):
physiology of the kidney. I mean, when you probably talk
to people about kidneys, they think, oh, they filter your blood,
which is true, but the kidney has a ton of
other functions, regulating the water content in your body, blood pressure,
helping make red blood cells, and all these things that
I found it to be absolutely fascinating. And I was
struck by several things that happened during my training. One
(03:31):
was meeting patients that would arrive in an emergency room
just sort of saying that they didn't feel well or
maybe they were swollen, or they were having trouble breathing,
and then they were diagnosed with kidney failure what we
call end stage renal disease or end stage kidney disease,
and told that they needed dialysis. I also was struck
by the reports that we were having in those times.
(03:54):
And remember this is the early nineteen nineties, thinking about
the race disparities and SoC economic disparities that we saw
in the disease, and that truly marked me because I
was thinking, why is this disease devastating this community is
in this way, and why are people showing up at
the very end stage of a disease? How is the
(04:15):
treatment for kidney disease changed over the years? Has the
medical establishment shifted the way it responds to the disease
as the number of cases in the US has grown
a lot of people don't know this. So in nineteen
sixty five, we had the Medicare Medicaid Act right that
now allowed us to provide care for seniors or in
persons with disabilities or low income right. And one of
(04:36):
the things people don't realize is that in nineteen seventy
two there was an amendment that was done to the
Medicare where people with end stage kidney failure would qualify
for services through Medicare regardless of age. And the reason
is because right around in the sixties and late sixties,
the technology both for the dialysis machine and what we
(04:56):
call vascular access, which means the way that we can
access the blood to clean it had improved in a
way that allowed people to get dialysis in a chronic fashion.
So it became a life saving treatment, but it was
really expensed and only very very few people could actually
get the treatment, and in order to reduce those disparities
and make it available to every American, there was a
(05:18):
decision to cover the service. But at the time, the
projections were that maybe there would be a you know,
maybe twenty thirty thousand people on dialysis, you know, maybe
would cost a billion dollars or something of the sort.
And today we're faced with a situation where a wonderful
policy has created an incentive where we put a lot
(05:39):
of resources in the end stage of a disease and
nothing on prevention. We couldn't have anticipated that. Now we
have over half a million persons undergoing dialysis treatment in
the US, and so it's incredibly expensive, causes a lot
of suffering, and naively, you know, as a trainee and
thinking that that I could solve it, I thought it's
so easy. All we need to do is test people
(06:01):
who have respectors for the kidney disease, detect the disease early,
so we can manage it early, educate people on physicians,
put in all the management strategies, and then this won't happen.
I thought, this is solvable because what we need is
to invest in the early stages. Little did I know
then that there were so many questions to be answered.
Can you give me some examples, meaning what test should
(06:24):
we order, who should we test, what populations? Understanding why
the race hathing differences that we see in outcomes where
people who self identifies African Americans have under order of
two point seven times more likely to start dialysis than
compare the white persons, for example, Hispanics about one point
three times. So I was very curious to understand those
(06:44):
because if you don't know the causes of those things,
that you can't solve them. So what happens at Cricket Health?
How do you address these problems? So at Cricket Health,
we partner with payers and health systems to care for
people with kidney disease. We then use laboratory data or
algorithms to identify persons who might be at risk for
(07:04):
having kidney disease or who we know have kidney disease.
So we provide a multiary care team that includes nurse,
social worker, dietitian, pharmacist, care navigator, and a peer mentor
because it is another patient that has gone through the
journey of kidney disease that I cannot concially help someone
that's just starting. And then what we do is we
essentially number one, put in evidence based measures to slow
(07:28):
the progression of disease for those who we can't despite
the best of our abilities, we prepare them and give
them a lot of education around both kidneys, how to
keep the kidney healthy, but also what potential therapies they
could use to treat their kidney disease, whether it's a transplantation, dialysis,
or medical management without dialysis. We then work with the
(07:48):
patient doctors and we are the eyes andeers in between
appointments for the providers. They don't have the time to
see people as often as they need care, and so
we are the service that is there to be able
to give this entire support through the kidney journey. You're
saying that we are being more reactive than proactive, and
yours to do early testing are more proactive efforts. What
(08:13):
happens after catching it early. We're not putting people on
dialysis necessarily early, but I'm assuming that there are treatments
for people who do detect chronic kidney disease as early
as possible. Absolutely. One thing to know is that typically
kidney disease doesn't really have a lot of symptoms until
it's very advanced. And also the symptoms tend to be
(08:34):
not very specific, meaning it's just maybe tired, maybe a
little bit of swollen legs, or difficulty breathing. The only
way to know that something might be going on with
the kidneys is to test the blood or the urine
in the United States, as high blood pressure and diabetes
are the typical factors that are associated with kidney disease,
(08:54):
and so the mainstay of the treatment is controlling the
typical risk factors. They lose weight, stop smoking, the typical
things to keep health. In addition, there are certain medications
that are crucially important to consider impatience with kidney disease.
Classes of medications that have been on the market for
decades called ACE inhibitor or JE tensing converting hiber flock
(09:16):
so as or ARBs. Those are the pills that people
might recognize that are also used for blood pressure treatment.
So those have shown to potentially reduce the progression of
kidney disease and reduce some of the complications. The other
thing that we have to think about is even as
people are progressing, and let's say that, Okay, no matter
(09:37):
what you do, we do everything perfectly, you know, do
you take every right pill, you do all the right treatments,
everything is perfect, But some people will progress. And the
truth is that sometimes we don't know why despite our
best treatments. Still the best treatments for kidney failures that transplant,
and so a big, important, gigantic reason to detect the
(09:58):
disease early. The earlier you detect it, the more chances
you have to prevent it from progressing. But also it
gives an opportunity for you to actually be in control
and have the possibility of having a transplant before you
even need dialysis. So that's another reason rather than waiting
until somebody needs dialysis. When you're trying to do preventative care,
(10:19):
trying to do early detection, what types of obstacles do
you run into when you're trying to implement those plans.
Some of the first obstacles were information really understanding the
epidemiology of disease. What populations are affected, what are the
risk factors for disease, why it happens. There's also a
lot of research going on really around just how can
(10:40):
a disease happens, like at the tissue level, of the
molecular level, at the mechanistic level of really understanding that
in order to develop new targets. Then the next implementation,
which I worked on, is to say, Okay, now we
need to educate the patient about kidney health, and we
also need to educate primary providers. And when you think
about it, in the United States, primary care providers are
(11:03):
very busy, and they have to deal with many things,
you know, and sometimes they have list that is so
long of the things that they have to address for
our patient. The patienter might have a different list. A
primarycare provider might say, oh, we're going to talk about
your blood person and your diabetes, but the patient wants
to talk about their headache. Now you're adding another disease
that they have to worry about. So a big part
(11:24):
of it has been how do we then provide tools
so that we can help the primary care provider be
efficient and actually understand how to test for kidney disease
flag When a patient has kidney disease. So we did
a couple of projects where we did that, where we
actually tested some tools to improve recognition of kidney disease
early with the hope that the end the management would improve.
(11:54):
How do you recomcile the work that you're doing being
very specific about kidneys, but also probably being something that
could be applied universally when it comes to healthcare. Do
you ever struggle with kind of the existential nature of saying, like, hey,
you know, I'll try to fix the kidneys, but this
is probably something that needs to be applied probably in
our hearts, probably you know, all kinds of other transplants
(12:15):
as well, when we're talking about prevention versus of reactive treatment.
Oh yeah, Well, but I can tell you is I
would love to just change the world right for everybody.
I think the thing that grabs me about kidney disease
is that it is so stark how much we invest
(12:36):
at the end of the disease compared to others. Now,
I'm not saying there's not a lot that we need
to do in diabetes and heart disease and high cholesterol
and all of these kinds of things, But when you
think about it, let's say, for example, heart disease. There's
a lot more knowledge out there, and primary care providers
are more aware. Patients are going into their doctor asking
(12:56):
to get their cholesterol checked. I mean, how many people
do you know they're going to their doctor and say,
can I have my kidneys checked? Right? And so I
think we've done a little bit better in the healthcare
system to talk about prevention when it comes to kidney health.
There's actually an executive order that was signed a couple
of years ago under the Trump administration, and in fact,
(13:17):
they are testing specifically models that promote early detection of
disease management early because they're realizing that the cost of
just putting all the efforts at the end of the
disease costs a lot of money and cause a lot
of suffering. So we are seeing a little bit of
a move. What I hope is that when we move
(13:37):
to paying for value and good outcomes, is that this
actually does that for all chronic diseases. And I think
we're seeing some of that shift in other chronic diseases
as well. It's testing expensive, Nope, it's actually quite cheap.
So if you just do you know, the blood and
the urine test can be pretty cheap. Why wouldn't this
just be a posture The doctors more widely take to say, hey,
(14:00):
why don't we just test this to make sure you're good? Yeah? Yeah,
So the funny thing is that the blood test is
often included in the physical but typically the urins not tested.
It's just a blood and you need really both tests.
I think it's a couple of things. One is lack
of education, both for patients and providers. I think it's
(14:22):
inaccurate perception by providers that if you find kidney disease
or a leader, that there's nothing to do. And I
think I've already hopefully convinced people that there is a
lot to do. And number three again is just not
having the time, you right to deal with so many
of the issues that our prima care providers have to
deal with, and frankly like a lack of support. You know,
(14:43):
the job of US special is actually to support the
Prima care community in handling all the competing, you know,
diseases that they have to they have to handle. Doctor praulta,
is there a way in which we perpetuate the brokenness
(15:04):
of the American healthcare system? And when I say that
I guess I'm asking in whose interest is it to
work from the reactive stance rather than the proactive stance. Well,
I think if you think about it, the healthcare system
in America rewards for procedures, for visits, for volume. So
the more patients to see, the more procedures that you do,
(15:26):
the more money a system will make. Right, And that
is what we call quote unquote fee for service, which
means that you get paid a fee for a service
that you do. But we are seeing a transformation into
what we call value based care, which is actually let's
pay for keeping people healthy, for keeping people out of
the hospital. And let's say five to ten years. What
(15:46):
does this look like or do you have a timeline
for when you say, hey, you know what we've done,
it solved, We're good. Yeah. Well I'm ready to change
the world today. Right. So I wish I could tell
you that in five years from now, we have touched
hundreds of thousands of lives and that barely any of
these people on dialysis, that the majority of our at home,
(16:07):
the majority have gotten a transplant, and that people are
living a full life even with kidney disease. So I
am still part of UCSF in a smaller capacity, but
being the chief medical officer Cricket has really allowed me
to take everything from my clinical experience, from what I know,
from what we know about the disease, and implemented and
(16:29):
actually make it a viable and incredibly successful program that
we are implementing nationwide. I said to me, this is
an accelerator and the final part is again a value
based program where we are rewarded for keeping people healthy.
Do you guys take insurance, Yeah, we work with insurance companies,
health systems and so forth. Yet do you ever have
(16:51):
concerned that being a part of a for profit company
with albeit an altruistic mission, that you'll ever be beholden
to the bottom line, to stakeholders, to the shareholders, to
the folks that really need the business to make money,
even if that runs a skew of the mission. I mean,
there's always going to be, you know, a business that
(17:11):
you're building. But the one thing about Cricket Health that
makes me very product that we are changing the way
even that reimbursement happens. So pretty much everything that we
are doing is value based. Once you change the incentive,
then it's a whole different way that you're thinking about
how you're going to build your business, and so that's
really what we're trying to do. What can listeners do
(17:47):
if they're interested in learning more about chronic kidney disease
or even the research that you're doing, or if they
want to get involved, What can listeners do? First of all,
get informed. The CDC has an incredible website that talks
about kidney disease. I would say, you know, talk to
your family members and community, because when you talk about it,
you'll discover that there's more people you know that have
(18:08):
kidneys than you ever imagined. You know. The other thing
is talk to your doctor, talk and say, okay, should
I be tested? And then what would we do about it?
I think that's important. I think people should also if
they have loved ones who are affected with kiddings, he
should learn about transplantation and living donation, for example. But
I certainly urged people to go get informed. Doctor Parlta,
(18:32):
thank you so much for being with us today. Oh
it's been so fun to talk to you. And I
tell you that we must have hope and when we
think about our healthcare system, understand that compassion is a
big part of what we need. To build. Doctor Carmen
Parlta is the chief medical Officer at Cricket Health. She
co founded the Kidney Health Research Collaborative at University of California,
(18:53):
San Francisco and the San Francisco VA. If you'd like
to learn more about kidney health and preventative medicine, we'll
include a link to the CDC page Doctor Barlta recommended
in our show notes. Solvable is produced by Jocelyn Frank,
research by David Jack, booking by Lisa Dunn, editing help
from Keyshell Williams. Our managing producer is Sasha Matthias. Our
(19:15):
executive producer is Mio LaBelle. I'm Ronald Young Junior. Thanks
for listening.
Pushkin, this is solvable. I'm Ronald Young Jr. If you're
anything like me, As you get older, you begin to
think about your general health and wellness, being more active,
my blood pressure, my cholesterol, trying to eat more vegetables,
(00:36):
making the appointment for my annual physical. But even if
I take the time to tend to my lifestyle choices
and overall health, some preventative care measures may still slip
through the cracks, just because I don't know all the
questions to ask. Patients are going into their doctor asking
to get their cholesterol checked. I mean, how many people
(00:56):
do you know they're going to their doctor and say,
can I have my kidney's checked? I certainly don't think
about my kidneys on a regular basis, But one in
seven adults has chronic kidney disease or CKD, and because
it's asymptomatic in the early stages, nine people with the
disease have no idea they've got it. And today we're
phased with the situation where a wonderful policy has created
(01:19):
an incentive where we put a lot of resources in
the end stage of a disease and nothing on prevention
for end stage renal disease. Also known as kidney failure.
Patients are often treated with dialysis. It's a very time
consuming and exhaustive treatment that can save lives, but can
also be extremely disruptive. Doctor Carmen Peralta co founded the
(01:41):
Kidney Health Research Collaborative at the University of California, San
Francisco to change all that. Some of the first obstacles
were information really understanding the epidemiology of disease, what populations
are affected, what are the risk factors for disease, why
it happens. Doctor Peralta is also the chief medical officer
at Cricket Health, a for profit company that specializes in
(02:04):
helping people with kidney disease by supporting early detection programs
and providing risk assessments. A big, important, gigantic reason to
detect the disease early. The earlier you detected, the more
chances you have to prevent it from progressing. Nearly thirty
seven million Americans lived with chronic kidney disease. Getting an
(02:25):
early diagnosis could improve the quality of life for many
and even prevent the necessity of in stage treatment. Chronic
kidney disease is solvable. How did you get interested in
kidneys specifically, my grandfather, who I never met, was a physician,
(02:49):
and so I grew up in em Barranquia, Colombia, and
he was one of those physicians that would just do
anything for his patience. And my mother always talked about
him and the way people loved him and all the
things that he did, and so that was an inspiration.
My uncle was also a doctor, and I love the
(03:09):
physiology of the kidney. I mean, when you probably talk
to people about kidneys, they think, oh, they filter your blood,
which is true, but the kidney has a ton of
other functions, regulating the water content in your body, blood pressure,
helping make red blood cells, and all these things that
I found it to be absolutely fascinating. And I was
struck by several things that happened during my training. One
(03:31):
was meeting patients that would arrive in an emergency room
just sort of saying that they didn't feel well or
maybe they were swollen, or they were having trouble breathing,
and then they were diagnosed with kidney failure what we
call end stage renal disease or end stage kidney disease,
and told that they needed dialysis. I also was struck
by the reports that we were having in those times.
(03:54):
And remember this is the early nineteen nineties, thinking about
the race disparities and SoC economic disparities that we saw
in the disease, and that truly marked me because I
was thinking, why is this disease devastating this community is
in this way, and why are people showing up at
the very end stage of a disease? How is the
(04:15):
treatment for kidney disease changed over the years? Has the
medical establishment shifted the way it responds to the disease
as the number of cases in the US has grown
a lot of people don't know this. So in nineteen
sixty five, we had the Medicare Medicaid Act right that
now allowed us to provide care for seniors or in
persons with disabilities or low income right. And one of
(04:36):
the things people don't realize is that in nineteen seventy
two there was an amendment that was done to the
Medicare where people with end stage kidney failure would qualify
for services through Medicare regardless of age. And the reason
is because right around in the sixties and late sixties,
the technology both for the dialysis machine and what we
(04:56):
call vascular access, which means the way that we can
access the blood to clean it had improved in a
way that allowed people to get dialysis in a chronic fashion.
So it became a life saving treatment, but it was
really expensed and only very very few people could actually
get the treatment, and in order to reduce those disparities
and make it available to every American, there was a
(05:18):
decision to cover the service. But at the time, the
projections were that maybe there would be a you know,
maybe twenty thirty thousand people on dialysis, you know, maybe
would cost a billion dollars or something of the sort.
And today we're faced with a situation where a wonderful
policy has created an incentive where we put a lot
(05:39):
of resources in the end stage of a disease and
nothing on prevention. We couldn't have anticipated that. Now we
have over half a million persons undergoing dialysis treatment in
the US, and so it's incredibly expensive, causes a lot
of suffering, and naively, you know, as a trainee and
thinking that that I could solve it, I thought it's
so easy. All we need to do is test people
(06:01):
who have respectors for the kidney disease, detect the disease early,
so we can manage it early, educate people on physicians,
put in all the management strategies, and then this won't happen.
I thought, this is solvable because what we need is
to invest in the early stages. Little did I know
then that there were so many questions to be answered.
Can you give me some examples, meaning what test should
(06:24):
we order, who should we test, what populations? Understanding why
the race hathing differences that we see in outcomes where
people who self identifies African Americans have under order of
two point seven times more likely to start dialysis than
compare the white persons, for example, Hispanics about one point
three times. So I was very curious to understand those
(06:44):
because if you don't know the causes of those things,
that you can't solve them. So what happens at Cricket Health?
How do you address these problems? So at Cricket Health,
we partner with payers and health systems to care for
people with kidney disease. We then use laboratory data or
algorithms to identify persons who might be at risk for
(07:04):
having kidney disease or who we know have kidney disease.
So we provide a multiary care team that includes nurse,
social worker, dietitian, pharmacist, care navigator, and a peer mentor
because it is another patient that has gone through the
journey of kidney disease that I cannot concially help someone
that's just starting. And then what we do is we
essentially number one, put in evidence based measures to slow
(07:28):
the progression of disease for those who we can't despite
the best of our abilities, we prepare them and give
them a lot of education around both kidneys, how to
keep the kidney healthy, but also what potential therapies they
could use to treat their kidney disease, whether it's a transplantation, dialysis,
or medical management without dialysis. We then work with the
(07:48):
patient doctors and we are the eyes andeers in between
appointments for the providers. They don't have the time to
see people as often as they need care, and so
we are the service that is there to be able
to give this entire support through the kidney journey. You're
saying that we are being more reactive than proactive, and
yours to do early testing are more proactive efforts. What
(08:13):
happens after catching it early. We're not putting people on
dialysis necessarily early, but I'm assuming that there are treatments
for people who do detect chronic kidney disease as early
as possible. Absolutely. One thing to know is that typically
kidney disease doesn't really have a lot of symptoms until
it's very advanced. And also the symptoms tend to be
(08:34):
not very specific, meaning it's just maybe tired, maybe a
little bit of swollen legs, or difficulty breathing. The only
way to know that something might be going on with
the kidneys is to test the blood or the urine
in the United States, as high blood pressure and diabetes
are the typical factors that are associated with kidney disease,
(08:54):
and so the mainstay of the treatment is controlling the
typical risk factors. They lose weight, stop smoking, the typical
things to keep health. In addition, there are certain medications
that are crucially important to consider impatience with kidney disease.
Classes of medications that have been on the market for
decades called ACE inhibitor or JE tensing converting hiber flock
(09:16):
so as or ARBs. Those are the pills that people
might recognize that are also used for blood pressure treatment.
So those have shown to potentially reduce the progression of
kidney disease and reduce some of the complications. The other
thing that we have to think about is even as
people are progressing, and let's say that, Okay, no matter
(09:37):
what you do, we do everything perfectly, you know, do
you take every right pill, you do all the right treatments,
everything is perfect, But some people will progress. And the
truth is that sometimes we don't know why despite our
best treatments. Still the best treatments for kidney failures that transplant,
and so a big, important, gigantic reason to detect the
(09:58):
disease early. The earlier you detect it, the more chances
you have to prevent it from progressing. But also it
gives an opportunity for you to actually be in control
and have the possibility of having a transplant before you
even need dialysis. So that's another reason rather than waiting
until somebody needs dialysis. When you're trying to do preventative care,
(10:19):
trying to do early detection, what types of obstacles do
you run into when you're trying to implement those plans.
Some of the first obstacles were information really understanding the
epidemiology of disease. What populations are affected, what are the
risk factors for disease, why it happens. There's also a
lot of research going on really around just how can
(10:40):
a disease happens, like at the tissue level, of the
molecular level, at the mechanistic level of really understanding that
in order to develop new targets. Then the next implementation,
which I worked on, is to say, Okay, now we
need to educate the patient about kidney health, and we
also need to educate primary providers. And when you think
about it, in the United States, primary care providers are
(11:03):
very busy, and they have to deal with many things,
you know, and sometimes they have list that is so
long of the things that they have to address for
our patient. The patienter might have a different list. A
primarycare provider might say, oh, we're going to talk about
your blood person and your diabetes, but the patient wants
to talk about their headache. Now you're adding another disease
that they have to worry about. So a big part
(11:24):
of it has been how do we then provide tools
so that we can help the primary care provider be
efficient and actually understand how to test for kidney disease
flag When a patient has kidney disease. So we did
a couple of projects where we did that, where we
actually tested some tools to improve recognition of kidney disease
early with the hope that the end the management would improve.
(11:54):
How do you recomcile the work that you're doing being
very specific about kidneys, but also probably being something that
could be applied universally when it comes to healthcare. Do
you ever struggle with kind of the existential nature of saying, like, hey,
you know, I'll try to fix the kidneys, but this
is probably something that needs to be applied probably in
our hearts, probably you know, all kinds of other transplants
(12:15):
as well, when we're talking about prevention versus of reactive treatment.
Oh yeah, Well, but I can tell you is I
would love to just change the world right for everybody.
I think the thing that grabs me about kidney disease
is that it is so stark how much we invest
(12:36):
at the end of the disease compared to others. Now,
I'm not saying there's not a lot that we need
to do in diabetes and heart disease and high cholesterol
and all of these kinds of things, But when you
think about it, let's say, for example, heart disease. There's
a lot more knowledge out there, and primary care providers
are more aware. Patients are going into their doctor asking
(12:56):
to get their cholesterol checked. I mean, how many people
do you know they're going to their doctor and say,
can I have my kidneys checked? Right? And so I
think we've done a little bit better in the healthcare
system to talk about prevention when it comes to kidney health.
There's actually an executive order that was signed a couple
of years ago under the Trump administration, and in fact,
(13:17):
they are testing specifically models that promote early detection of
disease management early because they're realizing that the cost of
just putting all the efforts at the end of the
disease costs a lot of money and cause a lot
of suffering. So we are seeing a little bit of
a move. What I hope is that when we move
(13:37):
to paying for value and good outcomes, is that this
actually does that for all chronic diseases. And I think
we're seeing some of that shift in other chronic diseases
as well. It's testing expensive, Nope, it's actually quite cheap.
So if you just do you know, the blood and
the urine test can be pretty cheap. Why wouldn't this
just be a posture The doctors more widely take to say, hey,
(14:00):
why don't we just test this to make sure you're good? Yeah? Yeah,
So the funny thing is that the blood test is
often included in the physical but typically the urins not tested.
It's just a blood and you need really both tests.
I think it's a couple of things. One is lack
of education, both for patients and providers. I think it's
(14:22):
inaccurate perception by providers that if you find kidney disease
or a leader, that there's nothing to do. And I
think I've already hopefully convinced people that there is a
lot to do. And number three again is just not
having the time, you right to deal with so many
of the issues that our prima care providers have to
deal with, and frankly like a lack of support. You know,
(14:43):
the job of US special is actually to support the
Prima care community in handling all the competing, you know,
diseases that they have to they have to handle. Doctor praulta,
is there a way in which we perpetuate the brokenness
(15:04):
of the American healthcare system? And when I say that
I guess I'm asking in whose interest is it to
work from the reactive stance rather than the proactive stance. Well,
I think if you think about it, the healthcare system
in America rewards for procedures, for visits, for volume. So
the more patients to see, the more procedures that you do,
(15:26):
the more money a system will make. Right, And that
is what we call quote unquote fee for service, which
means that you get paid a fee for a service
that you do. But we are seeing a transformation into
what we call value based care, which is actually let's
pay for keeping people healthy, for keeping people out of
the hospital. And let's say five to ten years. What
(15:46):
does this look like or do you have a timeline
for when you say, hey, you know what we've done,
it solved, We're good. Yeah. Well I'm ready to change
the world today. Right. So I wish I could tell
you that in five years from now, we have touched
hundreds of thousands of lives and that barely any of
these people on dialysis, that the majority of our at home,
(16:07):
the majority have gotten a transplant, and that people are
living a full life even with kidney disease. So I
am still part of UCSF in a smaller capacity, but
being the chief medical officer Cricket has really allowed me
to take everything from my clinical experience, from what I know,
from what we know about the disease, and implemented and
(16:29):
actually make it a viable and incredibly successful program that
we are implementing nationwide. I said to me, this is
an accelerator and the final part is again a value
based program where we are rewarded for keeping people healthy.
Do you guys take insurance, Yeah, we work with insurance companies,
health systems and so forth. Yet do you ever have
(16:51):
concerned that being a part of a for profit company
with albeit an altruistic mission, that you'll ever be beholden
to the bottom line, to stakeholders, to the shareholders, to
the folks that really need the business to make money,
even if that runs a skew of the mission. I mean,
there's always going to be, you know, a business that
(17:11):
you're building. But the one thing about Cricket Health that
makes me very product that we are changing the way
even that reimbursement happens. So pretty much everything that we
are doing is value based. Once you change the incentive,
then it's a whole different way that you're thinking about
how you're going to build your business, and so that's
really what we're trying to do. What can listeners do
(17:47):
if they're interested in learning more about chronic kidney disease
or even the research that you're doing, or if they
want to get involved, What can listeners do? First of all,
get informed. The CDC has an incredible website that talks
about kidney disease. I would say, you know, talk to
your family members and community, because when you talk about it,
you'll discover that there's more people you know that have
(18:08):
kidneys than you ever imagined. You know. The other thing
is talk to your doctor, talk and say, okay, should
I be tested? And then what would we do about it?
I think that's important. I think people should also if
they have loved ones who are affected with kiddings, he
should learn about transplantation and living donation, for example. But
I certainly urged people to go get informed. Doctor Parlta,
(18:32):
thank you so much for being with us today. Oh
it's been so fun to talk to you. And I
tell you that we must have hope and when we
think about our healthcare system, understand that compassion is a
big part of what we need. To build. Doctor Carmen
Parlta is the chief medical Officer at Cricket Health. She
co founded the Kidney Health Research Collaborative at University of California,
(18:53):
San Francisco and the San Francisco VA. If you'd like
to learn more about kidney health and preventative medicine, we'll
include a link to the CDC page Doctor Barlta recommended
in our show notes. Solvable is produced by Jocelyn Frank,
research by David Jack, booking by Lisa Dunn, editing help
from Keyshell Williams. Our managing producer is Sasha Matthias. Our
(19:15):
executive producer is Mio LaBelle. I'm Ronald Young Junior. Thanks
for listening.
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