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, 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 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 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 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 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 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, 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 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 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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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, 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 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 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 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, 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 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 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 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. 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 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 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 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, 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 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, 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 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, 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 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, 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 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, 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 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 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 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 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 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, 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, 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 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, 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 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 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 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 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 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, 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 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 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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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, 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 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 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 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, 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 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 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 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. 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 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 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 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, 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 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, 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 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, 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 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, 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 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, 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 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 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 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 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 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, 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, 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 executive producer is Mio LaBelle. I'm Ronald Young Junior. Thanks for listening.