An exciting, and sometimes heated, panel and audience discussion occurred today at Kidney Week 2019 on the subject of disruptors in the nephrology market. Major new healthcare players are entering kidney care, bringing perspectives and expertise on technology, big data, and artificial intelligence and integrated payer-provider platforms. These innovators are working to transform the landscape in kidney care. The audience was standing room only and the hour-long question period had a line the entire time.

The five panelists included:

• Josephine P. Briggs, MD – Editor-in-Chief of Journal of the American Society of Nephrology (JASN) and Interim Executive Director of PCORI, Patient Centered Outcomes Research Institute
• Bryan Sivak – Managing Director, KP Ventures and VP, Medicaid Transformation at Kaiser Permanente and Former CTO at HHS
• Bruce F. Culleton, MD – Chief Medical Officer of CVS Kidney Care
• Carmen A. Peralta, MD, FASN – Chief Medical Officer at Cricket Health and Professor of Medicine at UCSF
• Leslie Trigg – Chief Executive Officer of Outset Medical

Moderators were Krishna R. Polu, MD, and Wolfgang C. Winkelmayer, MD, MPH, FASN.

A More Patient-Centered Focus

A major topic addressed by all panelists was the role of a patient-centered focus in new innovations, research, and changes to the market. Dr. Josephine Briggs introduced three ways in which focusing on patients changes the conversation. First, patients bring urgency and impatience to the equation. They are the ones battling the illness and don’t have time to waste, which is disruptive but valuable. Second, patients make the questions change. For instance, physicians may ask can patients survive longer on dialysis, when really the question should be how quickly can we get patients off dialysis. And finally, the involvement of patients brings bring better innovation and implementation into the process.

Bryan Sivak, the former CTO of HHS, gave an unvarnished critique of the organ procurement system in the United States and the need for reform.  He praised the efforts of the non-profit ORGANIZE and praised co-founders Greg Segal and Jenna Arnold, for their advocacy work to improve organ procurement and bring transparency and objectivity to the Organ Procurement Organizations’ metrics – also honoring the work of former White House Assistant Director of Innovation for Growth at the White House Office of Science and Technology Policy, Jennifer Erickson, and ASN staff.

Bruce Cullerton, MD and CMO of CVS Kidney Care, explained that the current timing in the kidney sphere is a once-in-a-generation opportunity to innovate for  patients. He explained that early CKD identification is paramount in order to start treating patients much earlier and emphasized nephrologists must further empower patients and caregivers to have a role in their care. He described how seamless care coordination must be the main focus of innovation – must take into account patients, nurses, social workers, dieticians, nephrologists, and other physicians as well. The nephrology sphere must be made seamless and well-coordinated, and must be done at scale.

Carmen Peralta, MD, FASN and CMO of Cricket Health, noted how her company aims to reinvent the kidney care system to make it wholly patient-centered. Early detection, risk stratification, and personalized management is necessary, she described. She also called for a system redesign in order to support multidisciplinary care. One of her major points was to meet patients where they are, at home and in their daily lives, by designing systems with more technology like digital apps, SMS texts, but also with more bedside care.

The final speaker was Leslie Trigg, CEO of Outset Medical. With her involvement as a startup company in developing new devices for kidney care, she outlined how new technology can add flexibility in when, where, and how kidney care, or specifically dialysis can be administered. It can also give agency back to the patients as they hold more of the cards in making decisions about how they want to treat their CKD and technology can also provide insights through analytics to provide more customized care. By bringing kidney care up-to-date with the most innovative technologies, patients have more options and can be more involved in the conversations around their care.