The kidney is one of those organs that everyone knows is important, but few people can explain what it actually does. The easiest way to describe how our kidneys function is that they remove waste and extra fluid from our bodies. But when these two bean-shaped organs fail, the situation becomes dire—and expensive.

As of 2017, there were about 18,000 residents of North Carolina undergoing a difficult and costly procedure called dialysis. This treatment is what’s frequently ordered for patients whose own kidneys can no longer support their body’s needs. Though it’s been around for decades, the process remains both physically and emotionally draining for patients who must undergo treatment three times per week.

And then there’s the cost.

While nailing down exact healthcare costs can be more of an art than a science, there are a few pieces of the puzzle we know to be true. Medicaid and Medicare pay around $250, but according to publicly available data from the Blue Cross NC cost estimator, that cost could skyrocket to thousands per treatment.

There’s no doubting that modern medicine has eased the physical burden on patients undergoing treatments of many different types. We’re happy to report that there are a handful of promising and industrious companies out there who see dialysis as one of those areas ripe for disruption—and they’re focusing on early detection to do it.

Of those with chronic kidney disease, only about 10% are currently diagnosed and aware of what they’re facing.

As a result, diagnosis often happens when a condition has gotten to the point that it’s beyond repair. In fact, 80% of all patients crash into dialysis because there wasn’t a comprehensive preventive plan in place.

Simply put, better management of kidney disease is an opportunity to keep people healthier and health costs down. And that’s precisely what disruptors like Strive Health, Cricket Health, and Somatus hope to do by instituting value-driven and patient-centered kidney care.

With each of these innovative companies, the goal is to inspire earlier diagnosis so that patients can avoid crashing into the system. As with any preventive plan, it starts with the PCP and working with those doctors to increase the level of awareness related to kidney disease.

The next step is implementing more at-home dialysis treatment, which is already popular in other places around the globe. For example, 80% of patients’ cases in Hong Kong involve at-home dialysis, compared to about 13% in North Carolina.

Currently, there is a national duopoly of two dialysis clinics: Fresenius and DaVita. These two giants do a great job of treating their patients, but without competition or incentives to keep patients healthy, the population of dialysis patients keeps growing—and so do the costs. Traditionally, the at-home setup has been a challenging venture to accomplish for these large dialysis centers. Plus, many kidney doctors are not well-trained on home dialysis.

If Strive, Cricket, and Somatus have their way, that paradigm will flip and the shock to the system associated with traveling for treatment will cease. At-home peritoneal dialysis allows patients to receive treatment while they sleep, which is much more comfortable and provides easier access. It’s also gentler on the body, due to the process being slower and more natural than four-hour sessions at a center.

Unfortunately for North Carolinians, current laws will keep these healthcare pioneers out of our state. Certificate of Need or CON laws are government regulations that restrict the number of medical facilities which can operate in any given area. Dialysis clinics fall under CON, which means if a new facility wanted to open, there must be a demonstrated “need” for more clinics. Essentially, these archaic laws prevent new dialysis providers from entering the market and offering new competition that could lower prices.

The time is now for market disruption, and the players are willing and able to be here. Unfortunately, that won’t be possible without a change to CON.

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