While fee-for-service models incentivize in-clinic treatments, value-based care shifts the focus to outcomes and overall cost. Under these new models, home dialysis—which offers better patient outcomes and lower societal costs—becomes more profitable for providers, creating a powerful financial incentive to drive adoption.

Launching an autologous cell therapy is complex, involving a nephrologist, a biopsy doctor, and an interventional radiologist. ProKidney's CEO notes success requires standardizing this process to ensure a seamless, best-in-class experience for both the patient and all involved providers, which may mean a slower, more deliberate initial rollout.

While the FDA is often blamed for high trial costs, a major culprit is the consolidated Clinical Research Organization (CRO) market. These entrenched players lack incentives to adopt modern, cost-saving technologies, creating a structural bottleneck that prevents regulatory modernization from translating into cheaper and faster trials.

The tech world is fixated on trivial AI uses while monumental breakthroughs in healthcare go underappreciated. Innovations like CRISPR and GLP-1s can solve systemic problems like chronic disease and rising healthcare costs, offering far greater societal ROI and impact on longevity than current AI chatbots.

The pace of AI-driven innovation has accelerated so dramatically that marginal improvements are quickly rendered obsolete. Founders must pursue ideas that offer an order-of-magnitude change to their industry, as anything less will be overtaken by the next wave of technology.

While digital advertising constitutes 75% of spend in the general economy, it's only about half that in healthcare. This lag, driven by an entrenched reliance on in-person sales reps, creates a long-term secular tailwind for platforms like Doximity as the industry inevitably shifts its marketing budget online.

ProKidney's significant funding from co-founder Pablo Legorreta and investor Carlos Slim was driven by their direct family experiences with kidney disease. This shows that for high-risk, long-term biotech ventures, a deep personal connection to the mission can be a more powerful motivator for investors than purely financial interest.

Of the 30+ million Americans with chronic kidney disease (CKD), most are unaware they have it. The greatest societal impact would come not from a new therapy, but from widespread screening and education, as existing drugs and lifestyle changes can help patients in the early stages before they need advanced care.

Unlike typical tech disruption, healthcare often requires collaboration. Startups effectively "rent" distribution and patient access from incumbents. In return, incumbents "rent" cutting-edge innovation from startups, creating a necessary symbiotic relationship.