Great brief, Tim. What stands out to me is the strategic logic of strengthening care delivery in the home for people living with kidney disease. Supporting dialysis patients through home-based clinical services (that already exist) makes sense as it aligns care with how patients live, improves continuity, and reduces friction across the care journey. There are meaningful long-term synergies here. A strong home health platform creates optionality to support home dialysis and other kidney care services over time, as unanswered questions around integration, workflow, and patient experience become clearer. This is a space worth watching closely. The opportunity to deliver added value to dialysis patients through thoughtful, home-centered support is real, and investments like this signal clear intent around where kidney care is heading.
Thanks Dean, well said. I agree on the benefits of optionality here, and hope we see more updates on where it leads. Any thoughts on where advocates might play a role in this type of model where patients are already being seen at home?
Tim, I appreciate the question. My humble opinion is yes. Advocacy for people living with CKD remains essential. There is never enough of it. The real question is how we design it to be sustainable and cost-effective.
When patients are already being seen at home, advocacy should be embedded into the care ecosystem (private AND public) rather than added as a separate layer. I see a few practical levers:
• Upskilling home health clinicians with stronger CKD education tools
• Care coordinators aligned to value-based org (such as DVA's IKC model) and risk stratification
• Social workers and dietitians reinforcing adherence and lifestyle support
• Provider-based educators/advocacy team guiding modality and transition conversations
• Partnerships with organizations like NKF and home dialysis groups for credibility and community reach
I would also add early detection and lab intelligence as critical pieces. Platforms that layer AI insights onto lab data, such as HC1-style models, can flag rising risk earlier and help prioritize outreach before progression accelerates. That allows advocacy to be proactive rather than reactive. When designed well, advocacy, analytics, and home-based care reinforce each other. The goal is not to add cost, but to prevent downstream expense through earlier insight, smarter engagement, and stronger trust across the patient journey.
Agreed Tim. Our kidney care industry's desire and best efforts are not working. Edicts from the administration are not working. I think collaborating with the people who are successfully providing home care, especially with such a broad footprint and now with resources, is a reasonable way to potentially develop a working blueprint and move the needle.
Thanks for the thoughtful breakdown, Tim. This investment feels like a real inflection point where value based kidney care begins to extend meaningfully into the home as an operating model, not just a modality shift. IKC reaching profitability makes the timing especially notable, and Elara’s scale gives DaVita a credible way to support patients while rethinking how and where care is delivered. What’s especially interesting is the workforce implication if this scales, moving roles away from volume driven, chair based care toward more autonomous, integrated clinical work in the home. If this model proves durable and is mirrored by other LDOs, it raises an interesting question about the future role of in center HD clinics and how they evolve in a functioning home first ecosystem. Appreciate you laying out the signals so clearly. Great work!
Well said all around, Paul. I agree this could be the "beginning" of the next chapter. I do think it would be a very positive thing for home dialysis to not just get caught up in the narrative of in-center vs. home within dialysis orbits, and to instead be part of the broader complex care at home landscape. That feels like the right way to do right by patients *and* shake up the reliance on OP infrastructure.
![Signals From [Space]](https://substackcdn.com/image/fetch/$s_!IXc-!,w_40,h_40,c_fill,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F9f7142a0-6602-495d-ab65-0e4c98cc67d4_450x450.png)
![Signals From [Space]](https://substackcdn.com/image/fetch/$s_!IXc-!,w_120,h_120,c_fill,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F9f7142a0-6602-495d-ab65-0e4c98cc67d4_450x450.png)
![Signals From [Space]](https://substackcdn.com/image/fetch/$s_!lBsj!,e_trim:10:white/e_trim:10:transparent/h_48,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F0e0f61bc-e3f5-4f03-9c6e-5ca5da1fa095_1848x352.png)
Great brief, Tim. What stands out to me is the strategic logic of strengthening care delivery in the home for people living with kidney disease. Supporting dialysis patients through home-based clinical services (that already exist) makes sense as it aligns care with how patients live, improves continuity, and reduces friction across the care journey. There are meaningful long-term synergies here. A strong home health platform creates optionality to support home dialysis and other kidney care services over time, as unanswered questions around integration, workflow, and patient experience become clearer. This is a space worth watching closely. The opportunity to deliver added value to dialysis patients through thoughtful, home-centered support is real, and investments like this signal clear intent around where kidney care is heading.
Thanks Dean, well said. I agree on the benefits of optionality here, and hope we see more updates on where it leads. Any thoughts on where advocates might play a role in this type of model where patients are already being seen at home?
Tim, I appreciate the question. My humble opinion is yes. Advocacy for people living with CKD remains essential. There is never enough of it. The real question is how we design it to be sustainable and cost-effective.
When patients are already being seen at home, advocacy should be embedded into the care ecosystem (private AND public) rather than added as a separate layer. I see a few practical levers:
• Upskilling home health clinicians with stronger CKD education tools
• Care coordinators aligned to value-based org (such as DVA's IKC model) and risk stratification
• Social workers and dietitians reinforcing adherence and lifestyle support
• Provider-based educators/advocacy team guiding modality and transition conversations
• Partnerships with organizations like NKF and home dialysis groups for credibility and community reach
I would also add early detection and lab intelligence as critical pieces. Platforms that layer AI insights onto lab data, such as HC1-style models, can flag rising risk earlier and help prioritize outreach before progression accelerates. That allows advocacy to be proactive rather than reactive. When designed well, advocacy, analytics, and home-based care reinforce each other. The goal is not to add cost, but to prevent downstream expense through earlier insight, smarter engagement, and stronger trust across the patient journey.
Agreed Tim. Our kidney care industry's desire and best efforts are not working. Edicts from the administration are not working. I think collaborating with the people who are successfully providing home care, especially with such a broad footprint and now with resources, is a reasonable way to potentially develop a working blueprint and move the needle.
Thanks for the thoughtful breakdown, Tim. This investment feels like a real inflection point where value based kidney care begins to extend meaningfully into the home as an operating model, not just a modality shift. IKC reaching profitability makes the timing especially notable, and Elara’s scale gives DaVita a credible way to support patients while rethinking how and where care is delivered. What’s especially interesting is the workforce implication if this scales, moving roles away from volume driven, chair based care toward more autonomous, integrated clinical work in the home. If this model proves durable and is mirrored by other LDOs, it raises an interesting question about the future role of in center HD clinics and how they evolve in a functioning home first ecosystem. Appreciate you laying out the signals so clearly. Great work!
Well said all around, Paul. I agree this could be the "beginning" of the next chapter. I do think it would be a very positive thing for home dialysis to not just get caught up in the narrative of in-center vs. home within dialysis orbits, and to instead be part of the broader complex care at home landscape. That feels like the right way to do right by patients *and* shake up the reliance on OP infrastructure.