This was a great read and very insightful, thank you. During your research, did you find any indication of Medicare looking to transition the whole industry away from the fee for service model and put everyone on the risk based/value based model? Or does it look like the two will co-exist? If Medicare is paying more to providers under the value based model (via distributed savings) surely that will decrease following mass adoption because they will want to reduce costs?

Also does this model only relate to Medicare patients, or can the model be applied to privatively insured patients?

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Thank you for this thorough analysis!

Question on the commercial/medicare mix. The company discloses about 10% of patients are covered commercially. If I am understanding correctly that relates to the first 33 months that a patient with private coverage is on dialysis. You mention in your write-up that medicare typically only covers 80% of the cost of treatment, but with only 1% of revenues coming out-of-pocket I'm assuming the vast majority of patients have private (commercial) coverage for the remaining 20%. So I am asking: does commercial revenue reported by the company include the residual 20% not covered by medicare?

Wondering if that might skew the magnitude of the profitability difference that you have calculated on a per patient basis between medicare and commercial?

New item for my investment checklist: buy companies with CEOs that refer to themselves as "mayor" and to their company as a "village".

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