Mike Uchrin, Monogram Health, on Transforming Kidney Care through Value-Based, In-Home Treatment

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In this episode, I had the pleasure of sitting down with Mike Uchrin, Co-Founder and CEO of Monogram Health, to explore how his company is transforming the care landscape for chronic kidney disease (CKD) and end-stage kidney disease (ESKD) and related polychronic conditions. Since its founding in 2019, Monogram Health has integrated value-based care with in-home, evidence-based diagnosis and treatment, focusing on personalized care for patients with CKD, ESKD, and multiple chronic conditions. Monogram was recently recognized as the third fastest-growing privately held company in the U.S., backed by over $350 million in funding from major healthcare players like CVS Health, Cigna Ventures and Humana, among others.

Mike and I discussed:

• His journey from his early career to founding Monogram Health
• How Monogram’s value-based, in-home care model addresses CKD and ESKD
• The critical role of evidence-based protocols in improving patient outcomes
• The challenges Monogram faced when scaling nationwide
• Innovations in the future of kidney care, including genetic and pharmacological breakthroughs
• Advice on managing kidney health and preventing chronic conditions

Beginning — 02:29: From Childhood Dreams to Entrepreneurial Reality

Mike began by sharing his early inspirations. Though his childhood dream was to play center field for the New York Yankees, he was influenced by his father, who owned a small business. This entrepreneurial spirit carried Mike throughout his professional journey, instilling in him a deep desire to create and build something meaningful.

As he transitioned into healthcare, Mike found himself managing various aspects of health plans, which exposed him to the systemic challenges in treating patients with chronic kidney disease. He quickly realized that these patients — who often have multiple chronic conditions — were underserved by the traditional healthcare model. This experience catalyzed his decision to co-found Monogram Health.

• Inspiration from his father: Mike emphasized how growing up watching his father build a business motivated him to pursue entrepreneurship later in life. He expressed a deep admiration for the grit and dedication his father demonstrated
• Healthcare pivot: Mike’s work managing health plans exposed him to the difficulties of addressing the needs of complex, chronic patients. The inefficiencies he witnessed in treating CKD patients helped him identify an opportunity to deliver more comprehensive, home-centered care

“I just saw and felt that we as health plans were ill equipped to really create the clinical programs and manage the care delivery for individuals with chronic kidney disease”

02:30–06:17: The “Aha” Moment and Founding Monogram

The pivotal moment in Mike’s career came when he had a conversation with Senator Bill Frist, a renowned heart-lung transplant surgeon and former Senate Majority Leader. Senator Frist shared his insights on chronic kidney disease, which resonated deeply with Mike, given his recent observations of gaps in CKD care. This conversation led Mike to co-found Monogram Health in 2019 to manage care for patients suffering from CKD.

• Senator Bill Frist’s influence: Mike recounted how a single conversation with Senator Frist confirmed his belief that the current healthcare system was failing CKD patients. This conversation was the spark that led him to take action
• Founding Monogram Health: Mike discussed how the initial founding of Monogram was centered around the belief that kidney disease patients needed more personalized, home-based care models. With that mission in mind, Monogram Health was born

“After about a 30 minute meeting it turned into a couple of hours.. I had agreed to move my family across the country, on a handshake, just because I knew there was such an opportunity. We rolled up our sleeves in 2018 to get to work and are proud to have created what has now been become known as Monogram”

06:44–16:41: Monogram’s Polychronic Approach to Nephrology

One of the unique aspects of Monogram Health’s care model is its polychronic approach, which addresses the multiple chronic conditions — such as cardiovascular disease and diabetes — that often accompany CKD and ESKD. Mike explained how Monogram Health’s care teams deliver comprehensive, in-home care that simultaneously treats CKD and these other conditions, ensuring patients receive holistic treatment rather than focusing on just one disease.

• Treating the whole patient: Mike emphasized that kidney disease cannot be treated in isolation, as most CKD patients suffer from multiple chronic conditions. Monogram’s care model ensures that all these conditions are treated together to improve overall outcomes
• In-home care: Mike discussed the importance of delivering care in the patient’s home, particularly for CKD patients, many of whom may face difficulties traveling to clinics

“Chronic kidney does not exist in a silo. It’s all brought upon a number of comorbidities that when go unmanaged, go untreated, put tremendous strength on your kidney function and lead to progressed kidney function degradation..Our approach ensures that we’re treating all the patient’s chronic conditions, not just kidney disease.”

16:41–23:01: Evidence-Based Protocols and Clinical Success

At the core of Monogram Health’s approach are evidence-based clinical protocols. Mike discussed how Monogram worked closely with its national clinical advisory board to ensure that every aspect of the company’s care model was grounded in clinical research. Monogram’s clinical protocols guide how care is delivered, ensuring that every patient receives a personalized, research-driven treatment plan.

• National clinical advisory board: Mike detailed how Monogram Health collaborated with leading specialists in nephrology, cardiology, and geriatrics to develop its clinical protocols. This board continues to guide the company’s research and treatment standards
• Personalized care: Each patient’s care plan is customized based on their unique medical history and current condition, ensuring that they receive the most appropriate and effective care
• Lower readmission rates: Thanks to these evidence-based protocols, Monogram has seen a hospital readmission rate of 15%, compared to the national average of 30%. This success is a direct result of their rigorous approach to care

“We take all of this information and apply clinical research and criteria to each one of these assessments to drive an evidence-based care plan with very, very discrete and focused, deliberate care plan goals to ensure that we’re driving the best possible outcomes.”

23:01–28:53: Scaling Monogram’s Impact across the U.S.

Monogram Health’s rapid growth has brought both opportunities and challenges. The company has expanded its services to 35 states, covering over 12,000 zip codes, but scaling such a comprehensive care model has required careful planning and continuous improvement. Mike discussed some of the key challenges they’ve faced as they scaled operations, particularly in maintaining high standards of care across a broad geography.

• Scaling challenges: Mike explained how the complexity of managing care across multiple states necessitated major investments in infrastructure, technology, and logistics. One of their early challenges was finding the right balance between maintaining the quality of care while rapidly expanding into new markets
• Improving efficiency: To address the operational complexities of scaling, Monogram revamped its clinician scheduling system, which allowed them to more efficiently deliver care to patients spread out over wide geographic areas

“Growth is a privilege, but it is really, really hard…. And you know, you’re going to get some things right, you’re going to get some things wrong, but the worst thing is not to act.”

28:53–36:47: Innovations in Kidney Care: Genetic Breakthroughs and New Therapies

Mike is enthusiastic about the future of kidney care, particularly in light of emerging innovations in genetic and pharmacological treatments. He highlighted some of the cutting-edge developments, such as genetically modified pig kidney transplants, which could provide a solution to the growing organ shortage. Additionally, new pharmacological treatments, including GLP-1 and SGLT-2 inhibitors, are proving to be game-changers for CKD patients.

• Genetic innovations: Mike explained how advancements in genetic engineering are paving the way for new treatment options, including the potential for pig kidney transplants to address the organ donation shortage
• Pharmacological treatments: Mike emphasized how new therapies like GLP-1 and SGLT-2 inhibitors are improving outcomes for CKD patients with diabetes and cardiovascular conditions

“And so we’re really bullish on the future, and believe just as special as the genetically modified pig organ or the next generation pharmacologics is our polychronic approach to nephrology care where, on average, our patients are seeing over seven specialists.”

40:30 — End: Closing Advice for Kidney Health

Mike wrapped up the conversation by offering practical advice for managing kidney health. He emphasized the importance of monitoring blood pressure and blood sugar levels, especially for patients with diabetes or hypertension, as these are major risk factors for kidney disease. Early detection and regular screenings are key to preventing kidney disease from progressing to more severe stages.

• Monitor blood pressure and blood sugar: Mike stressed the importance of proactively managing these two critical factors, as uncontrolled blood pressure and blood sugar are among the leading causes of kidney disease
• Early detection: Mike encouraged listeners to get regular screenings for kidney disease, particularly if they are at high risk due to conditions like diabetes or hypertension

“Just know that managing your blood sugar and diabetes, as well as your blood pressure and other cardiovascular conditions, is directly lengthened and correlated to kidney function. “

We are very appreciative to Mike Uchrin for sharing his advice and wisdom with us on this episode of The Pulse Podcast!

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