DaVita

Economic moat assessment by component: Efficient scale 90/100 (high barriers and limited local market capacity deter new entrants; DaVita estimates ~36% share of U.S. dialysis patients), Switching costs 80/100 (thrice‑weekly, relationship‑intensive care with physician joint ventures, lab integration, and travel convenience make switching centers non‑trivial), Cost advantage 78/100 (procurement, centralized labs, IT and network density), Intangible assets 65/100 (reputation and measured leadership in CMS Five‑Star and QIP programs), Network effects 35/100 (weak at the patient level).

Weighting these by importance (35%/30%/25%/7%/3%) yields ~81. Evidence of durability is supported by scale, clinical programs, and multi‑year payer relationships, but risks to moat include: higher home‑dialysis penetration, plan design limits on commercial coverage, and gradual disease‑progression moderation from SGLT2/GLP‑1 therapies over time.