Neal Shah on Transforming Elder Care: From Wall Street to CareYaya

[00:00:16] Hello and welcome to The Uprising Show, where we speak, talk, discuss with the innovators, the forward thinkers, the game changers in the healthcare world. And today I have someone very special, Neil. Neil Shah, welcome to the show. Neal Shah Thanks, Vivek. Thanks for having me. Neal, in a very brief one minute, can you give like a brief introduction about yourself?

[00:00:39] Neil Shah Sure. I'm the co-founder and CEO of CareYaya Health Technologies. We're one of LinkedIn's top 50 startups in America and the fastest growing what they call age tech platform. We run a large caregiver marketplace connecting people who need care for older adults, mostly older adults with dementia, with great caregivers who are uniquely all college students studying to go into healthcare career. So think about your pre-med or nursing students at top universities in the country.

[00:01:06] Neal Shah We've scaled it from an idea to a national platform with over 28,000 students available in over 20 different cities over the last three years. So that's been really cool and it's an amazing social impact in improving aging care. Neal Shah And I'm also the co-founder of Counterforce Health, which is a new AI startup that is helping patients and small clinics fight denied health insurance claims, which I believe is one of the big social issues of our time.

[00:01:30] Neal Shah So yeah, excited to like be here and talk about different ways you can use technology to make positive social impact in healthcare and caregiving.

[00:01:38] Neal Shah Two exciting ventures, something both my areas of high interest after being in healthcare here. But before we go into that, let's talk about because I also know you managed a 250 million hedge fund and led billion dollar investments before you went into building these companies.

[00:02:03] Neal Shah But first, let's just rewind a bit. Where were you born and raised? Was either of your parents an entrepreneur? Neal Shah Sure. Yeah. So I was actually born in India. I grew up in North Carolina. My parents are not entrepreneurs by background. They work in the healthcare field, both in the clinical side. And no one in my family is an entrepreneur going back generations.

[00:02:22] Neal Shah I actually, I initially thought about going into the healthcare field myself, you know, just like traditional kind of pre-medical path. But I ended up choosing to pursue kind of investments in business because I really liked the entrepreneurial culture. And, you know, I thought the kind of the quickest way to learn was to go into Wall Street. So, you know, I kind of did my undergrad at Penn, went into Wall Street, classic like investment banking route.

[00:02:44] Neal Shah And then very quickly, like a year and a half in, you know, this was an early 2000s, hedge funds were starting to become kind of like a dominant force in the market. So I joined a large hedge fund that during my two years there went from 1 billion to 10 billion. So as a 23 year old there, I just got tons of autonomy and responsibility, which is like an awesome learning experience. Very quickly jumped into another fund where I became a partner by the time I was 27, youngest partner in the firm's history. And I was allocated a large portfolio.

[00:03:11] My expertise was restructurings and turnarounds and kind of like distressed debt. And I think part of it is skill, part of it is just luck and timing. But I happened to catch that during the 2008-2009 recession, where at a multi-billion dollar fund, I was the only person that knew how to do that, of like take companies kind of through a restructuring process. So I ended up getting a large pool of the fund allocated to me. Had some great years of returns, you know, just like turning around troubled companies, fixing balance sheets, like finding unique opportunities across industries, including healthcare, but also

[00:03:41] energy and, you know, old economy, industrial industries. So after those returns, by the time I was 31, one of the investors there backed me to start my own fund, started that with 10 million. And by the time I was 35, I'd grown that to a $250 million fund, including family offices, university endowments, pension funds, etc. And, you know, I love doing that work, you know, I was good at it. But I really didn't have any kind of other, you know, professional interests, like because I was just like, all I knew how to do.

[00:04:11] Becoming a caregiver, you know, so that was like, really my catalyst, my personal journey was, you know, first, I went through my whole grandfather's journey of dementia, kidney failure, cancer, and end of life care, where I was the one in the family doing a lot of care coordination. But really, my mom bore the brunt of like the actual direct care work. And I observed the frustration when we couldn't find good care help. And my mom felt guilty and just like ended up leaving her career to become a caregiver full time.

[00:04:37] And as you can imagine, when people do that for two, three years period, you know, she hasn't had the opportunity to go back to the workforce since because it's been very hard. So I kind of observed and just the strain of doing caregiving, you know, it's like, you know, I'd say my observation is like America has some of the best healthcare in the world, you know, in terms of like the most novel therapeutics and surgical procedures and machinery, it has some of the worst social care or home care in the world.

[00:05:01] And when you kind of go through some of these caregiving journeys, I found like 95% of the burden is like what the family is managing at home, you know, for the person going through illness and 5% is like what you're doing in the hospital. And I think that so at that point, I was still running my fund and I became kind of obsessed with the care industry. I was like, I can invest in this, there's got to be some innovation here. It's such a large need.

[00:05:19] And then at the peak of my fund, my wife became severely ill and, you know, went through years of cancer, failed therapies, multiple hospitalizations. At one point, I was in ICU and a medical coma. And I was primary caregiver. You know, we were living in New York and, you know, our families weren't living nearby. So I kept taking sabbaticals from my fund to manage her care. And at some point, I was just like, okay, it's like that every time I try to outsource the care and get help, it was just so low quality that I felt like super guilty that I was like, I'll just do it myself.

[00:05:48] And then at one point, I just kind of like burned out. And I was like, I wound down my fund, return all the capital and became a full time caregiver, because I thought it'd have a big impact on the outcome, you know, and knock on wood, you know, police to say after another two more painful years, she finally had a successful outcome has been in remission now for several years. So it's been a positive journey. We actually had our first child after the whole experience, which was like statistically told us, you know, it was like statistically impossible. So that's been awesome. We have a healthy baby daughter who's turning four. And yeah, and then after that, I was just like, so obsessed with care.

[00:06:17] And I was like, this is impacting a lot of people actually had found more of a purpose and a mission, you know, in like, at that point, I, you know, turned 40. And I was like, okay, I think there's another way I can contribute to the world. So instead of reentering finance, I was like, okay, I'll just like start care companies. I was like, I think there's a huge opportunity for innovation for impact. So that was like the genesis of like shifting, you know, mid career shift into healthcare and caregiving.

[00:06:38] Wow. What a journey. And I'm glad that your wife is doing well. And also, this is a big problem in general, like how you specifically coded that, like we have the best healthcare system in general, overall, the what you needed. But when it comes to especially in home care, or just like the support that you need, this is where there's a huge gap.

[00:07:05] And again, I was telling you a little bit about my experience in home care before this. And it is kind of mind boggling that like, even like, we built a site in northeast Pennsylvania, pretty rural, but it is, it is like not easy, accessible home care. Yeah. Yeah.

[00:07:56] Sure. Sure. Yeah. No, great question. So I mean, I think that one, the aging population is like the biggest demographic in the country over 60 million adults are over 65. And you know, you're about to enter a point, I think in the next three or four years, there's gonna be more above 65 than below 18. So it's like the population pyramid in the country has like inverted, you know, if you kind of think about the US population used to be like this, like a bunch of young people, less middle aged people, and then very few at the top.

[00:08:22] Now it's kind of more like this, like there's a lot of older, not that many middle aged, and then some younger, but you know, not as many. So you have kind of like, fewer people to support the top, you know, and as somebody lives past 65 past really 75 is when the care needs skyrocket. And a lot of people are living past 75. So you have 60 million people in the country, that of those about 20% of them need some form of care at home today. And 48% of them will need care kind of throughout their journey, you know.

[00:08:50] So you have literally 12 million to 20 plus million people that are going to need care. And you are starting from that situation with a current care workforce shortage of 6 million. So there are not enough care workers in America. So it's kind of like, it's already a disaster. But in the next five to 10 years, it's going to be like really obvious societal disaster. And I think that's going to have a lot of second order impact on a lot of people are not going to get care at home, a lot of people's son and daughters and family members are going to be stuck kind of doing the care, which means second order impact on the economy, because they'll have to quit their jobs.

[00:09:20] And they'll have to quit their jobs, which means third order, which is the economic loss, you know, combined with just the mental health and physical health strain of those people. To your question about why is the care industry broken, in my opinion, the industry's economic structure is completely broken. And it hasn't really innovated in the last 20 to 30 years, you know, and kind of the short of it is it hasn't really embraced technology, and it hasn't been forced to kind of optimize economics.

[00:09:39] So I'll tell you the way it works, right? Most care in America, it's, it's about a 500. You know, if you think about entire care is a trillion dollar market of home based care, or sorry, let's say elder care, off the trillion 500 billion is home based and 500 billion is at facilities. Over the next decade, it's expected to entire market double, and the home based share expected to grow. So 500 billion is going to grow to like 1.2 to 1.5 trillion of care at home.

[00:10:02] Of that 60% is happening in the gray market, kind of like informal care, people find caregivers on their own. 40% is happening in the formal care agency market where you use companies. Why is that? It's because the company's structure is broken. You have national franchisors and local franchisees running a model where let's say in your area in Pittsburgh, my area in Raleigh, Durham, North Carolina, most cities in the country, the care system would be you pay a local company 35 bucks an hour, they turn around and pay the caregiver 15 bucks.

[00:10:32] An hour who's doing 99% of the hard work. And then the rest of the money goes into franchise fees, royalties, local sales, marketing, Google ads, Facebook ads, administrator overhead, you know, so for every dollar you're spending less than half is going to the person doing the care. And then no wonder the care sucks. Like no one wants to do that work. People are leaving that industry in droves. They're burned out when you do get a caregiver. They're super disgruntled. They're goofing off on their phone. Sometimes they're multiple hours late, you know, sometimes no showing. So care quality is terrible because the care

[00:11:02] workers are not getting paid that much. And if you think about value created compared to value delivered, you know, our value captured, I guess, if you will, the care company is creating maybe 1% of the value by like making the introduction. And then the care workers doing 99% of the work, right, the grunt work of like taking care of someone at home, but the company is capturing more than half the value. So I think this is a, in my opinion, this is a completely antiquated model that in today's technology, it should not be really prevalent, but it is because of just inertia on part of the industry.

[00:11:32] The way we innovated was, I thought, okay, you could Uberize this and using technology, you could find a convenient way to have people book, schedule, vet, and match with caregivers on demand. It's so you wouldn't have a kind of like local companies forcing you into contracts and upcharging you this much. And then in our case, we run it in extreme where we just said, use all our booking and scheduling technology to find, schedule, vet. We do all that for you. And then we match with caregivers and then we take no take rate, you know, so we like fully defer monetization.

[00:12:01] So we are running a model across America now where it's averaging $20 an hour instead of 35 in most cities or 40 plus in most big cities. So it's like 30 to 40% lower cost. And guess what? The caregivers are awesome. Like imagine if you're in Boston and you're getting a traditional industry caregiver who is going to be a minimally educated person, right? Who's a middle age and they're just doing the job and they're getting minimum wage. Or you're going to get a Harvard pre-med student.

[00:12:28] You know, you're going to get a pre-physician assistant student at Northeastern University. You know, if you're if you're in San Francisco, we're at Berkeley, Stanford, San Francisco State, you're going to get wonderful students who are going to future clinical careers that are doing this at way lower costs than you would get through an agency because they're keeping most of it or in this case, all of it. And they're available and bookable online that we have vetted, verified, interviewed and rolled. And then you get to kind of book them as you need without being stuck in like contracts and fees.

[00:12:56] It's like, you know, it's like a really cool innovation that and and I think that the impact on that is we have single handedly like a handful of us have single handedly grown the care workforce by 28,000 people across the country. And we're just kind of an early innings of beginning. And I think at scale, if we can pull this off, we can get up to a million new people in the care workforce. There's 20 million college students in the country and about four million of them want to go into clinical careers at any given time. And at the universities where we're like the oldest ones we started at, like Duke University and UNC Chapel, we have about 25 percent market share of them.

[00:13:26] So if you do the math on those four million, if we can get a million students on this, this would be amazing. Huge workforce expansion and huge affordability expansion. So this is this is really interesting. This is almost a blue ocean here, like how you have tackled this problem because you are creating new workforce, which was originally not counted as the workforce for this industry.

[00:13:49] So not only you engage and created almost a new workforce out of how the model works. Yeah. And not only this workforce has an incentive to follow this because they are already on those tracks. But also this is young tech savvy workforce who not only probably going to value this, but also going to embrace the technology to the next level.

[00:14:14] So so tell me a little bit about like obviously it is super exciting that in a way in a unique that students are getting this. But what was like what would how it started for you? Like what inspired you about this approach? Like how did you come on that student will be a great idea to go to Michelin this?

[00:14:36] And now based on just the impact that you're overall seeing it again, are you now also facing some kind of a backlash from the traditional system? Because now they're like, oh, probably these people are going to take our jobs and they're going to this. So tell me about questions. Yeah, good questions. I started because this was a best kept secret amongst caregivers everywhere. You know, I'd gone through dementia support groups, cancer support groups, like during my own care journeys.

[00:15:01] And occasionally I found the best caregivers we use were students, you know, and but there was no system to do it. So everybody knows like people are going through cancer care for a spouse. People are going through dementia care for an aging parent. I think a lot of people know or they hear in their support groups that, oh, just go to local nursing school post flyers. So people know it's a best kept secret, but it's like you got to do a ton of work to manage that because you got to go find people. You got to schedule them. You got to background check them, vet them. They can't do it all the time. So it's by definition.

[00:15:28] This is a market that people who want to take a lot of time can engage in. But it's kind of this gray market and most people can engage. And so we thought, OK, bring the gray market to a normal functioning market, online marketplace where we do all that hard work for you. Then many people engage in it because they intuitively know these people have like aligned incentives and want to do a great job because they're not just doing it for the money, but for the upward mobility and the future experience for grad school applications. So it's like really from personal experience. As we grow really fast, the care industry doesn't really view it as like necessarily a threat.

[00:15:58] I mean, we're not big enough yet, but I think most of the care industry is over, I'd say, in over demand in terms of most people have waiting lists. Most people have all the business they can handle. Most people have a shortage of workforce. You know, interestingly, no one wants to go into this workforce because it's not the workforce that they want to staff. They want to staff full time workers. They don't want a gig economy, the thing. They're not set up well for that. So they're competing after kind of like how can we expand the traditional care workforce? So I think it's been kind of cool.

[00:16:24] Now, obviously, at scale, that may change, but I think right now, even from day one when we started and in our area, you know, we were going around and telling people, hey, we're going to get Duke and UNC Chapel Hill students to do this. These care companies were rejecting them. That was my biggest observation. Some of them would apply to those jobs. 3.9 GPA biology senior at Duke gets rejected from three out of three local care jobs. And I'm like, really? Are you guys kidding me? This is going to be the best care ever. You know, and it was just like they were like, yeah, I can't unless you can do 35 hours a week consistently. I can't, you know, have you.

[00:16:54] And, you know, students are like, no, I have glass. So we were like, OK, this is awesome that, you know, the industry has not been structured for the economy so we can build something different. Yeah, this is a very valid point that there is certainly more demand than the supply. So I don't like there's enough jobs. The whole thing is about how do they make these as their primary jobs.

[00:17:17] And one of the things that you, again, touched upon is like, and this is something we did at the home care company that swing that we took on was like we said we will not expand with physical location and those costs because then that you need the headcounts there. Somebody is a scheduler. Instead of that, we will train a tech enabled system to our caregivers and pay them slightly more than the industry.

[00:17:45] And that will make them treating this as like their second jobs to first jobs. Yeah. The main thing is like stop the churn in the turnover first. Right. Yeah. And then that opens, make it attractive enough because now the money is coming in the caregiver's hand. It's more incentive to stay. So it's almost the same thing.

[00:18:04] I will tell you what challenge what happened for us was like, which I think you are handling in much better way is the we were still going because nursing and caregivers. These are still folks who are not coming from necessarily college and school or the new generation. And so we suffered on the tech side a lot, even though we won. And it was even for them, like, yeah, they will take it.

[00:18:33] And then there are, of course, some other challenges like, you know, as we were, there were no starlings and stuff. So the EHR won't work. The tablet won't work. The real area. Then it's like a manual task. And then they are frustrated doing the notes afterwards, all that stuff. But so this is interesting in a way that I think one is if you go in the traditional or conventional workforce. Yeah. The near incentive is less to pick up a job, which is more of a gig.

[00:19:03] They want a job. Like for us. Yeah. Right. And so one is you have turned that into kind of like a gig platform. Yeah. And that now is and then you have younger population and that's tech enabled. That kind of is a brute force here to go. And so I feel really good about it. Like how this is going and shaping based on my experience, especially. Yeah. That was very difficult in a way. Yeah.

[00:19:32] But but I see the promising side of this a lot more. Yeah. And how from the. From the policy standpoint and how this shaped the industry. Do you see this almost like how much do you think can support you can pull in from schools and colleges directly through partnership in some ways? Where like, you know, they are open to this idea of like, yeah, let's make this part of option of our curriculum. Yeah.

[00:20:01] That when you're in college, this is the option instead of doing internship or assignment. Let's do real world this experience. And this is going to benefit not only to the system, but also you probably have some income, but also real world experience that helps in what you are doing. Are you in that direction? Did you have those? Yes. Yes. Great question.

[00:20:23] I mean, as the program grows, we're starting to develop a lot of collaborations more formally with the universities and what they call experiential education that many universities have where they're starting to give students class credit. I sign off on all these letters where if you do 150 hours of care, you get three hour class credit for experiential education within biology, you know, neuroscience, whatever major you're studying in. So that's been awesome. So the universities are very welcoming of it.

[00:20:46] And I think many universities, actually a couple of university administrators have told me that we should call this program Care for America, just like Teach for America, where you are training the next generation of healthcare workers to do good stuff in their community. Yes, like they're making some income, but they're helping older adults, mostly older adults with dementia. They're learning a lot about people's needs. They're really developing a lot of empathy and bedside manner. And these are the people that five years from now are going to be the doctors we see and the nurse practitioners and the physician assistants.

[00:21:13] So, you know, I think that the universities love it. You know, the biology professors, the pre-health career advisors, they love it because other than this, there's no convenient way for them to get kind of like experience during the year. And many of them have to do summer jobs at the hospital or do what's called a gap year. After they graduate, they have to do one to two years of full-time work, working at a clinic or whatever, as a medical assistant to get enough hours to then apply to grad school.

[00:21:37] So if you get on a program like Caria as a sophomore or junior, you might be able to get hundreds or thousands of hours of experience so that by the time you apply, you know, by the time you're a senior, you can apply and get straight in. So, yeah, universities love it. And I think we've gotten a lot of encouragement. I think they're viewing it as a workforce development program, almost like a pathway. And I think some of the things I've even noticed are many times you have people from less privileged backgrounds who want to go in health care fields and they enter, you know, for how many people enter freshman year wanting to go in health care compared to how many exits senior year and actually pursue health careers.

[00:22:07] There's about a 80 percent or 81 percent drop off. And number one or two reasons are the difficulty of getting paid experience towards the field, because many times to work at a hospital, you have to get like nurse aide certification, things like that. Number two is the cost of future graduate health care education, whether it's like a physician assistant program or med school or NP program. So I think and then number three is kind of like resources mentorship. So we can kind of build in all those into our program.

[00:22:34] And I think that offers like a really cool perk for the student that this is like a pathway program to future clinical careers and encouraging and building like a more diverse health care workforce. So I think people love that. So, yeah. I also love who was telling you to make it a care for America program. And this is great. It's almost like you are the the care apprentice with you. Yes. Yes. That's almost you get to like experience it. And I think you should tag that something like this. Yeah.

[00:23:03] Which will, you know, you have to create that label for people to feel good about also like what they are doing. Right. So, yeah. At the end of the day, like you have to say, you know, these college students are this is not the exact like they'll probably earn more afterwards. Yeah. Yeah. So kind of making sacrifices for this as well. Yeah. Yeah. It is obviously a bigger societal gain and initiative that these individuals are doing it by participating in programs like this. Yes.

[00:23:32] It is really fascinating. Wow. Thank you. I feel like I knew very little about it when I spoke to you. But now I know a lot and now I feel very excited about it. What you're doing. This is great. Now on to your second venture. So now with Counterforce Health, obviously big pain point in literally this morning I wrote a post about like, you know, how hard it is to get paid in healthcare complex. Yeah. Yeah. Right.

[00:24:02] Yeah. And this is for everyone, right? Like this is how it's coming set up. So you are tackling a massive pain point of insurance claims denial. Yeah. And again, your focus is totally tech enabled there and figured out how to tackle this. So tell us a little bit how big is this problem in terms of like just the market value and everything. And how did you stumble upon building this specific solving this specific problems? Yeah, sure. Sure.

[00:24:31] Also born out of deeply personal experience. But, you know, I'll say at a systemic level, over $250 billion per year of claim denials. The percentage of denied claims has skyrocketed at many insurers since the last data I found of 2013, 2014 up to 2024. It's some insurance companies that are up 10x. Gone from like 1.1% to 1.5% to now 15% to 30%. And it's been unbelievable. Like these guys are just getting away with it, you know.

[00:24:59] And I think that it's become denial as a source of profit. And I think that 48 million healthcare claims, legitimate claims are denied every year. And the reason I started on this is, one, personally, going through my wife's cancer, there were so many denied claims. And at various times when treatment wasn't working and, you know, she was super sick, I or her were spending hours writing letters fighting him getting on the phone with the insurer. And it was infuriating.

[00:25:25] And what I observed is that through all the cancer support groups, even previously through dementia support groups, at people's worst periods in their lives, like when it's really dark, you are afflicted with something, you're going through insane treatment. It's insult to injury that you're getting all these like denials. And I think that, you know, I thought that there was a huge opportunity here for impact. And really the opportunity is instead of you wasting hours doing it, and in our case, it's like, okay, we could rely on family members to help us craft letters. We could rely on people to help.

[00:25:53] But most people just don't do anything because they're intimidated. So the unmet need, and I would say this is the most interesting statistic, out of those 250 million denied claims, less than half percent of people appeal. So 99 plus percent of people don't even appeal. Like they either pay it or they let it go to collections and it ruins their credit. So that is an insane statistic from an unmet need. Like what market is there where 99 percent of people are not able to take an action?

[00:26:20] And if you bother to appeal, it's about half 50 percent win rate. So, you know, it's something like 45 percent, right? But so think about that, that that people are not appealing further off the 99 percent of people who aren't appealing. 70 percent of people don't even know their rights. They don't know you can appeal. And then the remainder are intimidated by the appeal process that if somebody the two most common reasons for denials are billing code. You know, it's like miscoded.

[00:26:48] And so you have to like just hit up code databases and fix the CPT or billing code. And then the second most common is medical necessity, which is like a little more subjective. And you have to pull references and, you know, kind of cite, you know, based on medical journals, et cetera, why you why a procedure was needed or why a blood test was needed, et cetera. So this I've experienced a problem. Personally, I've seen the problem professionally through our care platform. How many people are dealing with this? And then in light of all the recent events over the last few months, like with the UnitedHealthcare events and everything, you know, I was just like, OK, this is now becoming a societal issue.

[00:27:18] And it's top of mind. And then I went down a rabbit hole on research and I was just like shocked at how much the NAL rates have gone up. Wrote an op-ed in The Hill and everything. And, you know, it's kind of like doing a big advocacy move. But when I dug in, I realized a lot of this can be this is the beauty of AI. And I feel like right now, AI is this cool tool that a lot of big companies are using, but regular people aren't using. You know, it hasn't really been democratized. Yes, people are using some chat GPT and all that. Right.

[00:27:44] But in terms of like tools to like personalize and do things for you right now, I feel like it's a weapon that there's a asymmetric warfare going on that large insurers are programmatically using AI to deny claims at scale and just juice their profits. And then people are like, oh, I got to do four hours of work to fight this. Nah, if it's a $200 bill, I'll just pay it. If it's a few hundred, maybe I'll fight. And then obviously, if it's a critical life or death thing, yes, I will spend all the time fighting it.

[00:28:13] So I thought that this was a perfect use case where you build the tool and then give people the access. So now it's symmetrical warfare. You know, if insurance is going to use AI to deny you, I'm going to use AI to fight back and I don't have to waste six hours of my time. So the dream of the product was, how can I if you get a denial letter for a blood test that was 500 bucks, how can I one click that for you? Upload that. Upload any other relevant documents. One click within two minutes. Very well crafted appeal letter.

[00:28:42] Better than you can write on your own. Probably as good as if your doctor sat down for four hours and wrote one for you. Fixing billing code errors, fixing medical necessities, citing everything, you know, and linking to sources. So there's no like hallucination. And how can I offer that product? And then we have gotten the cost down like crazy. Like our version 1.0 of that was like 12 cents per iteration. We were having to ping all these databases and like do stuff. Then DeepSeq came out and we kind of like embedded some of their models in, got the cost down to like now it's like a penny.

[00:29:10] And it's like penny, sub penny. And I think the trend of the way things are going is like you can probably get the cost into fractions of a penny. At that point, you can programmatically appeal at scale. And like millions of people, it's like every denied claim in the country should be appealed. You know, that's kind of my view. So, you know, but if we can succeed from going from half percent of people appealing to maybe even like 10 percent, 20 percent of people appealing, that's a huge social impact. Because all those people, you know, don't have to pay. And then there's like a multiple step escalation process.

[00:29:37] So we can kind of help advise and guide people on like if the appeal fails, do a force and independent review and then et cetera. How do you escalate? And then the second thing, the most exciting innovation there is voice AI agents. You know, like agentic AI is like big right now. But again, it's like mostly used B2B. A lot of companies are using for like customer service and things like that. But I think the biggest power of agentic AI is for average people to then outsource the task that is costing you time and costing you stress.

[00:30:05] And like I know from firsthand experience, getting on the phone with the insurance company and wasting an hour or two dealing with the claims and the billing person who, you know, are just kind of sitting there programmed to like help you deny you. I don't even know how these people can like do their jobs, to be honest. You know, it's like such a tough job because, you know, you're morally doing something wrong, denying care to all these sick people. But I feel like when you're on the phone wasting your time when you or your loved one are going through serious illness, that is an insane amount of stress that you don't want to deal with.

[00:30:33] So how can I one click it for you so that our voice AI agent, what we call Maxwell, will just call the insurer on your behalf and deal with the whole thing? You know, because, you know, now they're starting to replace a lot of their processes with like voice AI bots. So I think, you know, it's kind of like, you know, fight same with same and just like make these tools available for people so that they're not so that warfare is an asymmetric. Love it how you explain this, how to make this battle very symmetric. You're in spade with spade now.

[00:31:03] Yes. Let's do that because companies are using AI to do your denials. Why can't we build a tool to fight those nails with AI for it? Yeah. Yeah. I guess the world was fearing that between AI and AI there will be this. It's a shame. But, you know, if that's the game, you know, then if you don't empower people to use it, they're going to lose, you know, because. Yeah. Yeah. But I think the key point is I was surprised with this.

[00:31:29] The number that you quoted less than one person fight for their denials or against their denials. 70% of people don't even know. Can you believe that? Like talk about patient rights and patient advocacy. Like, yeah, I almost think half the battle here is just doing a PR campaign, whether you use our tool or just do it yourself. I don't even care. Like now through building awareness, people will know their rights. Yeah. That you can appeal. Yeah.

[00:31:52] And also like how you were saying, there's a lot of, you know, of course, it's still not much consumerized that AI uses. It's more on the companies still. So, but I mean, look, I can tell you like there's a lot of things like even we have trained models even inside my company. And now even the talk track that we sent you, that was us as a model to where we feed you. It goes through. Wow. That's awesome. Comes back to you. And we have trained models on this mix of questions.

[00:32:22] And we actually then score those questions afterwards that it turns out organic reach and insightfulness and just like engagement element. That's awesome. Building it. Yeah. And again, this wasn't possible. If I had to do the same thing, we won't be as lean operation as we are. Yeah. Yeah. That's awesome. Yeah. So, I mean, look, it's very different world right now.

[00:32:49] And I think the more we use, especially the utility wise, I think on the consumer side, there is so much that we can do. And of course, you know, AI superpower is at least what's proven is it can take this zillions of data sets and then give you what is like the pattern that you can't see it from naked eyes. Yes. Or manual research, right? Exactly. Or at least that's proven like in medical. Yes. Right. So. Yeah.

[00:33:18] And I think to your point, I'm glad you mentioned the cost thing because lean is key here. And the reason that people are not appealing is because when the oncologist knows you got denied, get the statistic, $43.84 for the clinic or hospital to help you with an appeal. Like they don't have that kind of budget.

[00:33:38] So it's like when the appeal costs $43.84 for the doctor or the billing person to help you, they're going to be like, sorry, I can only help once in a while because I can't eat that cost. Right. A lot of times, you know, the appeal, it's not worth their time. When it costs one cent, anyone, you know, it's like we can offer it and anyone can do it. Yeah. So I think that that's the thing that lean, you know, it's like getting this cost way, way down can help a lot more people get access. And I think that's one of the big beauties of AI, you know, in this case. Yeah.

[00:34:07] Oh, very exciting about this too. Okay. So now more of a couple of personal questions to end our conversation. So you have worked both Wall Street and healthcare now. What's one thing healthcare leaders could learn from hedge fund managers and vice versa? Tell me about that. Yeah. I mean, I think one of the biggest things I think people can learn in healthcare is thinking about it as a market.

[00:34:34] You know, I think oftentimes like in a hedge funds, like you're very shaped by the forces of the market that you are kind of like just a fish in the ocean. But you have to kind of like think about the market. And then also another way of thinking is think about consumers, think about demand, supply, et cetera. I think a lot of times in healthcare, the market orientation isn't really there. It's kind of like there's not price transparency. A lot of times healthcare doesn't think about like the underlying patient as consumer. Everything is geared towards kind of B2B. A lot of healthcare organizations are just geared towards whatever the payer wants.

[00:35:04] And then, of course, the payer has its own incentives, not really what the underlying consumer wants. And so I think that a lot of healthcare leaders, wherever they are, and certainly in like healthcare innovation, but even at large hospital systems, frankly, even at payers, I think would benefit from like thinking about this as a market. You know, and that's like in hedge funds, you don't have a choice. Like you are just subject to the forces of the market and you're trying to read those forces and think where you can position. And I think a lot of times like, you know, healthcare leaders have been like, you know, in this like kind of almost silos, you know, not thinking about it as a market.

[00:35:34] And I think they should be because it's about to go that way. And I think that's also like the way you can make the best impact of, you know, just kind of like thinking about the market and its needs. Interesting. What would you say like the kind of like thinking is one thing? How can they put to practice? Tell about that a little bit after also running a couple of companies now. So give us a little bit on that of putting into practice for how to think about it as a market. Well, I think that's, that goes to policy. You know, I think that partly policy needs to change.

[00:36:02] You know, I think a lot of like entrenched health systems, partly it's not even their fault. They don't think about it as a market because they don't have to, they don't have to answer to anyone. Right. If you think about like large hospital systems, many times they're local regional monopolies. So if you're on a monopoly, there is no market, like you're the market. So, you know, you're like, okay, think about primary care, right? That's one thing where one medical and these guys have innovated, but it's like most massive, hospital systems. You know, if you're Mass General in Boston, who cares about primary care because you are the monopoly right in the region.

[00:36:31] So I think that oftentimes I kind of view it as that, that creating healthcare policy so that there is opportunity for competition and price transparency will create more of market forces. But I think, you know, of course, if you're like a very forward thinking leader, you might put yourself in that situation anyway. But I think most people aren't because that's not forced on them. So I think I would love it if people started operating with price transparency, like in our industry, in our caregiving business, like we operate with full price transparency. People know what the price is going to be when they go on the site.

[00:37:01] Believe it or not, in 2025, the home care industry in America has no price transparency. So you have no idea when you call like local player that might be even a national franchise, billion dollar company, whether it's going to be 35 bucks an hour in Pittsburgh or 38 bucks an hour or 42 bucks an hour. You have no idea. You have to call, home visit, sign contracts. And then at that point you get the price. I mean, can you believe, you know, it's like basic marketplace 101, you know, what is the price of the product? Right. I know.

[00:37:28] But I'll tell you after also running a home care operation, but I'll tell you one thing is like we were really big on like, okay, we want to make sure the caregiver gets the money. Yeah. And one of the practice that we had to do was always like, you know, like you get a authorization for a case or for the client, right? And it comes with the price tag from insurance that this is what you're going to get. Yeah.

[00:37:52] And then what we realized was like, oh, so nothing will change if we don't make the matters like as an agency owner in this role. Yeah. We have to actually come up with data and then renegotiate with them. Always like that won't work if we show them quality of care delivered by the, by the caregiver. So we built our system just to like, oh, now at least we can show them like on weekly basis. This is the NPS we have released from this.

[00:38:20] And that becomes our like, oh, for last 90 days or last six months or term of this art, this caregiver did this. Now we want $2 more on this so we can pay more to the NPS. Yeah. Yeah. I actually think there's a big option. Somebody can build this part with AI, this same that you're built. Yeah. We can build it for home care companies and just tracks them. And then renegotiate back with the peers.

[00:38:46] And this way you create a quality based, value based, at least compensation for caregivers and caregivers getting more money and there's more incentives for everyone. Right. Yeah. Well, great idea. So, uh, so I was just going to say like, sometimes it's not easy to say what's the number even. Yeah. Yeah. Because you're running through these cycles. Like we start with the base, but like, I want everybody to have it. But because of these challenges, it's not even easy to like say that's how complex our system

[00:39:16] is. Yeah. Now you're right. So, so I'm glad that you are moving towards like, of course, the, uh, transparent pricing is probably way to go. At least at this level, we should anchor pricing to something. Yeah. Yeah. And, and that is a good starting point. Let's say that. Yeah. Um, uh, all right, cool. So now I know that obviously you're doing so many things right now. Yeah. What is one habit that keeps you sharp every day? Hmm. Yeah. Good question. Um, reading.

[00:39:46] I read a lot. Uh, I love reading, um, one reading about things outside of my current field. Cause that's where I like get new ideas sometimes. Like for example, I love going down rabbit holes of like reading seven books on the health insurance industry history, you know, policy suggestions, everything when kind of like this becomes a topical issue. And then through that, I get a lot of ideas and then, and then it's also just kind of like interesting to like disconnect from day to day kind of work and just think big picture and then just reading about all kinds of things. So I'd say that's one habit that I'm like almost like swear by every day.

[00:40:15] I have to read at least half an hour to an hour, something unrelated, just like direct work. Um, and I feel like I view that as like over long periods of time when you keep that up for 10, 15, 20 plus years, you learn a lot. Um, and sometimes if you're especially interdisciplinary, those ideas are like really a payoff. So yeah. And it's fun. No, this is great. I, I actually do take this to the next level on our media network. I actually built a show which goes over, uh, PR and marketing campaigns from U S history.

[00:40:46] And this is an show that we, it's called selling cures on our, take it out. Uh, it's like five minute stories, AI narrated, and it tells about what they did for marketing campaigns and PR just because there are so many complexity in healthcare, but, uh, but it gives us the historical perspective, how things were done right on that subject. So, uh, but exactly, this is the same, uh, how you're saying like, you know, I am very curious

[00:41:11] about reading history in general and trying to find out and find like, what can we can transfer our things not to do. Yeah. Even those things. So it's, uh, it, I find it really valuable, especially like you, like, uh, take it to outside of what, you know, bubble and then what we can learn from there. So that's good. Um, last question, uh, this is a fun one.

[00:41:36] So tell us about one personal thing that no one in your professional circles know right now. And this is your chance to tell the world or is anything appropriate that you think could be anything. What is that Neil wants to share? Okay. That's a good one. Um, I'd say actually maybe dovetailing off the reading question, um, you know, and kind of like the hobby, uh, I'm kind of on the side. I'm working on this book idea that I've had for a while, which is like nothing to do

[00:42:05] with healthcare or caregiving, but it's more like astronomy or astronomy and astrology, if you will. But I have this theory that cycles of human behavior are shaped by, you know, how like the earth rotates around the sun and, you know, that creates kind of like the seasons, you know, over the course of the year, like, you know, uh, fall, spring, you know, winter, summer, et cetera. Um, I have a theory that there's a 24,000 year cycle going on, um, due to the procession of the equinoxes and the sun rotating around something, you know, cause the sun's not static, right?

[00:42:34] So if you have like the earth going around the sun, you have the sun going around something else. Um, and the theory there being, um, I believe that in this 24,000 year cycle, as you can see, as the sun moves over through the zodiac, uh, over 24,000 years, there are shifts in human behavior on earth because it gets closer to and farther away from the center of the galaxy. And the electromagnetism, um, that is kind of emanating from the center of the galaxy changes kind of the way humans operate and even like human intelligence.

[00:43:04] So I've been like working on this as a side project, but it's like fascinating of like, how do you go through these yo-yos in civilizations where you go through something like dark ages where like human knowledge is just like completely lost and society kind of goes totally backwards and, you know, you kind of read history about like, wow, these people didn't know anything. And then you have other stories from thousands of years back. Um, you know, whether they're like just things written down where you're like, wow, these civilizations were doing amazingly complicated things. Like people still don't know how they built the pyramids and things like that. Right.

[00:43:32] So one of the theories there, uh, in this book that I'm kind of writing is that what if human knowledge and human intelligence is flowing in these cyclic waves over like these long time spans, um, based on how the sun's moving around, um, and rotating around something else and going closer to the center of the galaxy and back. So it's kind of like a fun. That's fair. Did you already find some, uh, uh, correlations and patterns for like just tracing back? You did? Yeah. Yeah.

[00:44:00] I found some, some, I mean, obviously like recorded history, you know, only starts at like four or 5,000 BC, you know? So it's like hard to like truly prove this out because you don't have anything back 15,000 BC, 20,000 BC of like what was going on. But yes, like so far the correlation of the pattern seems to be that, you know, we are like the, the trough might've been like 500 AD, which was like kind of correlating with kind of like the, uh, bottom of like human knowledge or human civilization, like straight up dark ages, everything was lost.

[00:44:30] And then previously the peak might've been like a few thousand years back. And then now we're kind of on the upswing, which is like, kind of like we're 1500 years in the upswing, but like there's probably another few thousand to go. So it's kind of interesting. So it makes you wonder kind of like at the peak of the upswing, like what if it's like super intelligence, you know? And what if it's like full telepathic communication, right? Like if you're closer to the source of like the electromagnetic, um, emission, then it might be very different world than dark ages, like kind of the flip of that.

[00:44:59] So, well, no way to prove it is true because you don't have enough, enough info, but it's kind of a fun thing to think about. So this is, uh, this is exactly what this question was supposed to be, English things like this. So really thanks for sharing. Well, this has been great, much appreciated. Um, thanks for coming on the show and, uh, how can people, uh, get in touch with you if they would like to get in touch with you directly? Sure. Yeah. I hit me up on LinkedIn, you know, I'm reasonably active on there.

[00:45:27] Um, it's Neil, N E A L, uh, K Shah, uh, S H A H at Careyaya C A R E Y A Y A. And then of course, like for the caregiving platform, you're welcome to check us out at www.careyaya.org, uh, C A R E Y A Y A dot org. And then for the insurance AI tools, we're offering them free to people, um, and looking to collaborate with clinics. Um, and that's at counterforcehealth.org.

[00:45:50] So we will make sure we put all the links and all these, uh, website in our show notes whenever you get all these things. And, uh, Neil, once again, this has been great. Thank you so much for taking the time. Uh, I'm, I'm extremely gungo about the, uh, caregiving world. So, and so your company there, uh, gives me, uh, I'm, I'm, I'm actually really fascinated. We'll probably have more conversations about this. Right. Off the record too.

[00:46:18] Uh, and of course, uh, uh, you know, uh, being, uh, I consider that, uh, you know, there's no better way to also leverage AI. So I'm also very, very excited what you're building there, but this has been great so much for your time. Much appreciated. Thanks Vivek. Really appreciate the opportunity.