Full YouTube video link
Apr 7, 2025
On this episode, we’re joined by CareYaya and Counterforce Health to discuss their efforts to battle a broken healthcare system with new technologies and a people-first approach. Guests Featured: Neal Shah, CEO, CareYaya and Counterforce Health Nirvana Tari, Director of Patient Relations, CareYaya Dezarae Stone, Patient Advocate, Counterforce Health Gavry Eshet, CTO, CareYaya and Counterforce Health Host: Bill LuMaye Resources: CareYaya www.careyaya.org Instagram @wearecareyaya Counterforce Health www.counterforcehealth.org
Full Transcript:
hello I'm Bill Lay and thank you for
watching Community Matters we hope
you'll continue to watch as we discuss
issues facing our community and provide
you with the resources and information
needed to find solutions
[Music]
today we're diving into Care Yaya and
Counterforce Health two innovative
startups that are transforming elder
care and taking on the broken health
insurance system in America k Yaya found
a way to connect families with
affordable care from prehealth college
students making quality care more
accessible and affordable and let's
start with Kerry Yaya and see how it's
changing how we care for our most
vulnerable meet Neil Sha and Nirvana
Terry welcome to both of you a pleasure
having you on the show it's good to see
you again good to see you Bill thanks
for having us well I know when we first
talked I think it was a year ago I said
"This is an incredibly good idea." So if
you wouldn't mind let's start with you
uh talk a little bit about get everybody
up to speed what it is what Care Yaya is
all about and you know what what you're
doing today versus where you were a year
ago sure yeah so we're a local company
started here right here in Raleigh uh
and we connect uh people who need care
for aging parents or a spouse um with
care from wonderful college students um
who are going into the healthcare field
so think about our doctors and nurses of
tomorrow um we do it at very affordable
rates around 20 bucks an hour um so it's
30 to 40% lower cost than traditional
care options that can often cost $35 an
hour you know our mission is to solve
the homebased care crisis you know that
53 million Americans today one in six
people are taking care of an aging
parent or a spouse through serious
illness and most people can't afford
home care you know it's $ 35 $40 an hour
most of the care companies are keeping
much of the money they're paying the
care workers next to nothing and then
the quality of the care sucks so we
thought there's a way to use technology
innovation to solve that um so we built
a technology platform to connect all
these wonderful students who want to go
into medicine you know who want to go
into clinical careers and uh connect
them with families who need care uh
families pay them directly so it's only
$20 an hour we charge no fees or markups
and yeah pleased to say after running it
in Raleigh uh for the first like year or
so it's now started to scale all over
the country we now have over 30,000
students on it uh we've now received
backing from the American Heart
Association social impact funds AARP the
former surgeon general said very
positive things about our innovation is
the most interesting thing she's seen to
expand access to healthcare in America
and yeah we've even received backing
from Atrium Health the big hospital
system in North Carolina so it's spread
really fast and it's really cool to see
not amazing though in the sense that
it's spreading because it was a
brilliant idea i mean to fill a need
like that with something innovative and
you Nirvana are on the front line i mean
you're meeting with the families i mean
what is that like for you and what are
some of the biggest challenges you're
facing you know thanks for the question
i actually uh started out on the
platform as a joy giver myself as we
like to call the um caregivers and I got
to see kind of firsthand the struggles
that the families were really facing of
um you know of finding quality
affordable caregivers and how much of a
difference Kerry was making in their
lives so it really really inspired me to
kind of um meet with Neil and our other
co-founder Gavry and become a part of
the solution rather than um going into
like a more broken healthcare system and
uh so now I'm able to meet with the
families and get to really understand
their pain points and solve them for
them which the biggest pain points tend
to be quality of care and affordability
of care and Keria addresses both of
those problems with ease as the college
students are such wonderful caregivers
because you know they are the future of
uh medicine they are the doctors and
nurses of tomorrow um they are who is
going to transform the world into a
better place so they're getting this
experience firsthand starting out in
their undergraduate year so it's really
amazing to be able to see those
connections made the reason why I think
Kerrya is so novel and so such an
incredible win-win for both sides is
because the students like just like you
said aren't necessarily doing this for
the money it's more so for the upward
mobility and for learning and for the
experience because where else does a
20some get to engage with someone who's
70 80 90 years old and um learn from
them and also get that hands-on
experience that you can't learn in a
classroom you can't learn compassion
empathy bedside manner in a classroom so
being able to see these students um
learn those soft skills that are going
to truly make the difference in their
careers is really amazing um and also
seeing that translate to the families
and seeing the how the stress and the um
worries just melt away after like a few
first care sessions is just really
beautiful and inspiring and keeps you
motivated to keep going and doing the
hard work well and you know I see the
smile on his face and it must be
tremendous to know that here you you see
this need and you you have a way of
meeting it and everybody wins now you
mentioned you expanded to San Francisco
how does that work actually uh because
you're based here how does somebody in
San Francisco even hear about you yeah
so we're based here but really the
beauty of it is it works the best when
we spread all over the country because
there could be somebody living here
whose mom lives in San Francisco or
whose mom lives in Indiana or whose mom
lives in Texas or dad and you know the
best of this is there are wonderful
universities everywhere there are
wonderful students everywhere so um we
started spreading online uh to San
Francisco at Stanford UC Berkeley San
Francisco State we started spreading to
New York City Boston we're at now over
30 of the top 50 universities in the
country um students come onto our
platform get signed up online we put
them through a pretty rigorous
background check verification of
enrollment at the university video-based
interviews um most of the time they're
coming from professors and prehealth
career adviserss that we know and build
relationships with at the universities
and then they get on boarded onto our
site and then families who need help
with care can go to the site and request
so there are families in Raleigh getting
care for loved ones in Raleigh but
there's also families in Raleigh getting
cared for a loved one in Atlanta or in
Texas and I think it's kind of cool to
see how it spreads nationwide and the
more it spreads like that the more
availability there is on the care
platform the more that families might
hear about it and say "Oh my loved one
lives somewhere else i can actually
access this." So it's been really
interesting to see how it spread um the
unmet care need you know we've been
surprised is care in some of these
cities is even more expensive you know
in Raleigh Durham most of the
traditional homeare companies are
charging 35 to 40 bucks an hour in San
Francisco it's pushing 45 to 50 an hour
so I mean as you can do the math on
somebody who needs like 2,000 hours a
year of you know care like full-time you
know you're pushing sometimes $80,000
$100,000 a year families can't really
afford that right most even upper middle
class families can't afford that so it's
really cool that our innovation comes
into San Francisco and does that at 20
and people are like "Wow I can save
literally thousands of dollars a week."
And that's really rewarding to see
because a lot of people who otherwise
couldn't get care are now able to afford
well and that's so frustrating if you
have a loved one a parent that needs the
help and you can't afford to give it to
them uh it's it's a terrible place to be
well Nvana tell us a little bit about
this maybe some family that stands out
because you almost become a family
member don't you oh yeah absolutely i
mean because I know having gone through
it myself really rely on people like you
especially when you're taking care of
somebody that you love right so what's
that like for you to become part of a
family when I was a caregiver one family
that really I know you're not supposed
to have favorites but one family that
really really stood out to me uh was um
this Middle Eastern family that uh had
immigrated to the States like 94 years
ago I guess uh when um the the person
that I was caring for was like a baby
and I got to go to care for him every
single Sunday for almost a year where we
um spent did activities together i got
to know his family better and I even got
invited to his birthdays and Christmas
dinners as well um it has been about uh
8 months since he has passed but he will
forever have a really big part of my
heart and I still am in communication
with his sons and daughters we um send
each other Christmas cards he texts me
on my birthday and it's just really
amazing to know that that connection
that I had with that man for that year
is going to impact me for the rest of my
life and it's something that I'll be
telling my kids about that is awesome
absolutely the impact spans far and wide
and even like your loved ones and people
close to you can see that difference in
your life oh absolutely i mean the whole
family benefits there's so much more to
talk about and you know we are going to
talk more in just a little bit we're
going to come back and we'll talk about
their mission to fight health insurance
denials one of my favorite topics stick
around see
[Music]
welcome back desiree Stone is joining us
now with Neil Shaw to talk about their
latest project Counterforce Health it
sounds like you're taking on the health
insurance system which I kind of like
and I think there's a need for that and
this is another wonderful idea you just
keep coming up you're batting a thousand
let's start with Neil tell us about it
sure so yeah we think health insurance
is completely broken in America i've
been through this myself during years of
my wife's cancer battle you know at the
darkest times in your life you're
dealing with denied claims and necessary
treatment and just fighting the health
insurance company on getting care you
need and then now that we've been
running Kerry for a few years we're
seeing a lot of the families we help
just sitting there wasting hours and
hours arguing with the insurance
companies to get care for their loved
ones and you know I think it's become a
crisis i mean I think look all of us
know you know what happened in December
right the CEO of the biggest health
insurance company in America got shot in
plain daylight and most of the people on
social media reacted with glee and jokes
and I think that tells you how broken
you know the system is and you know I
don't think that's necessarily the
solution but there's ways you can
innovate and come up with a solution so
what we found is you know a lot of
people that are going through this
they're being denied claims almost
frivolously you know one in five
Americans who has health insurance had a
health care claim legitimately denied
within the last year that they should
have gotten and I think these insurance
companies are doing it because they know
you're not going to have the time to
fight back uh 99% of people who have a
denied claim don't appeal so that's
crazy right statistic only 1% of people
appeal but if you appeal 50% chance you
win and you get the care you need so we
kind of thought the real problem here is
most people are intimidated by the
appeals process most people don't know
their rights or most people think it's
going to take them way too much time and
money to do it right so we thought our
solution is we can rapidly build
awareness you know through uh being on
programs like yours and then we can
build an AI technology tool that will
generate a very welldetailed crafted
appeals letter in less than 2 minutes um
so patients can kind of upload their
coverage policy upload their denial
letter and any background information
and this will do all the research for
you it'll be like your brother is a
doctor and sitting there wasting eight
hours writing a letter cite all the
medical references cite the details of
the policy and make almost like a very
compelling case that this should be
covered you know boom print it out fax
it or mail it to your insurer and then
close to 75% chance that you'll win so
that's kind of like want to make it as
one click as possible and just get
everybody to appeal that's just amazing
because most people obviously were not
schooled in medicine or law yeah and uh
you've now bridged that gap that's
amazing now what about you now how did
you become such a passionate advocate
for this is it a personal experience yes
it is i was the caregiver for my
grandmother with Alzheimer's for over 10
years and throughout the process I
realized that even though there's not a
cure for the disease there's still
treatment medication scans that are
needed and she was oftentimes getting
denied 20% of all neurology claims are
denied and many people don't realize
that caregivers are increasingly
stressed during that time and people
with dementia typically can't advocate
for themselves so that's where I want to
come in and be able to help get those
claims appealed and approved so that um
families don't have to worry about the
medical bills and can just worry about
taking care of their loved one you know
so much of of this is if it's pain
medication it it impacts your life right
but even on a grander scale when you're
dealing with a really really tough
disease what can I just ask what what is
that like when something finally gets
approved by the insurance company it's
got to be tremendous relief for these
people it's so rewarding because most of
their time would be spent trying to
appeal trying to call doctors trying to
get all of their healthcare information
together and now they can just focus on
healing and treatment and just focusing
on getting better well you're a
phenomenal guy i got to be honest with
you because this is a it's a problem
that is monumental and I don't know many
people who can tackle it and you've done
it on an individual basis twice now and
I think both are great any grander
scheme how you've been looking at the
overall healthcare industry in general
what are your thoughts oh thanks I mean
we think the entire healthare system is
broken and it's going to have to change
so kind of the grander scheme is care
moves back into the home you get much
more affordable care without all these
markups and sir charges i think you get
a lot of price transparency i mean I
think part of the reason the system is
broken is you know there's collusion
between insurance companies to kind of
um set prices not give you transparency
hospitals aren't disclosing what the
costs are so everybody's getting
surprised with bills number one cause of
bankruptcy in the US is medical bills i
mean this is this is like absurd and I
think as a system we're spending
multiples of what any other developed
country is spending on healthcare and
getting worse outcomes now so I think
that's going all the way to the top so I
think federal government's looking at it
state government's looking at it we've
talked to the state insurance
commissioner about our work at
Counterforce Health and they're very
supportive you know they realize and I
think some of these things are sometimes
the regulators don't know as much on the
ground of what people are feeling so
here when we generate appeal letters and
we give it to um patients to send out to
the insurance company we also CC and
send it to the state insurance
commissioner so they can see oh wow this
is being denied and sometimes they don't
even realize what type of claims were
being denied and they they see the
denial and they see the appeal and then
they see a 75% win rate they're like
"Well this should give you some clue
that the insurance company's denying it
wrongly." You know so I think I hope
that regulation will catch up but I
think that you know the at least my hope
for the future is a consumerization of
healthcare you know people getting power
back people having a lot of price
transparency um maybe some shift in how
insurance works um yeah I mean I think
that'd be great a little skin in the
game probably would go a long way too
you know um
even as a business model if I were head
of an insurance company it would make
sense to deny it based on what you said
earlier i mean if so few people even
attempt to uh to challenge it i know
there's people watching right now and
I'll I'll bet you a thousand bucks right
now there's somebody has had something
denied what do they do how how does how
do they get in contact with you what's
the first step yeah reach out to us you
know go to our site it's
www.counterforce counterforcehealth.org
org um and can put a link in there um
and we will help you you know kind of
full hands-on we um will help you if you
want to use the tools yourself to
process an appeal letter um you know
people like Desire are willing to help
um with you a well-crafted kind of like
call to the insurance company we're even
building like a voice AI that can call
the insurance company on your behalf and
deal with the whole claims and billings
department and just have a full
conversation like there's so many tools
you can build to like reduce the stress
on people and do it for them um so yeah
we're happy to help manually and we're
helping tons of people then the most
interesting thing is actually we're
having clinics reach out so that was
kind of like a really unexpected
surprise is that we built this for
patients just thinking that patients
were overwhelmed but over time now we've
been you know kind of running it for a
few months we're having clinics reach
out because the clinics are overwhelmed
and think about from a clinic standpoint
if you're having like something like 15
to 25% of your claims tonight depending
on what specialty you're in you are
literally now forcing the clinic to go
collect the money from individuals or
deny treatment which the doctor has
approved and they want to do um or
sometimes chase down the patient to pay
the bill and then sometimes just lose
money so these clinics are losing
thousands of dollars a month per
provider on denied claims and they don't
have the time to appeal you know like
the average statistic was for a clinic
staff to process one appeal cost $45 so
the clinic's like losing money left and
right if they spend their staff time to
appeal so now they can do this for like
a cent you know we give it away for free
i mean it cost us some money but you
know they can do this for like next to
nothing and that's a major timesaver for
a clinic and it's a improves the revenue
cycle so you know if anyone's running a
clinic you know we have like
rheumatology practices dermatology all
kinds of practices are reaching out to
us to use the tools yeah I've talked to
a lot of doctors they spend a lot of
time on the phone with insurance
companies on behalf of patients so yeah
we've seen doctors stepping out in the
middle of a surgery to deal with calling
the insurance company because the
surgery claim got denied i mean that
went viral recently on social media and
it was absurd and you know the insurance
company sued the doctor for posting it
and it was like they litigated and she
was right she had to step out in the
middle of a reconstruction surgery that
was medically necessary to fight the
insurance company because they denied
the claim and said you can't do the
surgery that's crazy i mean this is like
getting out of hand you know absolutely
getting out of and you're getting me mad
i'm I'm so incredibly working on this
stuff desbury thank you for doing what
you're doing and I think you're going to
stick around again right cuz we have
another Saturday we got more to talk
about with about counterforce and
healthcare come
[Music]
back welcome back we're adding Gabriet
to the conversation with Desiree and uh
let's get right to it first of all thank
you for coming appreciate you being here
i understand that um you've expanded
into the rural area and I know there's a
difference between urban and rural why
don't you tell us a little bit about
that if you wouldn't mind yeah
absolutely so I think anyone with a
focus or desire to address a lot of the
inequities in healthcare should be
putting a lot of focus on rural health
specifically these are people who are
overlooked and often have reduced access
to some of the common basic things we
take for granted in urban areas uh so
obviously some of the common ones being
you know staffing um transportation and
medical equipment but also insurance is
a big one where insurance knows who
lives obviously in an urban or a rural
area and they know who has access to
resources to fight back and in this case
they take advantage of that and they
target those populations are you kidding
me seriously they do that yeah now
desire you've worked with both uh folks
who are in the urban scene and the rural
scene and uh both are fighting insurance
companies but yet they're different how
so yeah so I grew up in a small town
myself and then I went to Chapel Hill
and I'm currently pursuing my
gerontology and social work program so I
have gotten to see both sides from
growing up there and moving here so many
people in rural rural communities often
get denied and think that that means
they have to pay the bill automatically
and start beginning to get stressed
because they're oftentimes low income as
well whereas in the city there's here in
general there's Duke UNCC more access
and then you can get a patient advocate
more easy so now we're trying to make it
where you can call us or use our
equipment and we can do it on your
behalf we can advocate for you and make
sure that there's fair access to
everyone i mean that's just almost
shameful isn't it i mean that they would
know what your zip code is and based on
that they'd make their decision um you
mentioned medical care is also an issue
with folks in the rural communities and
I know that's true and it got worse
right as a lot of these clinics and
hospitals had to close when they did
whatever they did in government a while
back uh how bad is it it's bad and the
insurance pipeline I guess goes both
ways too where it impacts the clinics um
especially rural health clinics and
rural hospitals um they're equally as
negatively affected by the insurance
denials where a lot of these clinics
will you know go into medical debt um
and an interesting kind of tidbit maybe
is interesting and sad is that some of
the insurance companies also own um debt
collectors and they also own um lenders
and so for example Optum um is a part of
United Healthcare and Optum will
actually give payday loans to doctors in
rural areas and then these doctors and
rural hospitals will default and then
the hospital doctors are getting payday
loans yes that's right seriously that's
right and then didn't mean to interrupt
but I must I'm a little shocked by that
that they would It's unbelievable it is
unbelievable to imagine doctors as you
know the pinnacle of success of people
who have you know people who have a
steady income and people who don't need
to worry about these things but they do
actually and it's because there's this
kind of financial monster behind the
scenes pulling the threads
that's just unbelievable well they got
all the bases covered I guess uh I mean
they've thought it through uh Desiree um
do you have a story you can share at all
to kind of bring it down to a one-on-one
for the folks who are watching yeah of
Sure so as a patient advocate I've met
many families who felt like this was the
end for them um one lady had a $60,000
denial when she was rushed into surgery
after a neurology appointment and then
denied afterwards due to
pre-authorization and saying it wasn't
medically necessary even though she
would have never been able to move her
feet again if she didn't have that
surgery um another one was a veteran who
was trying to get care for pain and was
consistently being prescribed opioids
which he felt there were better options
because he knew for himself that
veterans have higher risks of suicide
and opioids is the second um is the main
cause for that so when trying to get
better care he was being denied
um okay okay so there's this AI program
you guys have and for folks that you've
just mentioned and those watching can
you just explain how does it work how
does it make it easier and
understandable for people like me who I
I wouldn't have an any idea how to fight
the system because I don't have that
knowledge yeah and I think that is a big
part of it is that like you said a lot
of people just don't know what to do and
so part of our role is educational but
AI is perfect for this specific use case
because um I'm sure you've heard of
large language models they're very good
at creating cookie cutter text and a lot
of the text that is needed you know to
communicate back and forth with the
insurance companies are cookie cutter in
a lot of the communication back and
forth between an insurance company and
the patient um or the provider things
are needed such as um researching and
compiling academic sources and
referencing other cases um that might
serve as a precedent in your case um and
so these are things that AI and you know
automated research on the back end is
perfect for it might take a highly
educated person several hours to
complete a single appeal letter and it
often does um but in our case it can
happen in a matter of seconds and you
don't need any of the knowhow or
knowledge from prior that's amazing i
bet you're talking to another AI at the
insurance company they're both uh are
are looking to see if that fills the
spaces that it may be just that simple i
don't know i have no knowledge of this
i'm just saying exactly right we we're
not going to talk to real people anymore
are we that's exactly right and that's
actually part of the reason for the
genesis of this is that a lot of reports
have come out over the past few years of
insurance companies unfairly using AI to
review the appeals and the claims um and
they'll deny it just based off of that
without even a human reviewer sometimes
and obviously they've been called out on
this um but this is an ongoing issue and
it's an issue also of kind of an unfair
fight or an unbalanced war between you
know the insurance company who has the
power and the knowledge of how to use
these tools especially at scale um and
then the individual patient who may not
have any idea or the specialized tools
and so we aim to kind of provide um for
lack of a better word weapons on the
behalf of the patients to fight back in
this unfair battle i don't know if
taking the person out of it is uh as far
as the insurance company uh I kind of
I'm kind of saddened by that i really am
but you're right that's exactly what's
going on well we got to wrap up what's
the best way to get a hold of you guys
uh for any of the services that you
offer desire do you have a website um
for caregiving you can go to
www.carecareya.org and for Counterforce
and for Counterforce you can go to
counterforcealth.org
beautiful guys thank you so much for
what you do thank you really appreciate
it thank you for being here and watching
we hope you've enjoyed today's show if
you have any questions or would like to
know more visit our website at
raleycw.com and
myrrdv.com i'm Bill Lame thank you for
watching Community Matters and we'll see
you next week
[Music]