In this episode of The Uprising Show, host Vivek sits down with Neal Shah, a game-changing visionary in the healthcare world. Neal is the co-founder and CEO of CareYaya Health Technologies and Counterforce Health, two groundbreaking startups making significant headway in age tech and AI for denied health insurance claims. With a profound personal journey shaping his ventures, Neal Shah shares his insights on redefining caregiving through tech innovation and addressing the critical issues in the elder care system and insurance claims. Neal's life's work is driven by both personal caregiving experiences and a deep desire to make a social impact. Tune in to learn how Neal is innovating the healthcare landscape by bringing together young, tech-savvy caregivers with those in need and leveraging AI to empower patients in fighting insurance claim denials. Beyond his professional endeavors, Neal shares fascinating insights from his passion for reading, drawing connections between distant fields and historical patterns. Whether you're interested in healthcare innovation or looking for inspiration from someone reshaping an industry based on personal challenges, this episode is packed with enlightening perspectives and actionable insights.
CareYaya - https://www.careyaya.org/
Counterforce Health - https://www.counterforcehealth.org/
The Uprising Show Website: https://theuprisingshow.com/
Timestamps: 00:00 Youngest Partner Turnaround Success 05:32 From Finance to Caregiving Mission 08:46 Impending Crisis in Care Industry 10:52 "Uberizing Elder Care Industry" 15:11 Streamlining Gray Market into Online Care 20:06 "Care for America: Experiential Education" 20:52 Healthcare Experience Program Benefits 26:32 Medical Billing and Necessity Issues 29:36 Agentic AI for Stress-Free Tasks 33:01 Lean Appeal Costs Barrier 34:45 Healthcare Market Perspective Needed 37:23 Negotiating Care Costs with NPS 42:22 Galactic Cycles and Human Intelligence 45:36 "Excitement for Caregiving Tech" Quotes, Hooks, & Timestamps: "Youngest Partner and a Recession Opportunity": "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. 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." ? Neal Shah [00:02:46 ? 00:03:12] From Finance to Full-Time Caregiver: "Um, 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, and knock on wood, you know, pleased to say, after another two more painful years, she finally had a successful outcome, has been in remission now for several years." ? Neal Shah [00:05:32 ? 00:05:46] "Broken Care Industry": "In my opinion, the industry's economic structure is completely broken and it hasn't really innovated in the last 20 to 30 years." ? Neal Shah [00:09:10 ? 00:09:16] "Disrupting Traditional Care Models: The care company is creating maybe 1% of the value by like making the introduction and then the care worker is doing 90% of the work...but the company is capturing more than half the value." ? Neal Shah [00:10:54 ? 00:11:01] "Revolutionizing the Care Workforce": "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 in 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." ? Neal Shah [00:12:45 ? 00:12:58] "The Power of Agentic AI for Average People": "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." ? Neal Shah [00:29:39 ? 00:29:48] "Revolutionizing Healthcare with Transparency": "Believe it or not, in 2025, the home care industry in America has no price transparency." ? Neal Shah [00:36:45 ? 00:36:50] "Cyclic Waves of Human Intelligence": "What if human knowledge and human intelligence is flowing in these cyclic waves over like these long time spans based on how the sun's moving around and rotating around something else and going closer to the center of galaxy and back." ? Neal Shah [00:43:21 ? 00:43:35] Neal Shah - ˇˇ/ˇneal-shah-careyayaˇˇ CareYaya - https://www.careyaya.org/ Counterforce Health - https://www.counterforcehealth.org/ The Uprising Show Website: https://theuprisingshow.com/ Vivek Nanda's LinkedIn: ˇˇ/ˇviveknanda1ˇˇ Vivek Nanda's Twitter: https://x.com/vickks TopHealth Media Website: https://tophealth.care/
Full Episode Transcript
Youngest Partner Turnaround Success
[Music]
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 sha welcome to the show thanks thanks for having me Neil in a very
brief one minute can you give like a brief introduction about yourself sure
um I'm the uh co-founder and CEO of Kera Health Technologies uh we're one of linkedin's top 50 startups in America um
and the fastest growing what they call Ag 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 in a healthcare career so think about your Premed or um nursing students at top universities in
the country we've scaled it from uh an idea to a nation uh national uh platform
with over 28,000 students available in over 20 different cities over the last three years um so that's been really
cool and it's an amazing social impact in improving Aging Care uh and I'm also the co-founder of counterforce Health
which is a new AI startup uh that is helping patients and small clinics uh fight denied health insurance claims
which I believe is one of the big um social issues of our time um so yeah excited to like uh be here and talk
about different ways you can use technology to make positive social impact in healthcare and caregiving thank you two exciting Ventures uh
something both uh both my areas of higher high interest after being in
healthcare here uh but uh before we go into that let's uh let's let's let's
talk about because I also know you managed a 250 million uh hedge fund and
Lead billion dollar investment before you went into building these companies so um but first let's let's just rewind
a bit where were you born and raised was either of your parents an entrepreneur sure yeah so I was actually born in
India I grew up in North Carolina um my parents are not entrepreneurs by background they work in the healthcare field um you know both in the clinical
side and no one in my family is an entrepreneur um you know going back Generations uh I actually I initially
had thought about going in the healthcare field myself you know just like traditional kind of premedical path um but end up uh choos to pursue kind of
an investments in business because I really liked the entrepreneurial culture um 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 pen um went into Wall Street classic like Investment Banking
route and then very quickly like a year and a half in um you know this was in 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 23y 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 um
youngest partner in the firm's history and I was allocated a large portfolio my expertise was uh 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
happen 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 ended up getting large pool of the fund allocated
to me uh had some great years of returns you know just like turning around troubl companies fixing balance sheets like
finding unique opportunities across Industries including healthare but also energy and you know old economy
industrial um Industries um so after those returns um by the time I was 31 one of the investors there backed me to
start my own fund started that with 10 million uh and by the time I was 35 had grown that to a $250 million fund
including family offices University endowments um pention funds Etc and you
know I love doing that work you know um I was good at it uh 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 and then I found myself suddenly um becoming a caregiver you know so that was like
really my Catalyst my personal Journey was um you know first um 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
um but really my mom uh bore the Bron offf like the actual Direct Care work and and I observed the frustration when
we couldn't find Good Care Help like my mom felt guilty and just like ended up leaving her career to become a caregiver
full-time and as you can imagine when people do that for two three years period um you know she hasn't had the
opportunity to go back to the workforce since because it's been very hard um so I kind of observed and just the strain of doing caregiving you know I was like
you know I'd say my observation is like America has some of the best health care 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 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 at 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 um and then at the peak of my
fund my wife became s really ill and you know went through years of cancer uh failed therapies um multiple
hospitalizations at one point was an ICU and a medical coma and I was primary caregiver um you know we were living in
From Finance to Caregiving Mission
New York and you know our families weren't living nearby um so I kept taking sabatical from my fund to manage
her care um and at some point I was just like okay it's like the every time I tried to Outsource the care and get help
it was just so low quality that I felt like super guilty um that I was like I'll just do it myself um and then at
one point I just kind of like burned out and I was like I wound down my fund returned all the capital and became a full-time caregiver because I thought
it' have a big impact on the outcome you know and and KN on would you know police just say after another two more painful years she finally had a successful
outcome has been in remission now for several years um 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 um and
yeah and then after that I was just like so obsessed with care 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 re-entering Finance I was like okay I'll just like start um care companies 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 wow um what a journey and uh glad that your wife is doing well and
uh also um th this is a big problem in general like how you specifically coded
that like we have the best healthare 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 and again I was telling you a
little bit about my experience in home care before this and uh it is kind of
mindboggling that uh like even like we we build a site in uh northeast
Pennsylvania pretty rural but uh it it is uh it is like not easy accessible
home care even that so yeah I'm I'm really excited to hear a couple of things that you mentioned one is uh you
said and you specifically mentioned that um uh obviously you know there is severe
caregiver shortage right and yes and what's what's broken in like today's Elder Care System what's what's like uh
you picked up after now building a company and also uh tell us a little bit
uh how is Kaya solving that Gap now that sure to fix it please 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
going to 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 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 car need Skyrocket and a lot of people are living past 75 so you have
60 million people in the country um that of of those about 20% of them need some
form of Care at home today um and 48% of them will need care kind of throughout their Journey you know um so you have
Impending Crisis in Care Industry
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 million so there are not enough workers in America so it's kind of like
it's already a disaster but in the next 5 to 10 years it's going to be like really obvious social disaster and I
think that's going to have a lot of second or 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 and then that's
like just economic loss um 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 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 um 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 homebased care or or sorry let's say Elder Care off the trillion
500 billion is homebased 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 1.2 to 1.5 trillion of Care at home of
that 60% is happening in the gray Market kind of like informal care people find caregivers on their own uh 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 franchises running a model where let's say in your area in
Pittsburgh my area in Raley Durham North Carolina most cities in the country the car system would be you pay a local
company 35 bucks an hour they turn around and pay the caregiver 15 bucks 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
Uberizing Elder Care Industry
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 workers are not getting paid that much
and if you think about value created compared to value delivered you know or 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 worker is doing 99% of
the work right the grant work of like taking care of someone at home but the company is capturing more than half the value so I think this this a in my
opinion this is a completely Antiquated model that in today's technology age should not be really prevalent but it is because of just that inertia on part of
the industry so the way we innovated was I thought okay you could Uber this and using technology you could find a
convenient way to have people book schedule vet and match with caregivers
on demanded so you wouldn't have kind of like local companies forcing you into contracts and upcharging you this much
and then in our case we run an extreme where we just said use all our booking and scheduling technology um to find
schedule that we do all that for you and then we match you with caregivers and then we take not rate you know so we like fully def monetization 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 their job and they're getting minimum wage or
you're going to get a Harvard pre-ad student you know you're going to get um pre-physician assistant student at Northeastern University you know if
you're um 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 uh verified interviewed enrolled and then you get to kind of book them as you need without
being stuck in like contracts and fees 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 work
force by 28,000 people across the country and we're just kind of in 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
andc chapelo we have about 25% market share of them so you if you do the math on you know those four million if we can
get a million stud students on this this would be amazing huge Workforce expansion and huge affordability expansion so um this is this is uh
really interesting this is almost uh blue ocean here like how you have tackled this problem um because you're
creating new Workforce which was originally not counted as the workforce for this industry and so not only you
engaged and created almost a new workforce out of uh how the model works
yeah and uh not only this Workforce has an incentive to follow this because they're already on those tracks but also
this is Young techsavvy uh Workforce who not only probably going to Value this
but also going to embrace the technology to Next Level so uh so tell me a little
bit about uh U like obviously it is super exciting that in a way in a unique
that students are getting this but what was like what what how how it started for you like what Ed you for this
approach like how did you on that student will be a great idea to goal in
this and now based on just the impact that you're overall seeing it um 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 this this so tell me about good questions yeah good question so 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 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
Streamlining Gray Market into Online Care
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 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 in so
we thought okay 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 is like really from personal
experience as we grow really fast the care industry doesn't really view it as like necessarily a threat I mean we're not big enough yet but I think most of
the Care industry is over um 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 to Gig economy the thing
they're not set up well for that um so they're competing after kind of like how can we expand the traditional care
Workforce um so I think it's been kind of cool 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 Chap 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 gonna 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 and you know students are like no I have glass um so
we were like okay this is awesome you know the industry has not been structured for Geek 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
uh like there's enough jobs the whole thing is about how do they make these as
their primary jobs and I one of the things that you again touched upon is like uh um and this is something we did
at the home care company that swing that we took on was like uh we said we been
not expand with the physical location and those costs because then that like
you need a head counts there somebody a schuer instead of that we will train uh a tech enable system to our caregivers
and pay them slightly more than the industry and that will make them transition treating this as like their
second jobs to First jobs and the main thing is like stop the turn in turnover
first right yeah and then that opens make it attractive enough because now the money is coming in the caregivers
hand it's more incentive to state so it's almost the same thing uh I will tell you what challenge what happened
for us was like uh uh which I think you handling in much better way is the uh we
were still going because nursing and caregivers these are still folks who are
uh not coming from necessarily college and school or the new generation and uh
so we suffered on the tech side a lot even though we won and
even for them like yeah will they will take it and then there are of course some other challenges like you know we
were larly there were no star links and stuff so the the EHR won't work the tablet won't work rural area then it's
like a manual task and then they are frustrated doing the notes afterwards all that stuff but um but so this is
interesting in a way that uh I think one is if you go in the traditional or
conventional Workforce yeah their incentive is less to pick up a job which is more of a gig they want a job like
for right and 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's kind of is a Brute Force here to go so I feel really
good about it like uh uh how this is going and shaping based on my experience especially
yeah that was very difficult in a way but um but I see the promising side of
this a lot more now from the from the
policy standpoint and how this will shape the industry uh do you see this uh
almost like how much do you think can support you can pull in from schools and colleges directly through partnership in
some ways where uh where like you know they are open to this idea of like yeah let's make this part of option of our
curriculum that when you are in college this is the option instead of doing internship or assignment let's do real
Care for America: Experiential Education
world this experience and this is going to benefit not only uh to the system but
also you probably have some income but also Real World experience that helps in what you are doing are you thinking in
that direction did you have those yes yes a great question I mean as as the program grows um we're starting to
develop a lot of collaborations more formally with the University and what they call experiential education that many universities have where they're
starting to give students Class Credit I 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 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
Healthcare Experience Program Benefits
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 ad 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 so you know I think that the universities love it you know the biology professors the pre-health career
advisers they love it because um other than this there's no convenient way for them to get kind of like um 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 what as a medical assistant to get enough hours to then apply to grad
school so if you get on a program like ker as a sophomore junior you might be able to get hundreds or thousands of hours of uh 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 um 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 healthcare fields and they enter you
know for how many people enter freshman year want to go in healthcare compared to how many exit senior year and actually pursue health careers there's
about a 80% or 81% drop off and number one or two reasons are um the difficulty
of getting paid experience towards the field because um many times to work at a hospital you have to get like nurse aid
certification things like that number two is the cost of future graduate Healthcare 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 and I think that offers like a really cool perk for
the student that this is like a pathway program to feature clinical careers and encouraging and building like a more
diverse Healthcare 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 uh you the the the care
Apprentice with you yes yes that's almost the you you get to like experience it and I
think you should tag that something like this which will 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 uh you know
these college students are this is not the exact like they'll probably earn more afterwards yeah so kind of making
sacrifices for this as well so there is obviously uh a bigger societal uh gain
and initiative that these indidual are doing it by participating in programs like this so yes um it is really
fascinating wow I I I I 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 this is great um now onto your second
Venture so now with the counterforce health obviously big pain point in
literally this morning I wrote a post about like uh uh like uh you know how
hard it is to get paid in healthcare complex yeah right and and this is for
everyone right like this is how system is set up so you are tackling a massive pain point of insurance claims denial
yeah and uh again your focus is totally um Teena there and figured out how to
tackle this so uh tell us a little bit how big is this problem in terms of uh like the just the market value and
everything and how did you stumble upon building this spr of solving the specific problems yeah sure also born
out of deeply personal experience but you know I'll say at a systemic level um over $250 billion per year of claim
denials um 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 anals 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 and I think that it's become denial as a source of profit um and I think that uh
48 million Healthcare claims legitimate claims are denied every year and the reason I started on this is one
personally um going through my wife's cancer um there were so many died claims um 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 uh with the insurer and it was infuriating and what I observed is that through all the cancer support groups
even previously through diens of for groups at people's worst periods in their lives like when it's really dark
um you are uh 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 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 sistic from an unmet need like what Market is there where 99%
of people are not able to take an action and if you bother to appeal it's about
half 50% win rate so you know it's something like 45% right but so think about that that that people are not
appealing further off the 99% of people who aren't appealing 70% of people don't even know their rights they don't know
Medical Billing and Necessity Issues
you can appeal um 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 Mis miscoded um and so
you have to like just hit up code databases and fix the cptr 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 site you know based on medical journals Etc why
you why a procedure was needed or why a blood test was needed Etc so this I've
experienced a problem profession 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 United Healthcare event and everything you know I was just like okay
this is now becoming a societal issue 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 all
rates have gone up rode an oped 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 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 and just juice their profits and then
people are like oh I got to do four hours of work to fight this nah it's if it's a $200 bill I'll just pay it if
it's a you know 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 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 if your insurance going to use AI to 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 so the 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 oneclick that for you upload that
upload any other relevant documents one click within two minutes very well-crafted appeal letter 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 um 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
deep seek came out and we kind of like um embedded some of their models in got the cost down to like now it's like a penny 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 every denied claim in the country should be appealed you know that's kind of my view um so you know
but if we can succeed from going from half percent people appealing to maybe even like 10% 20% of people appealing
that's a huge social impact um because all those people you know don't have to pay um and then there's like a multiple
Agentic AI for Stress-Free Tasks
step escalation process so we can kind of help advise and guide people on like if the appeal fails do it Force an
independent review and then Etc 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 use B2B a lot of companies
you're 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 and like I know from
firstand 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 program to like help you deny you um I don't even
know how these people can like do their jobs to be honest you know it's like such a you know tough job uh because you know you're morally doing something
wrong uh denying care to all these sick people um 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 a insane amount of stress that you don't want to deal with so how can I one click it for you so
that our voice AI agent what we call Maxwell will just call the insur on your behalf and deal with the whole thing you
know because you know now they're starting to replace a lot of their um 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 um so that they're not so the Warfare is an
asymetric love it how you explain this uh how to make this battle very
symmetric you you put in Spade with Spade now yes let's do 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 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 uh the number that he 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 I almost think half the battle here is just doing a p
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 you know
that you can't appeal yeah and also like how you were saying there's a lot of um
you know of course uh it's still not much consumerized the AI use it's more
on the company still 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
is a model through where we feed you it goes through wow that's awesome comes
back to you and we have train models on this mix of questions and we actually then score those questions afterwards
that it turns of organic reach and insightful and uh just like engagement
element and then that's awesome buing it yeah uh and again this wasn't POS if I
have to do the same thing uh we won't be as lean operation as we are yeah that's awesome yeah so um I
mean look uh it uh it's very a different world right now 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 of course you know a superpower is at least what's proven is uh it can take this zillions of data
Lean Appeal Costs Barrier
sets and then give you what is like the pattern that you can't see it from Naked Eyes or yes manual research right and
exactly or at least that's proven like in medical field orwhere right so yeah
and I think to your point I'm glad you mentioned the um 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 get this statistic
$438 for the clinic or hospital to help you with a with an appeal like they don't have that kind of
budget so it's like when the when the appeal costs $438 for the doctor or the billing
person to help you they're not they're going to be like I sorry I can only help once in a while because I can't eat that
cost right A lot of times you know they appeal it's not worth their time when it costs one cent anyone you know it's like
we can offer it anyone can do it you so I think that that's the thing that lean you know it's like getting this cost way
way down um 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 oh very exciting about this too um okay so now more of uh couple of
personal questions to end our conversation um 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
yeah I mean I think one of the biggest things I think people can learn in healthcare is um thinking about it as a market you know I think often times like
in a hedge funds like you're very um uh 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 Etc I think a
Healthcare Market Perspective Needed
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 consumer everything is geared towards
kind of B2B a lot of healthcare organizations are just geared towards whatever the payer wants and then of
course the payer has its own incentives not really what the under consumer wants 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 a payers I think would benefit from like
thinking about this as a market you know and that's the like by in hch 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 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 and I
think they should be because it's about to go that way um 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 like tell about
that a little bit after also running couple of companies now so give us a little bit on that of putting into
practice 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 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 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 run 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 and Boston who cares about primary care because you are the Monopoly right in in the region so I
think that often times I kind of view it as that that creating healthare policy
so that there is opportunity for competition and price transparency will create more of Market forces uh 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 they what the what the price is going to be when they go on the site 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 Pittsburg 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 so
I mean can you believe you know it's like basic Marketplace 101 you know what
Negotiating Care Costs with NPS
is the price of the product right I know but uh I'll tell you after also running a home care operation by 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 uh you know like you get a
authorization for a case or for the client right for the and and it comes with the price tag from insurance that
this is what you're going to get and and then what we realized was like oh um so
nothing will change if we don't make the matters like as a agency owner in this role we have to actually come up with
data and then renegotiate with them always like and that won't work if we show them quality of care delivered by
the by the caregiver so we build our NPS 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 and that becomes our like oh for last 90
days or last six months or term of this OD this caregiver this now we want $2
more on this so we can pay more to yeah and I actually think there's a big
opportunity somebody you can build this part with AI this same negoti that you're buil yeah we can build it for
home care companies and just track and then renegotiate back with the PS and
this way you feel like quality based value based at least compensation for caregivers and caregivers getting more
money and there's more incentives game for everyone right yeah wow great idea so uh so I was just going to say like
sometimes in h it's not easy to say what's the number even 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 yeah go through it's
not even easy to like say that's how complex our system is yeah no 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 should anchor
pricing to something yeah and and that is a good starting point let's say
that 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 H yeah good question um reading I read a lot I
love reading um one reading about things outside of my current field because 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 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
interdisplinary those ideas are like really pay off so yeah and it's fun good now this is great I I actually to take
this to the next level on our media Network I actually built a show which goes over uh PR and marketing campaigns
from US history and nice and this is AI narrated 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 and PR just because there are so many complexity in healthcare but but
it gives us the historical perspective how things were done right on that subject so wow that's super cool but
exactly this is the same uh how you saying like you know I am very curious 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 right so it I find it really valuable especially like
you like uh dig into outside you know bubble and then what we can
learn from there so that's great um last question uh this is a fun one 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 and yeah course 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 duv tailing off the reading question um you know and kind of like the hobby U 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 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 Etc um I have a theory that there's a 24,000 year cycle
Galactic Cycles and Human Intelligence
going on um due to the procession of the equinoxes and the sun rotating around something you know the sun's not static
right 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
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 magnetism
um that is kind of emanating from the center of the Galaxy changes kind of the way humans operate and even like human
intelligence so I've been like working on this it's a side project but it's like fascinating of like how do you go
through these yo-yos and 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 like wow these civilizations were doing amazingly complicated things like people still don't know how they build
the pyramids and things like that right 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 Galaxy and
back so it's kind of like a fun did you already find some uh correlations and patterns for like just
tracing back you did w yeah yeah 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 have been like 500 AD which was
like kind of correlating with kind of like the uh bottom of like human know or
human civilization like straight up Dark Ages everything is lost and then previously the peak might have 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 AG is like kind of the flip of that so wow no way to prove it dis because you don't have enough enough info but it's kind of a fun thing to
think about so no this is H this is exactly what this question was supposed to be to 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 it touch with you directly sure yeah hit me up on LinkedIn
you know I'm reasonably active there um it's Neil NE l k sha s at Kaya c a r y a
ya and then of course like for the caregiving platform you're welcome to check us out at
Excitement for Caregiving Tech
www.care.org uh c r y y.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 counterforce health.org so right we
will make sure we put all the links and all these uh website in our show notes
wherever 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 gives me I'm I'm I'm actually really fascinated we'll probably have more conversations about this right up
Recon too 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 really appreciate the opportunity