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Is there a single right way to run a home care agency? We sure don’t think so. That’s why we’re interviewing home care leaders across the industry and asking them tough questions about the strategies, operations, and decisions behind their success. Join host Miriam Allred, veteran home care podcaster known for Home Care U and Vision: The Home Care Leaders’ Podcast, as she puts high-growth home care agencies under the microscope to see what works, what doesn’t, and why. Get ready to listen, learn, and build the winning formula for your own success. In the Home Care Strategy Lab, you are the scientist.
Miriam Allred (00:10)
Welcome to the lab. are in studio in downtown Dallas. ⁓ I am joined by three home care tech founders and CEOs. We've got Alex Oosterveen, the co-founder and CEO at Caribou. We've got Todd Allen, the co-owner and CEO of AxisCare And we've also got James Cohen, the co-founder and CEO of Nevvon. Gentlemen, welcome to Texas and welcome to the studio.
Todd Allen (00:36)
Thanks.
Alex Oosterveen (00:36)
Thank you.
Miriam Allred (00:38)
This is a real
treat I am a local here to DFW but capitalizing on you guys being in town for a conference And so this is my first time in the studio I think this is all your first time in a studio setting like this so I think we're all a little nervous but mostly excited to have this conversation and I know bits and pieces about each of you I think you all know each other pretty well so I might be the odd man out here a little bit but excited to get to know you each a little bit better and to have this conversation about entrepreneurship and
and founding and leading the businesses that you do. ⁓ I'm a new entrepreneur as of this year. I think I caught the bug being in home care because home care is powered by entrepreneurs. Basically all of these owners, operators come to it ⁓ as entrepreneurs. And so that's what I wanted to focus this conversation on is the journey that all of you had, the decisions that you've made, the pivots that you've made along the way, some of the skills that you have or you have learned. I think it's going to be a useful conversation for the
owners, operators, entrepreneurs to hear from all of you. So let's just start out of the gate with ⁓ starting these businesses. You've all been at it for various amounts of years, ⁓ but the first thing I want to talk about is there's typically three reasons why people start businesses. Pain, passion, or profession. Pain meaning you personally overcame something, went through something, and it led you to founding this business. ⁓ Passion, you had a hobby or something that you were interested in.
and were able to turn it into a business or the last one profession you were already doing this in some form likely working for someone else and you thought I can do it too or I can do it better or I should go this route and start a business as well so I want to hear from each of you of those three pain passion or profession what led you to the business that you're in today James why don't we go ahead and start with you
James Cohen (02:29)
Sure. And again, thank you for having us over here. Excited to get going. ⁓ For me, it was definitely pain. I've been in health care, both in the owner operator facilities and home care for now 23 years. So I sat in the role of being a scheduler, a an executive, working with nursing staff, and I knew the pain points of training.
caregivers for their compliance requirements.
Most recently, I had a home care agency that I founded that served three states and the US and Canada. And it was really difficult to train all the caregivers in a high quality way and a scalable way. So when I sold the company about seven years ago, I decided I wanted to solve that pain point by creating Nevvon and ⁓ creating a high value
learning management system for the caregiver workforce.
Miriam Allred (03:31)
Amazing. Perfect example of pain. went through it yourself and that led to you, coming up with the solution, being a part of the solution. Todd, let's jump over to you. What about you? Pain, passion, profession?
Todd Allen (03:41)
Yeah,
sure. So as we were talking about beforehand, my journey is a little bit different. I took over AxisCare in day two, call it, and it was early on, but I didn't found it. And so I think for me, it was kind of combination of all three. I was working with the co-founders before they started. And so I got to learn home care from that perspective. But buried down years prior was my mom received home care. And I, at the time, I just thought, wow, what a great service, you know, and
this particular company in Tennessee did a great job. so that was kind of like buried for later. So then when, my partners now approached me about taking over AxisCare, that kind of registered that buried kind of passion registered. They explained to me the pain that they were experiencing with software companies in the arena. And so obviously it was good profession. So for me, it was kind of like a mix of all three. But I would say right now, what drives me is more the passion.
than anything else. We're seeing, the fact that people are using folks like AxisCare and experiencing tremendous growth because of the efficiencies that software companies are providing. It's stirring, and it's if we can do our job, we're empowering home care agencies and helping their operations to provide better care to people. So that is a passion point for me.
Miriam Allred (04:59)
Yeah, I'm glad you bring that up, but I want you to lean into this conversation today of you aren't a founder, but you were on since day two. And that's a really interesting perspective of you were there since the beginning, but you don't wear the founder title, but you've been the CEO for a decade now. so I want you to lead into that because I think, again, a lot of people at Home Care can relate to that being a part of something from the beginning and that role evolving as well.
Todd Allen (05:24)
Yeah.
Well, so not literally day two, but figuratively day two. So it had been around for maybe a year and then I picked it up when it was going to market, so to speak. so, the founders and then talking with the agency owners, you pick up the passion. So if they're, you're like me, you didn't actually start your company, but you came on early on, I would recommend like having conversations as many as possible with the people that you're serving. And then you will pick up the pain. will pick up that passion. ⁓ And of course,
the profession will come along as you learn how to scale your company.
Miriam Allred (05:57)
Yeah,
the thought that comes to mind is home care is extremely difficult and you all being technology companies serving these home care businesses, you're all still in it. You've been doing this for years and years. It's not easy. Like this business, this industry is not for the faint of heart. And that trickles over to all of us, know, providers, vendors, consultants that are serving these businesses. It is not for the faint of heart. And we'll talk about challenges and pivots and lessons learned in that regard as well. ⁓ Alex, what about you? What, what led you to starting Caribou?
Alex Oosterveen (06:26)
Yeah, I'd say a mix for me as well, but the biggest one, definitely passion. From a young age, my dream was to start a business, become an entrepreneur. And what motivated me the most was trying to work on a big problem, one that kept me up at night. And I also wanted to work with people that I just love working with. Then it doesn't really feel like you're working. And I guess from a professional sense, you don't really know what problem is going to keep you up at night. But I was working in investment banking
my early 20s and I decided to go work in the senior care sector so mergers and acquisitions of senior living and home care businesses and for me it was just the senior and his care industry was just quite interesting you know it's like a big growing industry and thought hey I'm young you might as well align yourself with an industry that's got some tailwinds and from a personal level my mom was a home care worker so I got to learn about you know some of the trials and tribulations and also the great stuff from her you know the deep connection she had with
their clients and purpose from the work. And ⁓ it was literally my first week on the job. I got staffed on the sale of one of Canada's largest home care companies. And I saw right away that the labor shortage was the biggest challenge for these home care companies. And, you know, this was only going to get worse and worse. And then you look at all the knock on effects that this has on, you know, families not getting the care they need. They stressed out like work is impacted. You know, the businesses suffer.
care systems become overwhelmed. All these things kind of stem from this core of how do we create a really stable and robust workforce in this industry. I'd say that's where from that light bulb moment my life changed and sleepless nights were really out of passion trying to figure something out. And then after two years of banking I decided to quit, jump in full steam and I actually became a scheduler to try to learn the realities of the
from the ground floor. And from a pain perspective, also early on in the journey, I got diagnosed with multiple sclerosis. And my first attack was pretty rough, and it took some time just to adjust and adapt. And I'd say kind of going through the healthcare system as a recipient was pretty eye-opening. And I'd say that further fuels the motivation behind the problems we solve.
Miriam Allred (08:51)
you
I want to talk a little bit more about the pain and the discomfort. James, you cited it. You talked even about just like sleepless nights, the nature of being an entrepreneur and founding a business is you go through a lot of pain and discomfort. When I say pain, I'm talking about stress and the burden of decision-making, like, you know, there's literal pain, but then there's just like figurative pain in, business. so want to hear from each of you about your tolerance for pain. You know, we've all been doing this for various amounts of time. And so your, your tolerance for pain.
changes as you go through this business. What does that look like for you James in learning to deal with the pain and the discomfort of business?
James Cohen (09:30)
Yeah, so interestingly enough, I come from a family of entrepreneurs. I look at pain as almost change. And when there's change, there's opportunity. And we actually, I think all of us here really like change because it gives us an opportunity to go fast and do better than some of our competitors and help the industry that we're in. So often when some of the staff or other people in the industry
We are talking about new regulations that might be difficult for the industry. I actually look at that as an opportunity. feel ⁓ change and pain is a good thing and we actually embrace it and we talk about it in different ways often between the three of us.
Miriam Allred (10:16)
Yeah, I think that's something that you learn in business is turning it from maybe stress or sleepless nights into fuel into passion into motivation. It's it's like a, like a dial that can start out as pain, discomfort, sleepless nights. And then it's yeah, what do we do with that? How do we morph that into excitement? Todd, can you think of an example in all your years of maybe a time when you're in that kind of like pain state and how you worked through it?
Todd Allen (10:39)
Well,
I mean, my main example is that that was my whole world, you know, when I was first getting AxisCare, helping get it off the ground. And, ⁓ you know, to go back to what you were saying, you know, I was thinking about athletes when they think about how well they did, you know, in that tournament or performance, they're not thinking about, I had a really great shot on hole number 17. They are thinking about the missed putt on 16. Right. And so for me, the way that I saw the first five or six years of building AxisCare, it was a it was a harbor. And there might be
a couple of boats that were sinking. And that actually drove me to passion because those that was pain, right? You know, whether it was customer support or, you know, a broken product piece, you know, something like that. And so we would put time and resources towards those things. And that helped the whole water level to rise. Right. If you just focus on what's the worst part of my company right now. ⁓ And so that's how I go about it. So it's hard to give one example. We've experienced so much pain, I think all three of us. Most of the pain, I will say, is
entrepreneurs revolves around people. At least that's my scenario, right? Like we invest in people and it's the people, I think all three of us would say it's not us, it's our people that are leading our companies. I mean, not necessarily leading the companies, but are the true backbone of the company, right? And so when there's people conflicts, that tends to be painful. So that's the biggest area of growth that I've experienced is how to deal with those.
James Cohen (12:06)
And Todd, feel you're so right there. As we were also in the scale up stage of our company, we're not really startups anymore. We're probably scaled up, upstarts right now. And you know, the first 20, 30 people in our company were just
unbelievable people. Once we're getting to like 100 people in the company, it's really painful to keep the culture ⁓ going. And ⁓ Todd, we talked a little bit about it. Alex, we talk about it quite a bit. ⁓ How do we keep that culture going?
Todd Allen (12:38)
can't agree more, if I could say this, culture creep is so hard when you're scaling a company. When I was around and leading, when we first got AxisCare off the ground, I hired the first three or four people, and it was us. And the way that I started our team meetings was to look at a funny YouTube video, just to kind of lighten them up and loosen up for good conversation, right? Well, we have 200 people on the Zoom now in all different countries, and so that's a little bit tougher to do. But I feel like a broken record when I'm saying, here are our core values, here is our mission statement.
And you have to continue to do that in order to keep that passion and I guess mitigate the culture creep. You got to keep it close.
Miriam Allred (13:15)
to make sure people understand culture creep. are you saying that is?
Todd Allen (13:19)
Well, the culture is really strong. The fewer amount of people that you have, right? It's it's concentrated, so to speak, and it has a tendency to be diluted the more people that you hire, especially if you're not the one doing the hiring, because, you know, the three of us, we know how to hire to culture very well. That gets a little bit more diluted if other people are hiring. It doesn't necessarily, you know, happen that way. But ⁓ and so culture can creep. You know, the core of what you're about can kind of creep with the more people that can
dilute it that don't really get it right that don't get the passion.
Miriam Allred (13:52)
But it sounds like to mitigate that, it's focusing on the fundamentals, the mission, the vision, the core values, sticking to your guns, no matter how big the organization gets. The other thing, you mentioned kind of that golf analogy a second ago. I think we as business leaders are our biggest critics. And being a CEO can get lonely. Who are you held accountable to? Maybe a board, maybe outside parties. But oftentimes, everybody rolls up to you, everybody looks up to you. And I don't know if that resonates, but I think we're typically our biggest critic.
We are hardest on ourselves. We're setting ourselves at really high expectations. Does that resonate with you all? Do you feel like you are your biggest critics as CEOs? And how do you handle that? Alex, what are your thoughts?
Alex Oosterveen (14:35)
Yeah,
big time. I mean, it's a lot of pressure. I remember this realization at some point when it started to feel like we were a real company. I was like, man, there's a lot of people that cover their rent, mortgage, food, you know, based on a lot of the outcomes that I was primarily responsible for driving, you know, around growth and partnerships and getting investors, and you can see kind of your months of runway declining quite quick during the early days when you're spending a lot more than you're bringing in because, engineering and product resources are all
very expensive to have top quality talent. yeah, I'd say ⁓ what really helped is really from a mentality perspective just to, kind of get into meditation and a bit of the, stoic principles of like, zoom out, what's the worst that can happen here? And don't be too hard on yourself because that'll also impact your performance. You know, you have to really kind of feel calm and at your best and then you're able to navigate and respond
on to those ever-changing conditions, which I think James, Todd, and me are quite good at adapting quickly to and maybe seeing an opportunity and then going full steam at it. ⁓ And when you're early on in your journey, the nimbleness and speed you have is a real advantage because it's really hard to move a bigger ship and turn all those people in a different direction.
Miriam Allred (15:56)
Absolutely. Thoughts
from either of you on being your biggest critic?
James Cohen (15:59)
Yeah, I think for me definitely put a lot of pressure on ourselves. What helps me the most is actually my co-founder and my leadership team. think we all have, you know, I know Christian very well, I know John very well, and I have my co-founder Tal, who's a chief operating officer, and it's extremely helpful to have them around us and be helpful to us. Often when I'm feeling that pressure, it's coming together with them to talk it through.
Miriam Allred (16:28)
Yeah, that's a good point. You all, think, have co-founders, co-owners. It's you have somebody else as a sounding board, somebody else to maybe hold you accountable, somebody else to be vulnerable with when times get tough.
Todd Allen (16:39)
Yeah, I don't know if I have much to add. I totally agree with what James was saying. You know, the people around us, they shape us. And if we can be humble enough to change and have advisors, then I think that that's really helpful. They're, you know, sometimes we're not very quick to notice our own, struggles. And it's great having people and spouses to show us those things. Right. And I think we're all better because of it. You know, if we're humble enough to actually say, OK, you know what, that's true. I do need to change the way I communicate at meetings or whatever the case may be.
you
Miriam Allred (17:09)
Thinking
about change in your businesses, you've all experienced a lot of change. That's an understatement. A lot of change. Sometimes as a, as a leader, it's hard to know when to push through pain, push through hardships, challenges, obstacles versus pivot. That's probably one of the things that keeps all of you up at night is knowing when to push through an obstacle, push through a people issue, push through, you know, all sorts of challenges that arise versus.
we shouldn't push through, should actually stop, we should actually zoom out and pivot to a different direction. I want each of you to share an example of pushing through something and maybe it going right or it going wrong or deciding to pivot and you're thinking around that decision making. Anybody ready to start with that?
Todd Allen (17:59)
I could fire
one off real quick because mine's going to be the worst answer and then they can come in for the cleanup. For us, think all three of us, we all have an underlying thesis that's very solid, right? And so there hasn't been a huge pivot needed. know, like we started our company and it's not working, so we need to do something else or have a different product. None of us have experienced that, to my knowledge. If you have, you're great at what you do because you could know. But we always have little pivots, know, like little tweaks along the way. One, actually, we just
made, we were actually going after a geographical area and we thought, wow, and it's treated a little bit differently. It's in the Northeast. And we said, okay, we need to make some product tweaks. We need to hire up for this and ⁓ let's go after it. And then all of a sudden, we're just kind of open-handedly going through the normal course and we're still focused on this geographical area. But then another person came to us and said, hey, you guys have a great product for IDD, which in the software, if you're familiar, it's
amazing market. The people involved are just amazing. ⁓ so we actually pivoted. We decided to hire another person and we're product wise, we're going for IDD instead of hardcore after this other geographical area. So I think like little tweaks like that happen all the time, but I've never fundamentally shifted the pivot of, hey, we're not doing the right thing at the baseline level. Hopefully that helps.
Miriam Allred (19:25)
Yeah, oftentimes pivots come out of just opportunities, comments from customers. They just arise and give you a sense of, you know, those micro pivots where we should pivot our time.
James Cohen (19:35)
James? Yeah,
for myself. Next month will be six year anniversary for our company. And when we first started the company, virtual reality and augmented reality were all the rage. And we're a training company. So we wanted to build everything through augmented reality and virtual reality. And I was so hard headed. I really want to build everything that way. I felt it would create
better outcomes because you would get better training through that way. And realizing that the technology was not there, but mostly the hardware was not there. All the virtual reality sets were in the hundreds of dollars for each set. ⁓ You know, we have right now about 600,000 caregivers learning on our platform every day. So imagine having to buy
virtual reality sets for 600,000 people, it's just not feasible to do. So it took a lot out of me personally to get away from that because in my head, I kept telling myself that I was the only way to go. But from a business perspective, it just made no sense. And then we found other ways to build the training in a very high quality way. So that was definitely a way how we pivoted away from that product standpoint.
Miriam Allred (20:59)
I think that reminds me of like shiny object syndrome, which also is something that can plague leaders is there's too many opportunities. There's too many opportunities to pivot and to find new ways to attack different problems. And so that reminds me of there's just a lot of distractions. And sometimes it's hard not to pivot too much too quickly because there's just a lot of opportunities and distractions out there. Alex, what comes to mind for you?
Alex Oosterveen (21:22)
We actually had a huge pivot before we met. ⁓ We've always been focused on the labor shortage challenge in home care. But when we started, the top driver of turnover was caregivers ⁓ basically having unstable schedules. You couldn't predict if a client was going to pass away or cancel a visit or get hospitalized. And the caregivers are the ones that suddenly lose hours. And then it's hard for them to earn a stable living when that's ⁓ happening all the time. Their schedule is kind of like this.
House of cards that gets built up and it falls apart, you know, seemingly every week ⁓ And so we were initially focused on partnering with home care companies and then helping them get last-minute demand For that last-minute capacity that freed up so they could earn some revenue off those idle Caregivers and then also help, you know give their team this extra way to to earn some extra income ⁓ And then felt like we validated that had some product market fit ⁓ right when
hit and then all of a sudden, you the world changed and what a terrible time to scale a new care model. People don't want to see caregivers. don't know caregivers don't want to see families. They don't know. So we were really running in place for for I don't know if it was months or weeks or anything like that. I think we tried to see if we could make it work during covid, but it was clear that we couldn't. But what I would say did happen was the labor shortage was now like front page news.
right? It was everywhere during early early days of the pandemic and we saw this shift where now the caregivers were, you if they wanted hours they could get them. There was no shortage of demand but the bigger issue they were saying is like, hey, I'm not paid enough for this and I'm not appreciated enough for this and we saw the agencies really would love to pay their staff more. They would love to appreciate them more but they only have so many resources, only so much margin, ⁓ you know, to work with. So, that's where we thought, hey, Caribou
could be the incentives, rewards, pay for performance layer in home care and really master that and integrate with partners and automate and really try to get the best results possible for an agency's rewards budget. that really felt like the right move. And had we not done that, ⁓ I feel like we probably would have failed. And it was scary. And big credit to my co-founder, Christian, who's always a very level force for me.
He's somebody who sold his house not long before this to come invest and become a co-founder when I had gotten sick. It says a lot about his character. now, then you go to the pressure, like, man, this guy just made a pretty huge life-changing decision. And we've got to get through this. But I always knew he was the type of person that I wanted to face any challenge with. anyway, long story short, it was the right move. And I remember we had some summer interns starting.
James Cohen (24:06)
Thank
Alex Oosterveen (24:22)
right around this time and they had basically joined a different company when they were interviewing and then when they were starting they were like, we're a rewards company now. And here we are.
Todd Allen (24:31)
But it's noteworthy that your focus was always on the caregiver, right? You always wanted to help the caregiver, like, you know, be able to receive rewards or, you know, have a new schedule right away, but your focus was caregivers, which is really cool.
Alex Oosterveen (24:44)
Right.
Miriam Allred (24:45)
want to talk more about people. The nature of business, the nature of home care is people first. And oftentimes people are our greatest strength, but also our greatest weakness. I want you to think about people from the push through versus the pivot lens. All of you have hired other leaders, have hired a lot of people at this point in time, and also probably fired people at
this point in time to think about this people from the push pivot lens how how do you think about
people from the lens of giving them the benefit of the doubt, keeping them on for a set period of time versus knowing that they're not in the right seat, they're not on the right boat, you you've got to let people go. That's a really hard thing in business is knowing when to push through and refine people and get them in the right place versus moving on and mutually, you know, agreeing that this isn't the right fit. All of you have probably lived through this experience. I think this is relevant for home care leaders because I've heard many vocalize how hard it
is to let people go, especially those early hires. You invest a lot in them. You care a lot about them. Nobody wants to let people go, but that's something that you face as a leader. So James, why don't you share an example of when you've had to do that and how you frame keeping people, moving people around, letting people go.
James Cohen (26:09)
Yeah, so Todd, you spoke earlier about the people being the hardest thing. And I think as we scale up our companies, our early people.
have the most difficult time adapting to the growth of the company, including ourselves. ⁓ There was no division of labor when we first started. We did everything from sending FedExes to doing all the banking to booking all our travel to doing all the CEO stuff. And as we grew and we had more people in the company, ⁓ there is more division of labor and we grow up as a company and we professionalize and it's
been very difficult for some of our early people that were, you know, number seven in the company or number 17 in the company to adjust to that and to change with that. So we've tried very hard to give them more opportunity ⁓ in different roles ⁓ to come and show their passion in the company, in the industry. And sometimes it's worked out, but unfortunately, sometimes it has not worked out. ⁓
We've come to mutual decisions where they had to go and go to different companies, but we've also seen sometimes where it's been excellent and they've moved to different areas in the company or different roles and they're thriving. But it is something that we think about every day. The people, especially the early on people right now.
Miriam Allred (27:34)
Yeah, I'm glad you bring that up, the early on people. It's hard to adapt mindset thinking when it was one thing a few years ago to a completely different thing today. Todd, what comes to mind for you for how you handle pushing versus pivoting when it comes to people?
Todd Allen (27:49)
Yeah, I mean, because we hire to culture, we don't necessarily hire to skill. I mean, we even had someone that came through the as a candidate for in our HR department. And ⁓ I just work right next to the person who heads HR and they're like, yeah, it's a tough decision because this one candidate is incredibly skilled and this other candidate is just a joy to be around. And ⁓ and we went with the second we went with the person that is, you know, a joy to be around because it's a culture thing for us. And so when
When it comes to pivoting for people if we have the right people on the bus, we just move seats, right? And so ⁓ now sometimes that works, you know, that sounds easy, but sometimes it works sometimes it doesn't but if we're hiring the right people and if they have found a home in AxisCare, they love it There's alignment on their end and then there's obvious alignment on our end as well Then say that department is just maybe over staffed or you know something's going on that we need to move someone will happily retrain and cross train and have that person that's
should be on the bus just at a different seat.
Miriam Allred (28:52)
I'm curious about both of you. Do you hire to culture? Is that a priority? Is that how you're thinking about hiring?
Alex Oosterveen (28:58)
big time. mean,
culture and really belief in the mission. You know, if someone's joining your company just because they like the paycheck or something like that, they'll go to the next big paycheck that they can kind of leapfrog to. But there are certain intangibles that are hard to replicate ⁓ around the problems you're solving and the people you're doing it with, the culture. And so I think that's a huge focus. And I think that's been
we have in my mind one of the best teams in the industry alongside you guys. And yeah, I mean, I love the whole Caribou herd. I'm looking at it with But there's a couple examples that really stand out to me. ⁓
you know one of those interns i spoke about uh... amanda she uh... she was a critical care nurse before caribou and she came to join our customer success team as one of our first hire she'd gone back to school to do her masters in health informatics and you know very raw had never worked behind a you know it computer really in her professional career and now all of sudden she's launching home care companies and ensuring that they are successful and you know it was
so clear that she believed in the mission, she worked hard, and she was extremely smart. So as problems came, she solved them. And people really respected her because she had walked in their shoes in healthcare. now just a couple weeks ago, she was promoted to head of enterprise customer success at Caribou. And she's had a long rocketship of a career with us so far. And ⁓ there's other examples like that that we're seeing unfold before.
our eyes, like Andrew, he was a physician's assistant a couple years ago. He still does one thoracic surgery a month to keep his license. And he's also on our customer success team handling some of the biggest home care companies in the nation and just absolutely crushing it. you know, I think when you really hire for that belief in the mission, you know, a lot of those intangibles, yeah, being smart and hardworking, you can figure all the rest out. You know, you can train and pivot and find the right fit for somebody.
James Cohen (31:11)
We should do more of hiring for culture, but we work very hard on culture. ⁓ So we do hire for skill sets. ⁓ But as a leadership at Nevvon, we talk about delightfulness a lot. And delightfulness doesn't mean necessarily being nice all the time, but it's being fair and transparent and being more of a giver than a taker. ⁓
which is very much what Nevvon is and that means to our partners, to our clients, to our prospects, to ourselves. And that's very much in the culture of Nevvon. We like to listen, we like to solve. So we're looking for more of that personality, but learning from you guys, maybe we should be hiring a lot more ⁓ for cultural fit ⁓ rather than working on culture in the company after they come in.
Miriam Allred (32:04)
I'm glad you bring that though. was gonna be amazed if all three of you hire for culture first because I don't know what's the norm. I think every business thinks of these things differently and there's no one right way and so it's interesting to hear that you hire for skill, you guys hire for culture, ⁓ mission fit, I think that's really important as well. ⁓ It sounds like all of you as well have hired a lot of people outside of the industry and so home care knowledge, home care experience isn't necessarily a priority for you. You find people that are culturally
fit, that they're a joy to be around, you find these people and then you can teach them maybe some of the technical know-how when it comes to home care. Does that sound accurate as well?
Todd Allen (32:44)
Yeah, I'll just say, going back to what you said, I think for Alex and I, it's a given that they have the skill, right? You're not gonna hire someone that's unskilled. ⁓ And so I think we're all three kind of doing the same thing. ⁓ But I just think it is really important to say, okay, this person could be the perfect hire. Maybe they're in a competitor and they came to us and it's very strategic. But if it's gonna be cancerous, if it's not gonna be a good environment to work with that person, we will pass.
And I think we all would agree with that, that in the skill has to be there.
Miriam Allred (33:18)
Yeah, the reason I think this conversation is relevant is these home care leaders, they're hiring their office staff, this office team, and they're up against the same challenge is do we hire people that we enjoy working with that would add value to the team, to the mission, to the culture, or do we hire for skill? We think of schedulers and care coordinators and all of these roles. There is a certain level of technical skill needed.
But I hear, think more often than not, home care companies hire for culture, hire for just like energy and the skill they can teach, they can train, can upskill them once they come into the company. So that's why I think this is interesting is every business leader is up against this decision. Do I hire for culture? Do I hire for skill? Given that there's a base level of skill that's already there.
Alex Oosterveen (34:07)
Yeah, and I think what we've learned is that mission cultural fit is a requirement for us. And then I would say the skill piece is it's going to come so long as you can tell this is like a smart person, and they'll learn, right? And so long as they have that growth mindset, they're willing to work hard, they'll be really successful. Don't necessarily need them to be an expert on home care or software or anything like that. That can be learned.
Miriam Allred (34:35)
Just a small tactical thing. All of you have headquarters offices, but if I'm not mistaken, all of you have a good amount of remote staff as well. What's your opinion on virtual interviewing, hiring versus mandating an in-person interview before you make a hire? What are your tactics on that?
James Cohen (34:51)
Before COVID, we were remote first, so we always hired remotely and we have a good culture around that. We actually hired HR consultants to help us through that. We have a four-stage interview process and I think we've actually done really well with that. ⁓
Miriam Allred (35:08)
So remote 100%. No
in person at the end stage.
James Cohen (35:13)
I think the only person I interviewed ⁓ in person at the end was our CTO.
Miriam Allred (35:19)
Yeah,
interesting. So 100 % remote. what about you guys?
Todd Allen (35:22)
Yeah, we're maybe 60, 40 remote to headquarters in central Texas, right down the road from here, actually. And for me, it depends on how senior the person is, if we'd like to see them in person during the interview process. So all of my senior leaders, we've talked to them in person. And ⁓ most of the teammates, especially if they're going to be remote, it's a remote interview experience. But all of our customer support and most of our ops are in central Texas.
Miriam Allred (35:50)
Okay, great. Alex?
Alex Oosterveen (35:52)
Yeah, we hit our growth spurt when remote was all the rage during COVID. And so we started with that. And I would say it's worked out well for us, but we do need in-person time. in a couple of weeks, our whole team's going to ⁓ offsite, like a little resort we rented out. And we're going to get three great days together. And I find those relationships.
really like skyrocket during those three days and then we can maintain that remotely. But I do find we need a balance of the two. And then we try to do about one day a week in person as a team. So it does make it a little bit harder if you're in a different city ⁓ to keep that. But we also try to just bridge it by getting together whenever we need, know, fly the team in if there's something that's more creative. We've to get on a whiteboard and share a meal after because that's where a lot of the breakthroughs happen.
And so we'll just kind of selectively do that.
Miriam Allred (36:48)
Yeah, I like that. A mix of both and prioritizing the in-person time because a lot of good can come out of that. I want to talk about skills and I want to talk about hard skills. And I know you all probably don't like talking about yourself, but I want you to think about hard skills that you have or that you've developed that have led you to where you are today. We've talked about culture. We've talked about leadership. We've talked about hiring. Think of tangible hard skills that you have or that you've developed that have led you to where you are today.
What is that skill and how have you developed and how is it attributed to your growth and to your success? Todd, let's start with you.
Todd Allen (37:25)
Yeah, so I think there's two ways to answer this and ⁓ I'm gonna replace the word skill just for a moment with trait. So what kind of trait do I focus on? And for me, it's humility because from humility and I'm not the best at humility, ironically, right? But I think if I have a humility that enables me to listen well, then that's what I'm going for. So I guess you could say the skill is listening. So whether that's to the market reverb that we get,
whenever we are talking to clients or prospects, or if it's employees ⁓ or advisors, if I'm humble as a trait, as a characteristic, then the skill of listening will really help me and serve me. And so hopefully I can answer that in a sideways way. And my last thing is that there was a coach that told me, a CEO coach that told me something last year that really stuck with me. said, Todd, you've built this company and you have been doing things. I think as entrepreneurs, you're a do-
but you need to turn from doing to communicating. And that's really the mark of like, okay, you've scaled your business and now you need to be a better communicator. So I'm working on that skill, whether it's public or at my company.
Miriam Allred (38:39)
Can I ask you how you're working on communication? What training, what mentorship, what are you doing to improve communication?
Todd Allen (38:47)
Sure,
well just really quickly, I have a CEO coach that our sponsor, our private equity firm, recommended and I think he's awesome. And I'm going through that. I also listen to great speakers, you know, and just like hear tips. I mean, even being here with these guys, you know, like I surround myself with awesome leaders and I think that helps when you're trying to drink the water of leadership, it helps to be around the same well as great leaders.
Miriam Allred (39:09)
Yeah, because
we're all trying to upskill ourselves and communications one where it's like it's tangible but it's also intangible and abstract and it's like how how do we improve ourselves with these like technical hard skills and communications one that we're all trying to improve on it but it's like how do we how do we become better communicators but I like that also surrounding yourself with good communicators and reading too I don't know if you guys are avid readers but reading a lot to just read well articulated people and to try and replicate that
⁓ Alex, let's jump to you on skills. What skill has led you to where you are today?
Alex Oosterveen (39:46)
would say.
good pattern recognition, listening to the reverb in the market, conversations you're having, what you're reading, data that's coming out, and just being able to see like, ⁓ I think there's a big opportunity there or here. And I think being able to keep that antenna in tune and help it guide how you're allocating your own resources ⁓ for your own time and the company's resources
really important. know, and if you keep, you know, making good decisions based on those patterns you're recognizing, it's going to just help you grow and hit your milestones. So I'd say, you know, that's been a good skill.
Miriam Allred (40:33)
I want to ask is that something you feel like you had coming into the business or is it something you feel like you've learned through the business?
Alex Oosterveen (40:39)
You know what, think it's always, that's been a fairly ingrained thing for me. know, just always being curious, keeping your eyes open, just listening and asking a million questions to folks, because I'm just genuinely curious. And then when you notice something, ⁓ then trying to create a thesis around it. And before this, I was doing investing and stuff like that, which is a similar mindset.
Miriam Allred (41:05)
I like the way that you're positioning though pattern recognition. You've shared a lot of like keywords that surround themselves to this concept, but I like that pattern recognition. I think that's a really unique skill that maybe a lot of people wouldn't define maybe as that, but have that skill and I like how you positioned it.
James Cohen (41:22)
Yeah.
Alex Oosterveen (41:22)
If you
see like a few signals, a few clues, you know, you can say, there might be something big, were big shifts about to happen. So let's position ourselves to be able to capitalize on it.
Miriam Allred (41:32)
⁓ James, what about you? What skill has been important in your growth?
James Cohen (41:37)
So I'll go on a longer rant about this because I think about this every day. think Todd, you just said what I heard is your role is changing from more from doing to communicating right now. think Alex, you're probably going through the same stage. I think as CEO is of a scale up. I think about my role every day and I work on that role every day. I would say the skill I came in with, we bootstrap the company. We never took any professional funding.
So for me, it was always trying to project our growth and then hiring or build a technology to support that growth. Because if you over hire, overbuild technology past your growth, you're just going to build a technology that goes to waste or you're going to hire people that are not fully utilized. So we've done an excellent job at the company of always forecasting our growth and just keep growing with people.
and keep growing with technology. And then in terms of me, you talked about ⁓ reading books. I do read books a lot. My favorite book that I read at least once a year is by Adam Grant, Give or Take. We're big givers in the company. We believe in giving rather than taking, and we feel the winners are the givers. And we try to be really easy to work with, both from a partnership.
standpoint and with our clients. And that's something that I think we embed in our culture. And it's a real skill set to always be giving and not getting something in return right away is sometimes difficult, but that's okay. Keep on giving and life will come back to you even in a business sense.
Todd Allen (43:21)
Can I just glaze on James here for a second because that is so true as a partner of Nevvon's. We've noticed a lot of that giving culture that they have had and it's been challenging actually. ⁓ He's asked, know, we're a software company and we partner with many folks in the industry like James, but James was very like, hey, how can I help you? How can I add value to your company? And so anyway, I just wanted to say yes and amen to what he was saying.
Miriam Allred (43:46)
He
practices what he preaches. I want to ask about the first skill that you mentioned, which was like forecasting or pacing. I think that's a hard skill to get good at and to be able to repeat over and over and over. I think in home care too, it's a lot of the chicken or the egg clients, caregivers. There's like so much ebb and flow. And so how have you gotten better at forecasting? Like what's the, what's the how to of improving that skill specifically?
James Cohen (44:12)
I have a bit of, like Alex, I came from finance, so I know how to read financial statements. empower my sales team and my customer success team. We use HubSpot as our CRM to fill that out really well. And I stay in touch, but also on the expense side. I'm in my bank account 10, 20 times a day. I'm seeing every expense. I've seen that we're getting paid on time.
⁓ We barely have any bad debt and I attribute that to be just on top of everything. And I feel very close to our financials and I think that's really helpful for us.
Miriam Allred (44:54)
Okay, I appreciate the honesty there in the bank account 10 to 20 times a day. you guys relate on this forecasting being a strength being something that you came into the business with or something that you have learned developed over time?
Todd Allen (45:08)
I can say that it's been a learned ⁓ skill for me. So this is our 13th or sorry 14th year. And, ⁓ you know, we've grown a lot like the industry has really had, you know, lot of adjacent kind of overlap with it. And ⁓ I can't say that I saw all of those. Right. I mean, I can't sit here and say, yeah, we saw every single one. We knew exactly what was going on. And so I think to that's been that antenna has grown over time and become more sensitive and just ⁓ really it's
Honestly, talking to partners and talking to the industry and going to conferences and listening to clients, things like that.
Miriam Allred (45:45)
And
Alex, you come with a finance background too, so maybe some of this is second nature, but what's your take on forecasting and pacing and knowing when to bring in additional hires versus when to dial it back?
Alex Oosterveen (45:56)
Yeah, I would say I'm definitely still learning. I don't have as quite a sixth sense as James. But yeah, think we actually brought on venture capital investors. We couldn't bootstrap like Nevvon, but they helped almost force a level of sophistication in the business to learn that. So that's been a great way to learn, and they've been really great investors to work with, working with us and being patient to help us.
build that muscle and it just really comes from doing it. You look at the quarter, the year, a couple years ahead and you try to just set big goals, see what we can achieve, what's going to be the smoothest path to growth, kind of work backwards of what kind of team do you need and other supporting services and then ⁓ kind of month really assess how did we do based on how we expected we would
and like you're a sports team, know, look at the tape, try to retro it, what went well, what didn't, what did we get wrong. I think every time you do that exercise you just get a little bit better. So I think for the first time now I'd say we're on budget as a company, you know. Congrats. Yeah, you know, and it took some time to really figure that out.
James Cohen (47:16)
And
Alex, I hear that about, I heard corporate governance when you said that, your venture capitalist forced you or compelled you to have a good corporate governance because we have no one to answer to except for ourselves. We haven't been forced to do that and we're actually working on that right now. And something I say we're necessarily struggling with, but it's hard to do right now, six years later. But it's something that we're working on right now.
Miriam Allred (47:41)
And it
brings us back to like the pain and the discomfort forecasting out of reality, you have to figure that out. You know, sometimes there's pain, discomfort, along the way that help you course correct when it comes to forecasting. You have to figure it out through going through obstacles over and over.
Todd Allen (48:00)
Right. And can I
mention if you're forecasting too far ahead, like did anyone see the big short? Right. So the whole financial crisis in 08, you know, there was a saying in there, if you're too early, you're wrong. Right. And so because there was there were people that were guessing that was coming and they were way too early. So they were like, it's the same thing. Too early is wrong. And so I've really taken that to heart. And if I'm trying to forecast where the ball is going in our industry, I'm getting ahead of my skis and I want to listen a little bit more and pay attention to what's right in front of me.
Thank
Miriam Allred (48:30)
Hmm.
I want to, I want to shift gears a little bit. ⁓ I had you always all listen to a podcast that, before this episode going into it, I don't know if you had the chance to listen to all of it, but, I learned this moat framework from Cody Sanchez. She's actually big in the private equity, kind of a big shot in private equity world. ⁓ and this really resonated with me and I want your take on all of this. So the moat stands for the is for margin. ⁓ a business that makes you money and doesn't just generate revenue. There's, you know, kind of a difference there operations, you know, you've had to think through, can this thing scale?
over time, ⁓ unfair advantage, you what are the advantages that are unique and hard to replicate for you and what that has led to? And then total addressable market. You know, we're talking about home care, but is this a real market with enough people to sustain this business? Successful businesses oftentimes have maybe three of the four of those things, margin operations, advantages, unfair advantages, and total addressable market. I'm curious from each of you, which of those maybe four things has been
your greatest strength in building up your business and or which of those four have you focused on heavily that you feel like has led to your success today? So margins, operations, unfair advantages, total addressable market. James, and maybe let's start with you. Which of those four have you leaned into?
James Cohen (49:46)
So definitely we came in with the unfair advantage ⁓ coming from healthcare facilities owner operator, ⁓ coming from home care agency, also founder operator, sitting in every seat in that organization. I knew exactly which pain points our clients have when it comes to training. So I didn't have to guess, I didn't have to interview too many customers.
definitely came in with unfair advantage and I think that's why in just shy of six years we've been able to scale so fast.
Miriam Allred (50:19)
Yeah.
the others, margin operations, total adjustable market, which maybe of those do you feel like you've had to work on the most?
James Cohen (50:28)
Definitely operations. Because we lead with delightfulness and because we lead with give rather than take, we're often doing more for others than ourselves. But again, we are big believers that that is the winning formula at the end. But we do work obviously on operations and we've got playbooks and all those things that you need, but it is a struggle to go through.
Miriam Allred (50:52)
But
the unfair advantage has been kind of the steady horse from since day one and you're still reaping the benefits of Alex what about for you of those four what stands out as being a strength for yourself and caribou
James Cohen (50:57)
Absolutely.
Alex Oosterveen (51:04)
Yeah, I would say unfair advantage as well. think, yeah, for us, it's really related to our team's willingness to work really hard, learn, and adapt. They always bring their best for the home care agencies we serve. And then that leads to great outcomes, great experiences. And then they tell their friends. And it kind of comes up full circle back. So I'd say that's been kind of consistently what's helped us the most.
Miriam Allred (51:33)
Okay. And maybe same follow up question, which of the four, do feel like you're working on?
Alex Oosterveen (51:38)
I'd say we're working
on the margin side of things, because since we do have some venture backing, it does cause you to kind of hire.
ahead of where your cash flows can support. ⁓ So I'd say now as we're maturing and kind of hitting that scale up phase, we are caring a lot more about the unit economics and just making sure this is a sustainable, long-term, strong business.
Miriam Allred (52:06)
Good answer. Todd, what comes to mind for you?
Todd Allen (52:09)
Yeah, I mean for us, it's more the same. I mean really it's just that unfair advantage. I think for all of us though, can I just back up and say the baseline is that we're in an amazing TAM. I mean our total adjustable market is there and it's growing and it's, I'm consistently blown away. was just looking this morning at how much, just us, you know, and I represent one of maybe a dozen or so software companies, just the amount of leads that we're getting in a day, which is indicative of like how big the industry is growing. So anyway, the TAM is awesome. ⁓
It's not complicated. ⁓ On the software side, you have different products, but there is a lot of parity in between the products, right? You know, it depends on what nuanced report you want or, you know, how you want the user experience to look like for your scheduling team. ⁓ But what I have found is our unfair advantage, which shouldn't be, is just customer service.
⁓ I know that's not sexy. might not be the answer that you're wanting to hear, but honestly, it really is. If we can treat people well, I mean, it's amazing what people come to us and say their experience has been like with other software. And so, ⁓ again, that's really not, you know, like a super juicy answer, but unfair advantage. What keeps me up at night is the operations, obviously, because it's like we're always trying to tweak the engine so that it can purr a little bit better. And, ⁓ you know, that's, guess, just as operators and entrepreneurs,
we're never going to not think about that.
Miriam Allred (53:33)
But I want to push you to think about what would optimal operations look like for AxisCare? know, if that's what you're both working on is you're working on perfecting operations, What does that look like? If you could, paint the picture of what optimal operations look like for you to where it is a strength of yours, what would that look like or what differences would there be against what you have today?
Todd Allen (53:54)
In the software world, there will always be a tension between product and sales. Product is saying, sales, we have an amazing product, sell more. Sales is saying, we need this in the product or we can't sell. And so that tension is what we're getting good at. I live in that tension, it keeps me up at night. I would say specifically that's the pain point in the operation that keeps me up because they're both right, right? We always want to take ground in the product.
space, but at the same time, you know, there's always more excellence that we can have on the sales team and, you know, we can have good ops on the revenue side. So ⁓ I hope that answers your question, but that's what keeps me up.
Miriam Allred (54:36)
Yeah,
I want to ask you the same question.
James Cohen (54:38)
I
want to double down on the time that the talk talked about.
Two years ago, you might have not even thought about IDD as TAM expanded it. I'm sure you've seen it. We've seen the expansion of a TAM in even a self-direction, family caregiver training. That has become almost a bigger TAM for us right now than our initial compliance training for professional caregiver. We're starting to sell directly into states right now, which expanded our TAM. So that's extremely exciting for us as well.
Miriam Allred (55:12)
I want to ask about operations that I want to actually come back to the total addressable market. Operations, I just asked him the question of optimal operations. What areas of operations do you all need to focus on to get you to that level where operations feel like a strength?
James Cohen (55:27)
I mean, the easy answer is to talk about like how many accounts each customer success manager can handle, whether it's 70 accounts or 100 accounts. But our main metric would we look at is that retention or the opposite side is churn. That's what we care about. If our clients are staying with us and they're renewing with us, we know we're operating really well.
⁓ if we see a high churn, we know something's wrong. So that's our big metric that is always flashing in front of us all the time.
Miriam Allred (55:58)
That's
how you quantify operational success is customer retention.
James Cohen (56:03)
Yeah,
You know, we all know it's more expensive to acquire a new client than keep a client and going back and again around the delightfulness and more of a giving nature, we want our clients to stay with us and we have a super high retention rate and we're very proud of that.
Miriam Allred (56:22)
I
like yeah that way of quantifying what operational success looks like because again, it's kind of ambiguous There's so many facets of operations. What does optimal operas operations look like? But I think retention is a really good metric of that back to the total addressable market I think this is interesting because some people may think home care is finite We're always talking about how many home care businesses there are in the US, you know Is it 25,000 is a 30,000 is a 50,000? We talk a lot about that But it sounds like from your comments that you just made That's actually not the lens that you're thinking about home care through is there's
caregivers there's these other verticals in the post-acute space that overlap with home care and it sounds like you all aren't just thinking of home care as these home care agencies it's actually a much bigger ecosystem in the post-acute and family caregivers. Am I understanding that right?
Todd Allen (57:08)
Yeah, yeah, I would say it is. We know that there's a future state that's much bigger, but it's impossible to quantify what that is. But we know that it's growing and we know that other adjacents are getting more blurred into home care, right? Like IDD is a great example. Skilled is even a good example too. ⁓ And so we're it's half instinct and half experience. We know based on past, you know, home care grew into more VA, grew into Medicaid and grew into some of these others that were considered ⁓
⁓ at one point. Now they're all together in one vertical. And my instinct and my experience tells me that it's going to be much bigger. I can't quantify it. I'm sure there are studies out there that, you know, they're going to be off though in some degree, you know, a margin of error. But we just all know that it's going to be growing.
Miriam Allred (57:56)
How much are you thinking about what's in existence today versus this future state? You know, are you mostly focused on what the industry is and looks like today and there's still a lot of growth for you as is, or are you starting to shift and think about, what this becomes and we need to focus on what it's.
Todd Allen (58:12)
Yeah
as a software company you have to do both you can't leave your current customers behind and so you have to develop the things that they're asking for while at the same time you're looking out you know over the horizon and so we we do try you know I can't give you a pie chart as to how we focus on that oh it's you know 40 60 but we do both we really want to make sure that our current product is getting more and more excellent and we're using you know new tools that are in on the software side AI is is a big disruption
⁓ and we're putting those in too, while at the same time looking out and kind of asking the market, what are you thinking about for the future?
Miriam Allred (58:50)
Alex or James, any thoughts on that on focusing on the industry as it is versus what it's becoming? ⁓
Alex Oosterveen (58:58)
I'd say, yeah, our answer might be a little bit different, because I'd say Caribou is the earliest stage company ⁓ on the sofas. And so I'd say we have ⁓ probably more to...
just to kind of accomplish with the here and now, you know, because it's like a more nascent product category. ⁓ But, you know, at the same time, we're always seeing where is the market going, especially like payment models, and how might that impact our own roadmap and where we're focusing our R &D efforts. So one example is, ⁓ you know, the battle between fee for service or value-based payment models. And, you know, could the caregiver really be somebody
who's really championing those better outcomes and are there incentive structures for those caregivers that can help motivate them to improve outcomes for their patients and can our product evolve with those things? So I have a say to have a similar answer that you've got to be doing both, but we're kind of trying to focus on just operationalizing our core thing with the market that hasn't yet adopted a
incentive reward solution yet.
Miriam Allred (1:00:16)
Thank
James Cohen (1:00:16)
We have a unique way of looking at future TAM. We have a grant writing department. So we're looking at where government funding is going. And about two, two and a half years ago, we started seeing a lot of grants and funding towards family caregivers again. And it makes a lot of sense. The workforce is...
the hard part of the business. We don't have enough of a workforce. A lot of the workers want to leave the workforce and who's going to take care of the aging population other than family caregivers. It's all going to the burden is going to fall on the family caregiver. So the government has been trying to find ways to empower and pay that family caregiver. So we saw that about two and a half years ago started building some
programming, education and training around that. And it's come to life right now. I think we all know about this new CMMI program called Guide, which is a dementia experience, seven year ⁓ grant funding. We're extremely involved with that and we attribute to being in front of that because we saw that too, two and a half years ago. So that's a way we look at what's happening in future time.
Miriam Allred (1:01:35)
Yeah, think there's back to there's no one right way. It's how do we focus on the here and now on our current customers on the current needs that are just flying in from every direction and how do we balance that with trying to forecast, trying to predict what's coming down the pipe because that can greatly influence where we're at today. So I think that's a prime example of challenges that CEOs face is how do we balance the here and now versus the what's coming down the pipe. ⁓ The last thing I want to wrap up here is talking a little bit about each of you and your
reputation. Here you are three CEOs of these well-known companies in home care and ⁓ home care companies, these home care owners, their reputation, their credibility, their presence in their community. Like your presence in home care is a big part of growing the business. You often have to be someone to help your company get recognized. How much has that influenced ⁓ the growth of your companies is leaning into not necessarily being an influencer,
per se, but being a personality, being a presence, being someone that people can approach and focusing on your reputation, your credibility to grow your business. James, and looking at you, how influential has that been in growing the business?
James Cohen (1:02:47)
Yeah,
extremely influential. And I think all of us here on the couch have some of the same characteristics. We're all kind people. We're all approachable. ⁓ I talked about delightfulness doesn't mean nice. you and I haven't had conversation, haven't haven't had hard conversations. Alex, you and I have had hard conversations, but we're still extremely collaborative and helpful to each other. ⁓
and really good to each other. And you could use another word, but internally, like we said, we use delightfulness. And I think we're an extremely approachable company. We've had our clients ask us for different technologies that we don't even think about building because we've provided really good software to them. So we take that as a compliment when they come back to us and do that.
One challenge I have, I think both of you probably have it, is as we grow, Todd Allen is an AxisCare. Alex isn't Caribou anymore. And I work on James Cohen not being Nevvon. Some people are like, you guys have 100 people in the company. They didn't even know because I'm so out there and at many conferences and at speaking engagements. So it's really important to me to show our little world.
that it's not just James Cohen. There's a lot more people who do much better work than I.
Miriam Allred (1:04:18)
And here you all are on a podcast. But Todd, what about you? How much does your reputation, your personal reputation play into the growth and the success of the company?
James Cohen (1:04:20)
Exactly. Thanks, Miriam.
Todd Allen (1:04:28)
I think it's more of
a background thing for me. I do not focus on it. I actually try to decouple that. ⁓ And I might be the anti on this issue. ⁓ But I think you're right. I agree with you. Your reputation is very important. The way that people see you, it's just that I see some leaders that make their company all about them. And that is a slippery slope because you can mess up once and then the fate of the company can be on that. And I'm not willing to risk
you know, the company just on like me leading with my chest, being out there, being big and bold. Now that's not to say that I'm not super passionate and I really believe that we're the best solution and are vertical. ⁓ But I don't try to say like, so as Todd's reputation goes, thus AxisCare goes as well. ⁓ I really try to lead from behind and, know, servant leadership is one of those things that I really subscribe to. And if I can push people up more to the limelight, I would much prefer that, you know, it's a lot easier.
It's personally, right? ⁓ But it's also fun leading. Like I love fun. In my company, it's actually a little bit different. Like I love like being upfront. I love like the positive influence that I can have on those folks, on my folks, right? But as it comes to, you know, going outward facing to the industry, I'd much rather like put other people upfront because they're awesome.
Miriam Allred (1:05:52)
That's a
really interesting distinction. Internally, you want to be the face, the voice, kind of the ringleader, but externally you want to be more behind the scenes and let everyone else be in the limelight.
Todd Allen (1:06:02)
To
some degree, mean that's the extreme version of that, but I have an amazing partner as well, a COO and CTO, John, and he and I kind of tag team a lot of that stuff, so it's not just me. But I'm just saying I would much prefer to do that internally than to, you know, just be so well known in the industry that it just kind of takes my life away, you know.
Miriam Allred (1:06:24)
Yeah, good
thoughts. Alex?
Alex Oosterveen (1:06:26)
I guess for me is, yeah, just, I think it's something that's...
developing but at least it's just been organic. You we just show up places you don't know your expectations may you don't even have expectations half the time and then you know one conversation can change the course of your business or one new relationship and I think it's just about you know every time a new opportunity arises just kind of being good intentioned, heart open and say hey you know hope for the best try my best and you know that compounds and and it also has helped attract great people on the team and I
to give a lot of credit to Christian again, my co-founder, because ⁓ I think he brings, our culture really was just him and I at the beginning. And ⁓ I didn't really know.
so much why I wanted to work with him. It was more of a feeling, you know, of like who he was as a person. And ⁓ I think, having that at the core of the company has really served us well. And ⁓ then as we continue to, attract folks that, want to work alongside somebody like Christian, it just really helps, all the outcomes get better and better. the credit I'll give myself is having great people on the team and
And then you get amazing clients and then they want to do more and more with you and then they're happy to advocate for you.
Todd Allen (1:07:48)
Yeah,
do you know what I've seen in some companies? the leader is so out front that there's this line and sometimes they can cross it where it's like, okay you're actually making it too much about you and not a not as much as you need to about the company and I so I think we need to get maybe as close to that line as we can but still we don't want to take too much of the attention of the company that is looking at us, right? We don't want to be attention grabbing. We want them to look at
or caribou or axis care, not James, Alex, or Todd. You know, I mean, that's my thought.
Miriam Allred (1:08:24)
And
I was just going to say, think that it's safe to say that all of you have done that really well, which has attributed to your success. All three of you have achieved a certain level of success. And I think that's the linchpin, is you all have built a really well-rounded, deep, strong team. And you lead with that. And that's what you are known for. That's what Nevvon, AxisCare, and Caribou are known for, is that well-rounded, strong team.
Alex Oosterveen (1:08:46)
They make us all look
good, right? Like when I only hear happy clients at Nevvon and AxisCare, and ⁓ that then contributes to our reputation.
James Cohen (1:08:58)
This
is not scripted. didn't expect to see this, but what Alex said before around just showing up and I feel entrepreneurship is sometimes illogical. We do things and we don't always do all the analysis because of course that creates paralysis. And I feel like all of us have really good intuition. know, I've seen you, Alex, just show up and have maybe, like you said, not with the full out game plan.
but you have the intuition of really listening and being at the right place at the right time. I know you do 100 % Todd and your team does and we rely on that too and ⁓ that's entrepreneurship, right? Taking chances.
Miriam Allred (1:09:42)
and collaborative in nature. We're figuring this out together. We don't have all the answers.
Alex Oosterveen (1:09:46)
You know how
James said, how can I add value? You know, it's gonna come back, you just gotta trust it. And it won't be so clear or linear all the time, but you do that enough times, you're gonna just keep going.
Todd Allen (1:09:58)
Yep.
Miriam Allred (1:09:59)
OK, last question. I want to wrap up with this. ⁓ In the spirit of entrepreneurship, obviously we've covered a lot of ground in a lot of different areas. Hard lessons learned. What advice do you have to all these home care owners, operators listening to this? They're entrepreneurs. They're CEOs. And they're up against challenges that you guys are facing every single day. What last piece of entrepreneurial advice do you want to give to the audience listening to this?
Todd Allen (1:10:23)
Well, I'll start with the worst one and then we can get better. How about that? I wanted to just say, you know, it's about risk tolerance. ⁓ I remember, you remember I was talking about, you know, having advisors is really helpful, at least for me. And about six years ago, I'm in a group, local group of CEOs, and we're just learning from each other, rights peer group. And one of them said, hey, you know, you guys are growing and your TAM is amazing. ⁓ It seems like there's a parable, you know, about this landowner and he gave talents to different people. And the one
with the one talent just buried it, right? And he was like, I didn't want to lose it, you know? And he said, you're kind of acting like that. You're not really out there and making that talent work. And you have talent and you need to, you know, you need to do this. And I had been, you know, I thought at least I had been out there and working my talent. And but that really helped to hook me into a new line of thinking of, you know, this is such a great market. It doesn't even feel that risky to make these bold moves. But I really leaned into risk.
more. And so that's what I would say, like wherever you are as an entrepreneur, lean into risk more. You can always be more risky. Calculated of course, but I think risk is the linchpin.
Alex Oosterveen (1:11:32)
Yeah, I'll piggyback on Todd. This is not my concept, but somebody said it recently and it resonated is we have a bias as humans to overestimate risk and underestimate opportunity, and the potential of something. And that can lead to us just not taking the leap, you know, not taking the jump. So,
Maybe it was just all of our characteristics or traits. Maybe we just had less of that internal bias and we just wanted to get after it. But I'd say self-reflect and think, where am I on that bias? Do I have a really strong, Do I tend to over analyze and anticipate risk and to a point where it causes inaction or me not taking the leap? I would really try to ⁓ coach yourself on that or maybe get an external
coach and and then also be more a dreamer you know if you dream and see the big potential you can really bring it into reality and you're gonna align all of those little actions whether consciously or unconsciously ⁓ in your day with working towards that and so don't stop dreaming even when it gets hard and painful because that's a given.
Miriam Allred (1:12:41)
I like it.
James Cohen (1:12:41)
I'll give two.
give, uh, I ran a home care agency and I founded one, as I mentioned before. When I thought about the business, I thought about the demand and supply demand being the patients that we're serving. We all know we living in an aging population. Numbers are 10,000 people, 10,000 people turn 65 in the United States every day. I think it's the first time in modern history that we have people over eight, over 65 that under 15 years old.
people are living longer with comorbidities, finding the demand is not hard. The secret sauce here in our industry is the supply, the workforce, ⁓ keeping them, hiring them efficiently, ⁓ making them happy. And when I had the agency and we grew quite rapidly, only, not only, but we majorly focused on our supply end of the business. And then,
And then from a personal perspective, ⁓ I grew up in a house that, you know, we studied the Bible, we learned about charity. My grandparents and my parents always told us about charity and taught us about that. We didn't come from an affluent family, but charity doesn't give, doesn't mean giving money all the time. You can give your time as well. You can be compassionate. You can be giving.
And I feel like ⁓ we can do that to our workforce. Our workforce ⁓ works really hard. They don't get paid extremely well. ⁓ They have a very hard job. And ⁓ if we can keep being charitable to them, ⁓ I think we can win over here, all of us as an industry.
Miriam Allred (1:14:28)
great advice. Was that one or two both?
James Cohen (1:14:30)
That
was both. was both. Yeah.
Miriam Allred (1:14:32)
Yeah, I love that charity is you know, it's not monetary and that's what we have to give especially to this caregiving workforce Yeah, ⁓ gentlemen great conversation. Thank you for joining me in the lab James Todd Alex here in Dallas. What a fun experience for all of us Thank you for the stories the frameworks the concepts everything you shared today again in just the spirit of entrepreneurship we are all on this journey to becoming better leaders better CEOs better entrepreneurs and ⁓ Home care is such a collaborative space and we can all learn
And the three of you, great examples of just learning and growing and collaborating together. And that's what we have to bring to this home care world is just the rising tide lifts all boats. all here to better one another and to become the best entrepreneurs that we can be. So thank you so much.
James Cohen (1:15:17)
you
Todd Allen (1:15:17)
Thank
you.