Candace Dellacona: Welcome to the Sandwich Generation Survival Guide.
I am your host, Candace Dellacona, and I am super excited to welcome today Neal
Shah and Sydney Rosbury from CareYaya.
Welcome guys.
Neal Shah: Thanks, Candace.
Sydney Rosbury: Yeah, thank you for having us.
Candace Dellacona: Oh gosh, I am beyond excited to have you.
So just to give everyone a little bit of background Sydney, one of our guests
reached out to me recently on LinkedIn.
Because of my background in doing estate planning and elder law and saw
the Sandwich Generation Survival Guide podcast and thought that I should
know about an entity called CareYaya.
And, candidly, I hadn't heard of it before and Sydney and I had the
most amazing discussion about this alternative to traditional home care.
And I am really excited to share with our listeners, guys, all about
CareYaya, what it is, and how it's this really incredible, remarkable social
experiment which is mission driven, that I love so much, created by Neal.
So I'm going to let you guys go ahead and introduce yourselves and
tell us a little bit about you.
So Neal, why don't you tell us a little bit about you, and how we got
here, and then we'll go to Sydney.
Neal Shah: Sure.
Yeah.
Thanks, Candace, for the opportunity.
A quick background on myself.
I grew up in North Carolina, which is where we started CareYaya but I
actually spent most of my twenties and thirties living in New York City.
I have a non traditional background for caregiving.
I actually was in finance.
I started my career doing investment banking in my early twenties.
By my mid twenties, I went into the hedge fund industry.
And, I was good at the work and generating very high returns.
So I became a partner at a multi billion dollar hedge fund when I was 27.
And actually drove really high returns on investments across
healthcare and technology.
And by my early thirties, one of those investors backed me to start my own fund.
So I started that with 10 million.
And by the time I was 35, I got it up to 250 million.
And I was managing money for university endowments, charitable
foundations, pension funds, et cetera.
So it was really rewarding experience.
And I was good at it.
And I used to work really hard at it.
And then kind of out of left field, I became a caregiver and starting
my early thirties, a secondary for my grandfather through dementia and
kidney failure and end of life care.
And really I saw, I was the person in that family helping a lot of the
care navigation side because I'm the researchy person and but my mother, bore
the brunt of the direct care and it was my first eyeopening experience in how
broken the care industry is, just how difficult it is to get care help the
reliability the quality of the care, kind of the industry structure where
the caregivers aren't getting paid much as a result, they're often burned out.
I became like somewhat obsessed with the care industry through that experience.
And after he passed, I was looking into, okay, how can I invest in this
industry through my fund and back people who are doing good things in
it, but it was really hard to find.
And then unexpectedly at the peak of my fund career at 35, my wife
became severely ill and went through years of a difficult cancer battle.
And I was the primary caregiver because we were living in New York City and,
our family, her family's from Michigan, my family's from North Carolina.
It was we were dealing with on our own.
And, I kept taking sabbaticals for my work to manage her care.
And, at that point, it was a firsthand experience where when you can't
get good care help and you can't get respite you feel guilty and you
end up doing a lot of it yourself.
And, I over time realized that might influence the outcome.
So after several sabbaticals, I made a difficult decision to wind down my fund,
which was like a very heartbreaking and painful experience when you've dedicated
almost 15 years of your career to doing something and you've gotten to near
the top of the field to just walk away.
But I thought it would make a big impact on the outcome.
So became her full time caregiver for a couple of years.
Pleased to say, knock on wood, she finally had a successful outcome and has
now been in remission for a few years.
So it's been a positive journey from that perspective.
And then we actually, even more positive, we actually had our first
child after the whole experience.
So we have a happy and healthy four year old baby daughter.
So that's been really cool.
And then as as part of that journey, I, relocated back home to North
Carolina just to be near family.
And once my wife recovered I started CareYaya.
I was like, I've experienced the problem now secondhand.
I've experienced it firsthand.
I've looked at it from an investment standpoint.
This is a half a trillion to a trillion dollar industry, depending on how
big you count as like caregiving for someone with serious illness, or that's
aging, or if you count just home based care, but the industry is growing,
it's going to double in the next 10 years with our aging population.
It's I can't believe there aren't good quality, reliable solutions.
There's a huge workforce shortage.
There's minimal technology.
The industry operates in like the 1980s, 1990s.
So I thought there was a huge opportunity for innovation and social impact.
And I was like.
Okay.
I'm a smart person, but I finally now in the middle of my life found something
that gives me meaning and purpose.
And I've talked to so many family caregivers for just burning at both ends,
trying to make things meet and that was the genesis of starting CareYaya so
Candace Dellacona: You've said so much, Neal, and I think while you were
talking, what I was thinking about is that, that old adage where necessity
is the mother of invention, right?
And you combine those things with, as you point out a passion and a talent, right?
Here you are a person who is really in the finance world and entrenched in that
world, but none of us are immune to the human condition and caring for our loved
ones and that's the genesis of CareYaya.
And, I think that's a perfect segue to talk about who Sydney is and what her
role is with CareYaya as a student.
Sydney, you are a brilliant University of Michigan student in the healthcare field
looking to establish yourself one day.
So obviously a very intelligent young woman and tell us how you came to CareYaya
and what your role is with CareYaya.
Sydney Rosbury: Yeah, thank you, Candace.
So I am currently a senior at the University of Michigan.
Last year, particularly around the summertime, I was looking for a summer
job, and I had known that I wanted to do something caregiving related, but
I wasn't really sure which population of people I wanted to work with.
Previously, I had mostly worked with neurodiverse children, and I had
a lot of fun doing that, but I was hoping to expand my age range that
I've worked with, and there was no better opportunity than CareYaya,
which I actually found out about through my neuroscience major advisor.
He sent an email, trying to recruit students in the
health related fields to join.
So I joined there, and all summer long I got experience with different
elderly people in the community.
Some of them were couples, some of them were like retired
professors, retired just all kinds of professions, and it was really,
really interesting to work with them.
And I myself do have octogenarian grandparents.
So I, not to say I didn't have some experience caregiving for the elderly.
But it's really, it's been a really cool and fulfilling experience to see
all of these people from different walks of life and how they have very
different perspectives on the world which is a really, I wasn't expecting
that at all the diversity that they have and how they see the world and
how they think the world should run.
Candace Dellacona: I think what's really important to point out is that what
Neal has created is really a connection.
So for our listeners, CareYaya isn't a home care agency.
It's a really revolutionary Organization, if you will, that connects college
students, like Sydney with for me as someone who is advising families every
day on long term care and being able to, what we call age in place, with
your own surroundings in your own home, something like this is truly
remarkable and unique in the marketplace.
Neal, tell us how you came up with the moniker CareYaya.
Neal Shah: Sure.
And also thanks Candace for explaining what CareYaya is because I totally
realized I forgot to explain it, but yeah a couple of things I think, came
up with the name because we wanted something positive, and just like
playful and fun and techie, because we realized a lot of the care industry has
names that allude to the later stages of life or potentially death, and we're
like, okay, we want to make aging and just caregiving more fun as it can be.
So it was just the word, Ya, twice.
But it also Yaya, means grandmother in Greek.
Yaya, also means caregiver in Hindi and Swahili and Thai.
So it has like this double meaning.
And then we thought y-a-y-a is a great acronym for you are your advocate.
Which would be like the future of self directed care.
We thought that the care industry just has several break points where there's
multiple opportunities for innovation where booking care is very inconvenient.
A lot of the local care agencies don't have price transparency.
You have to call and get quotes.
You have to have somebody do a home visit and sign contracts.
It hasn't really caught up to 2025, that we're in now.
Meanwhile, you look at things like food delivery, like DoorDash or
getting a ride, like Uber, it's so convenient and streamlined.
So in our case, the innovation is really multifold of could we deliver
a online booking experience that you can spend less than two minutes to go
online, fill out a few basic things about yourself and your loved one.
And schedule and book caregivers right away.
Then could we do something that's much better than care.com
or other online players where all the vetting and background checking and
interviewing of the caregivers is done for you and you just simply put the days
and times you need and you're like given someone and then could we do something
where the caregivers are all off a niche population that is much better than what
I think is in a traditional care industry.
Which are wonderful college students across America who are not only
in top universities, but who are aspiring to future clinical
careers and graduate programs.
So they have a really vested interest in doing a good job.
So think about pre meds, nursing, pre physician assistant, pre physical therapy.
These are students that, yes, they can get paid through the program, but
they're not just doing it for the money.
They're doing it for the career experience and like career development.
And then the final thing is we do it for no fees, so we absorb all the costs
on the technology and the bookings, which has been like an interesting
innovation, initially it was just bootstrapping and funding it, but over
time we've had social impact funders, but, pleased to say that when a family
books care through CareYaya and on average they're paying 20 bucks an hour.
The full 20 goes to the student.
We're not even in the middle of the transaction.
So it's unbelievably streamlined for students earning good income and
families paying what in most markets is 30 to 40 percent lower than prevailing
home care rates, which is awesome because a lot of people can't afford
industry that does a lot of markups.
So yeah, there's multiple kinds of innovations,
Candace Dellacona: And to that point, Neal, and for our listeners, I think
what's really important to note is that as people age and particularly
they need help with what we call the activities of daily living, those
activities are not skilled services.
So traditional insurances don't cover assistance that one
might need to stay independent.
Whether it's, bringing food or help preparing food or that
companionship that can sometimes be missing from a senior's life.
And because of that, families, as you point out, Neal, are spending a huge
amount of money paying privately because traditional insurances do not cover this
type of care, which is companionship care.
And enter in someone like Sydney, who, I may be a little biased having gotten
to know her a little bit, but as you point out, Neal, you have these brilliant
college students who have a zest for life, and they're coming in, and you're
making this connection across generations, which is really so remarkable and kind of
beautiful experience for both generations.
Sydney already has a fondness for her grandparents.
So why not expand that?
So Sydney, from your perspective what do you see, can you, without obviously
revealing any any information about your particular assignments, but share with
us a great example of what you might do with one of your seniors on a daily basis.
Sydney Rosbury: Yeah, so there's actually, there's a decent amount of freedom.
You can balance the things that need to get done, and then also the things
that they want to do that bring them joy within their activities of daily living.
For example, if someone were to be, visually impaired or hearing
impaired, I can help be that extra set of ears, extra set of eyes, to help
them navigate tasks around the house.
Sometimes it's as simple as putting socks and shoes on, helping guide them to the
bathroom to brush their teeth and do their personal hygiene things in the morning.
But I can also help with meal prep, light cleaning, taking out the trash.
In Michigan, in particular, in the winter, I do not want any of my clients going
outside in the ice, so I'm always like, I will take your trash out, I will do
anything that needs to be done outside.
I'll salt your porch, anything like that, just to make sure that they're
living in a safe environment, and that they're able to do the things that
they love, whether that's watching TV, reading, knitting, I have some
clients who I've done woodworking with and doing those activities that
they really like with them and they enjoy teaching a younger person too.
Candace Dellacona: As somebody who is getting older and being a member of
the sandwich generation, Neal, we're always in search of finding the way
to make sure that we age with grace and our loved ones age with grace,
with dignity and not to disparage institutions and long term care facilities
because certainly there are examples where they are absolutely necessary.
You point out as somebody who studied the market, if you will, finding this
dearth this real sort of vast emptiness where there weren't these options.
Can you tell us maybe what the difference would be between hiring,
let's say, a home care attendant versus a student and why it almost can be
the same thing and, inform everybody?
Neal Shah: Yeah, sure.
And great question, Candace.
I think that there's like a spectrum of care needs, and I think, people
have to make the decision that's right for them, but I think that,
so we did, we're backed by the AARP.
We've received funding from the AARP Innovation Labs.
And age tech collaborative from AARP and as a result of that, they brought
us under their fold and given us a lot of access to their research.
And one interesting research that they have internally is that cumulatively
of the amount of hours cared for people above 65, 61% is people
with companion level care needs.
So 39% have a higher acuity, clinical or subclinical needs and those we cannot
address with college students, right?
But 61 percent is a large portion of the 500 billion current home
care market, and that is something that I think is ripe for innovation
because the costs are just too high.
So for those people, CareYaya can serve as a wonderful alternative because in the
traditional home care industry currently the cost of care, let's just say if
you're booking, traditional, 40 hours a week because the sandwich generation
son or daughter might be working and you want somebody around mom or dad.
Current cost of home care right now is pushing $65,000 per year for that.
So if you think about it that's unaffordable for a vast majority
of the middle class, even the upper middle class, right?
Because most people don't have, 100k plus of pre tax income just to
spend on that or tons of savings.
So there we find CareYaya delivers a similar thing for half the price
because all the money is going to the students and there's no fees or
markups and even better the money circulating in the local economy.
You are literally directly paying somebody's future med school tuition
or, physician assistant school tuition.
So it's cool.
You're almost getting care for yourself or your loved one while enabling somebody
to be set up for a pathway towards becoming a future healthcare worker.
So I think that's pretty cool.
I think for people who have more clinical care needs, I do think
that a lot of the home care agencies are a good viable option.
Because many of them have certified nurse aides and people that can do
medication administration, insulin injections, things like that.
Those are things that students can't do and shouldn't be doing.
So I do think that makes sense.
To your point about the institutional and the facility based care, I
think there's a need for that in the market because many people don't
have the luxury of aging at home.
Unfortunately, no matter how good the facility is, so much research has come
out, like near us, Duke University put out a research report about six
months ago, and it was the statistics adjusted for every other factor.
If you move an older person into any institutional care, life
expectancy goes down by three years.
And that's adjusted for like race, income level, you name it, right?
Gender or anything.
It's just that's a reality, that people really thrive on their
independence and, living, in their home.
And of course, as they lose some abilities they would like to get help in the
home rather than move out somewhere.
And when you move them out somewhere into an unfamiliar setting, no
matter how good the care is, just like life expectancy declines.
So I think that we're going to have this interesting thing in America where.
The cumulative care market is now 1 trillion, which is about 500 billion
in home, 500 billion in facilities.
It's expected to more than double with the aging population.
So by 2035, it'll be 2 trillion, but I think market share shift is
going to be significant that I think the home care part is going to more
than double because facility based care is becoming out of favor.
And my kind of final point on that is that today's baby boomers, they were the
generation that their parents, they saw moving into these facilities, cause if
you think about assisted living facility as a concept, it's like a very 1980s,
1990s type of innovation where these facilities spread all over the country.
During that time period.
So the boomers had their parents go through it.
And then they realized like, Hey, this isn't a great place I want to go to.
And then I think COVID kind of destroyed, whatever remaining shred of reputation
there was because the, just some of the outcomes at these nursing homes and
assisted living facilities are horrible.
So I think now there's a fear in many of today's 75 and 80 year olds that
do not put me there at all costs.
Like I'd rather die at home.
And then the final thing is a lot of these places that are dealing with
unbelievable staffing shortages.
I think for a variety of reasons, like the workers have burned out during COVID.
I think they can get better opportunities elsewhere.
There's been regulatory pressure from government.
So like in our area in Raleigh, Durham, we often hear from people where,
okay, mom fell and broke her hip or is recuperating at a skilled nursing home.
And I literally, I hear horror stories where it's like the
staffing is like 25 to one.
And it's just like somebody hits the button to get a glass of water and
it takes them 40 minutes to respond.
So believe it or not, people are using CareYaya in the facility.
Completely never would have imagined that, but a son or daughter
will say my mom's in this place.
We're paying eight grand a month and there's no one paying attention.
So I'm going to book students a few hours a day to be one on one,
and same, whether it's skilled nursing, assisted living, et cetera.
So I think it's crazy.
The staffing shortages is impacting people's
Candace Dellacona: Great.
And, you just did so much, Neal, to unpack, right?
So I want to point out to our listeners that all of the statistics and the
research that Neal just referenced.
There's something coming called a gray tsunami, which is our population
is aging and staying alive much longer than our prior generation.
So we have a huge part of the population that is going to need this level of care.
And to Neal's point, I think it's important to note that we
want choices as we get older and right now there are less choices.
So what you found in CareYaya was providing an option for people to
make sure that they can age in place.
And, for our listeners out there, this is not just Neal's opinion.
He is very humble as is Sydney.
They are backed by Johns Hopkins and Harvard and, really legitimate and
cutting edge organizations, including the AARP that advocates for aging in place.
Because the level of lifestyle and care you get one on one clearly is better than
any institution could hope to provide.
And, Neal, I want to say also that we're in the New York area, and
so you talk about 8, 000 a month, that is probably a third of what
it costs here in New York City.
Neal Shah: Wow.
Candace Dellacona: So I think that is something worth noting.
So what I'd like to know is, and I'm sure a lot of families would want
to know, When a student gets started to sign up with CareYaya, what sort
of training or information are they provided about being a caregiver?
Can you share a little bit about that process?
Neal Shah: Yeah, sure.
Great question.
And that's been something we've continued to add to our offering.
So initially, when we started, we had collaborations with UCLA Public Health.
So we were offering their Alzheimer's and dementia training videos, just cause
online YouTube based videos and curriculum that students could do self directed.
We were also finding many of the students themselves had come in with a CNA or an
EMT licensure, and Sydney can talk about that as well, where, they've done that
on their own, or they volunteer at a hospital, or they've worked at a hospital
those students were already equipped, and then we approached the National Institute
on Aging, because they had heard about our program, and Johns Hopkins had heard
about the program, and there was this collaboration between them, where they
wanted to increase workforce development.
So, we went through this whole process with them where they gave us a grant
to build what it's called the Yaya Guide, but it's basically what they
call the duolingo of caregiving, which is kind of bite sized training
modules to meet Gen Z where they're at.
We've been working on that grant funded innovation which is the first AI
powered dementia care training program.
Right now, we're, like, been prototyping with students, and it'll be, broadly
rolled out over the next few months.
But it's been pretty cool where, there's an ability and an opportunity to upskill
the students while they're doing it and to upskill them through bite sized modules
where they don't want to necessarily all go through a hundred hours of coursework
before they go out in the field.
You can give them lower acuity companion level care and then say, watch these one
minute, two minute, five minute videos.
Where you get a tutorial from a geriatric physician at Johns Hopkins
or a geriatrician at Duke, et cetera.
And then you learn that way.
So that's been pretty cool.
Then the final thing is a lot of them learn from the families
as well, so there's like real practical field experience.
Candace Dellacona: I was just going to say too, and then I want to
hear sort of Sydney's perspective.
I think it's important to know, I think families have a false sense of security
that when they go through an agency, if they hire a companion, there is not
training beyond what you're talking about, and candidly, the resources
that you're talking about are top of the top, and again, another shout out
for your being very humble and earnest about how remarkable, CareYaya is in
that regard, that it has been, received so many accolades from the National
Institutes of Health and organizations like that, that see the need and recognize
the This is a viable option everyone.
So Sydney, talk about a little bit about maybe what your training
is or what you've learned.
And I would like to know if you do something different now, since
you've been in CareYaya for a while, and if you are giving those tips to
your peers who have joined CareYaya.
Sydney Rosbury: Yeah, absolutely.
So like Neal said, there is the certifications list on the app.
I believe the families can see it on my profile too.
It's at least on my profile when I click on it where there's options
where you can select if you're CPR trained, CNA, EMT, or med tech in my
case, I'm basic life support certified.
So that encompasses CPR and first aid.
And those were qualifications that I needed for my previous job
working with special needs children.
So a lot of those initial certifications can carry over, but the memory care
modules and the dementia modules are really helpful and especially for
people like me who might not have worked with older adults that much before.
And then I would say that a lot of CareYaya students have majors where we
are learning about these things too.
So as a neuroscience major, I'm constantly learning about the new cutting edge
things in memory care and Alzheimer's research, dementia research so I can
keep those things in mind too as I am delivering care to people in real life.
Candace Dellacona: Amazing.
And, I can't as a sandwich generation member, I can't imagine anything better
than having this young, bright student who is in the medical field, who wants
to be there, who really sees it more as a vocation, a calling, as opposed to a
job and, Neal, to your point about the burnout and the caregiver industry, we've
seen a shortage here in New York City.
So tell us a little, maybe from the university perspective, you've been
able to get these amazing universities on board, and what should a university
do to become part of CareYaya or are there students that can get that started
in certain cities like New York that maybe you don't have as great of a
presence and how would one go about that?
Neal Shah: Yeah, great question, Candace.
Pleased to say we are as of the last two to three months starting out in New York.
So we started at Columbia University where pre health career advisors usually are
like main opening point is when pre health career advisors, biology professors, reach
out to us because they realize, and I think this is like an interesting point.
It philosophically like even with Sydney's career trajectory and many
of the students career trajectory.
It has become harder and harder now to get into medical school, to get into physician
assistant school, to get into nurse practitioner programs than, let's say, 20
years ago when I was in college, so, as a result of that, many of the students are
trying to get a lot of field experience sometimes graduate, and then take one to
three years after college to accumulate a lot of care experience and then apply.
So the career advisors know that, and they're always like looking for how can
I help this student who really wants to apply to medical school, who applies to
physician assistant school, by the way, physician assistant is a fast growing
field over the last 20 years, right?
And many of those schools require you to have 1000 to 3000 care hours
to have a competitive application.
Sometimes people, students prefer I need to get to 3000 as fast as
possible so I can show I'm serious.
Now, mathematically, there's no way to get that stuff during undergrad
unless you can do part time, flexible hours, gig economy work, which no one
in the care industry is set up for.
Except CareYaya.
Whenever the University of Michigan Pre Health Career Advising hears that, hey,
here's a way that my students can actually get field experience in what they want to
go to, and if they start on CareYaya as a sophomore, as a junior yes, by the time
they graduate, they will have 2000, 3000, plus hours, and they can apply straight.
And the grad school will be impressed that they'll be like, wow, this
student is so passionate that they went out of their way to do that.
And then for the students perspective, it's like, why not do this instead of
working at the local coffee shop or doing DoorDash food delivery, right?
It's like in line with what I want to do in my future.
So the schools are very welcoming of the program and they're
continually telling students about it and they love the feedback.
So I think that's been an easy way to expand for us, but of course
we're like a relatively small team.
So I think when we expanded in New York, we went, Columbia
first because they reached out.
We now have a couple hundred Columbia students on actively doing it.
That's been really awesome.
One of them was featured on CNBC, which is really cool.
Like they actually followed her into a care session.
That was really cool.
And then we're also active at Fordham.
And I believe Hunter College we just started, but of course, if you guys
know anyone at NYU or any of the other great universities we'd love to expand
because like you said, New York is a huge market and sometimes I'm running
this in North Carolina, we're always surprised when we go to new markets to
realize what the cost of home care is.
And I was stunned.
I think in New York, it's averaging like 42 or 45 per hour.
It's something unbelievably high, and
Candace Dellacona: Absolutely.
And it price was people out of the market almost immediately.
And, Sydney, I would love to know, you have all of these hours under your
belt and you are a healthcare major.
What is next for you?
And what experiences from CareYaya will you take in your future profession?
Sydney Rosbury: Yeah, so I am hoping, I'm in the process
right now of applying to several different Pre med gap year programs.
I would really like to get into one of those because most of them allow
a research component as well as a clinical care job and I think that would
be a really cool combination to have and it's a combination that's pretty
difficult to balance if you don't have a specific program designed for it.
Because if you have a research job, that's going to be a full time job.
And if you have a clinical care job, that will be, but some of these allow for both.
So that is my goal right now.
And I will say that CareYaya has had such an impact on me and I think it's
really shown me the importance of treating patients as an individual
and as a person and not generalizing care to an entire population because
the reality is each person has really specific needs and it's really important
to listen to their advocates, whether that be their son, their daughter,
their spouse, brother or sister.
Because those people truly do know the patient best.
And I have so many examples of that, that I've just been really thankful that the
CareYaya families are also so helpful, and they are really just hoping for
the best for their loved one, and they give me that information that I need.
So it's taught me a lot about care advocacy, and just how to approach a
care situation, too, to make sure that the patient's needs are fully met.
Candace Dellacona: You've almost created a runway for yourself and
becoming the best caregiver in a professional setting that you can.
And CareYaya has brought you to that place.
And I think one of the things that you said that is so important
is the advocacy piece, right?
That's what we're trying to do with the Sandwich Generation Survival
Guide is provide these resources like CareYaya, so that those of us stuck
in the middle trying to advocate for our loved ones, whether it's our
spouse and Neal in your circumstance, thank goodness your wife is okay.
Having the sort of inside view of the limited options and knowing
it's not one size fits all and that everyone is entitled to have
the care customized for them.
And it really should be something that is the norm as opposed to the anomaly.
So I really can't thank you both enough for taking the time to share with us
this incredible mission of CareYaya.
Neal, do you have any sort of maybe inside scoop of what's coming next
other than the amazing technology that you've obviously developed?
Neal Shah: Yeah, actually, I have a very exciting project that's coming
next that's rolling out quietly across the country right now, which
is regarding people's troubling experiences with health insurance.
So as we've all learned, I think it's been a national conversation
where, health insurance claims denials have been skyrocketing
in the last two to three years.
And we see, of course, like with the United healthcare event
it highlighted in the national attention, but we had been seeing it.
One, I've experienced it myself, like during my wife's cancer, a
lot of claims were denied and I was fighting it for hours and hours on the
phone and writing all these letters.
But then we started seeing it in our caregiving population where as Medicare
now has been shifted to being administered by Medicare Advantage plans, like over
half of the country's Medicare is going through Medicare Advantage, you know,
these are for profit plans and they have absurdly high rates of denying claims.
So we're seeing it across populations with, such as dementia such as terminal
cancer where routine medications, we're seeing procedures, checkups
are being denied, and it's creating a financial problem for people.
So, we basically rolled out a new project through CareYaya called the Counterforce
Health which is a suite of AI tools which we're just giving away for free to people.
Like we built it as a passion project to automate the creation of well crafted
appeals to the insurance companies.
And the statistic there was we did a lot of research on this.
And really, the problem is of the 49 million people that have had a denied
claim within the last year, less than 1 percent of people appealed.
Because most people don't know their rights, or most people
think it's too intimidating.
How am I gonna write an 8 page letter with medical necessity citations, fixing
incorrect billing codes, things like that.
They're overwhelmed.
They're like, I don't have a brother or sister who's a doctor who can do
this for me, so I'll just eat the cost, if I'm denied my meds, I'll
pay, whatever, a few hundred bucks or I'll let it go to collections,
so or in many cases, if it's a prior auth, people just not get the care.
So we thought this is an outrage.
And then when we started talking a lot of the clinicians, they were like, I
don't have the time to do this because it cost my staff time and money and
an average appeal cost a clinic around 45 dollars to process so that I can
only write a few appeal letters once in a while, but not all of them.
So we thought this is a great use case for AI.
So we trained AI models using thousands and thousands of examples and case studies
of appeals that have successfully worked.
And now we've gotten it down to the point where you can upload your denial
letter, you can upload your coverage policy, any other backup information,
and within two minutes, it crafts a very well engineered, detailed appeal letter
with real citations of okay, you had XYZ hospitalization, this is why it should be
covered, you're on this XYZ medication for cancer, this is why it should be covered
so you give full citations and then we are able to send the appeal letter for you.
And then we built a voice AI agent that can actually call and deal with
the insurance company's claim and billing department on your behalf.
So these are all like the pain points that people don't want to deal with,
or when they're sick, they find it extremely stressful to deal with, or
their family caregiver has to deal with.
So these are ways to reduce caregiver stress.
So we're rolling that out now and that's going to be like, that's probably
the most exciting thing for 2025 is want to improve care advocacy work.
And I think our healthcare system is just so broken, like this, my
takeaway, it's like screwing over all these people who cannot afford
any extra time or financial stress.
And the I'd say technology has been asymmetrically weaponized,
by the large insurance companies.
And, this is a good time to give people the tools to fight back.
Candace Dellacona: Neal, if we needed any more proof that you're such a good egg
using, your skills and your passion and your experience trying to help the rest
of us muddle through being advocates.
From the bottom of my heart, thank you so much.
And we are going to put all of these resources online.
And Sydney, I just want to wish you the best of luck as you graduate.
And as you put forth your applications, any med school or graduate school
would be so lucky to have you.
And I am sure that, your path has been enriched by so many of
the seniors that you've helped.
I just knowing you the little bit that I do, I know that you've enriched their
lives and I'm sure they've enriched yours.
And for all of those who are listening to this, who's saying,
Hey, one way university student would be a great fit for this.
We'll make sure to have those resources for you.
Any university administrators as well.
I'll put you in touch with Neal.
But I can't thank you both enough for spending such time and sharing your
passion and your mission with us.
Thank you so much guys.
Sydney Rosbury: Thank you so much for this opportunity.
Neal Shah: Yeah, thanks for the opportunity Candace.
This was awesome.