Is your health insurance company using AI to deny your claims? In this eye-opening interview, Andrew Yukawa sits down with Neal Shah, founder of CareYaya, CEO of Counterforce Health, and the #1 bestselling author of "Insured to Death." Discover the secret war being waged by health insurance giants against patients and doctors through programmatic claim denials. Neal Shah exposes the broken system, revealing how administrative waste consumes over $800 billion annually and why 99% of denied claims are never appealed—even though over 50% of appeals are successful. This is more than a discussion; it's a playbook. Learn the exact steps you can take to fight back against a health insurance claim denial, leverage free AI tools from Counterforce Health to draft powerful appeal letters in minutes, and advocate for meaningful healthcare reform. Plus, Neal shares his innovative solution to the elder care crisis with CareYaya, a platform connecting families with affordable, high-quality student caregivers and pioneering the use of technology to help seniors age in place with dignity.
➡️ Resources Mentioned: Fight Your Denied Claim for FREE with AI: https://www.counterforcehealth.org/ Get Neal's #1 Bestselling Book, "Insured to Death": https://insuredtodeath.org/ Don't forget to like, subscribe, and share this video to empower more patients and caregivers to take back control of their healthcare.
Transcript
Introduction to Neal Shah, CEO & Bestselling Author
Neil, welcome to the show. Thanks for having me, Andrew. I'm super excited to be speaking with you today
because there are so many different directions in which we can take this conversation. And as a moderator, I I'll
do my best to kind of follow some type of linear or narrative um storyline to
to this podcast episode. But I I want to start with a more recent current event
because in addition to being, you know, a CEO and a founder and a chairman, you
are also now a number one best-selling author of the book Insured to Death.
And I encourage all of our listeners to to check it out. There it is. Right here. Here we go. Yeah.
So, my very first my very first question for you, Neil, is what was the catalyst for writing Insured to Death? Was there,
you know, a specific moment or a personal experience that pushed you to start the project?
Yeah, I mean, I think there was a series of catalysts. I mean, you know, as you can kind of see in the book subtitle, you know, it's insured to death how
health insurance screws over Americans and how we take it back. I'd say there were kind of like three defining
The Catalyst Behind the Book "Insured to Death"
catalysts. you know two being external and one being kind of internal you know so over the years you know I've gone
through uh you know a varied care journey uh taking care of loved ones and you know through my wife's multi-year
cancer battle had faced significant health insurance claim denials you know for uh very necessary treatments and
therapies and I just thought it was an individual issue you know this few years ago then I now run one of America's
largest elder care platforms at karaa um and through that we help thousands of people who are taking care of loved ones
with dementia, it's either the adult children or the spouses, you know, taking care of mom or dad um, you know,
living with dementia and we see the, you know, at scale all these people dealing with health insurance denials. So, I've
been kind of like thinking about and working on internal ways to help people fight back. And then, of course, you
know, the third external catalyst was what happened in December, you know, with the shooting of the United Health CEO, you know, by Luji Manioni. uh
really I think woke up society to the fact that hey there's something going on that there's uh such popular rage at the
insurers and this uh epidemic of claim denials is beyond you know what everybody thinks it's just happening to
them you know whether it's individual patients physicians uh family caregivers you know people are drowning in this so
I thought it was like uh one of the biggest kind of epidemics of our time that has gone under discussed for far
too long um you know and I really think over the last few years the health insurers have really weaponized a new
technology which is AI um and individual patients and um you know family
caregivers and doctors you know they don't even stand a chance you know so I think it's been asymmetric warfare you
know one person's programmatically denying stuff and then the other side doesn't have this technology and has to sit there and do 6 hours 8 hours 10
hours of BS work um and you know just people feel powerless so I kind of wanted to you know I've I've been in
that situation myself feeling powerless I've helped tons of families who are caregiving been in that situation who
feel powerless. I've talked to so many doctors who are burning out of the system. I think it's an absolute travesty. So, uh the book was kind of um
almost catalyzed by what's happening in the world. And you know, I really like the main purpose of the book was really
kind of the part of the end of the subtitle is how we take it back. You know, I really wanted to have people uh
get a sense that one there is agency. You know, there's things you can do individually, you know, to navigate this
BS system that we have. And I think there's collective action that we can do to change policy. Um, you know, so I
think that that was really the message and the catalyst for the book. And yeah, I certainly want to talk a
little bit about the playbook uh in due time. But just some quantitative stats here to kind of contextualize I think
the scale and the magnitude of the issue that that you are discussing here. And
yeah, um, you know, the first one that is kind of mind-boggling to me, and I have to
chuckle at at this every time I read it, but, um, in your book, you mentioned that American hospitals employ more
billing specialists than beds. Uh, physicians complete an average of 43
prior authorization requests a week. And these administrative costs consume uh
$800 billion dollars annually which represents almost uh onethird of the
total US healthcare spending. So just some quantitative stats I think that help contextualize the scale and the
magnitude of the issue we are discussing. I also want to move to the more qualit qualitative side because
behind every denied claim is you know an individual, a friend, a family making
tough choices and and you even talked about how you have been in uh that situation before and I I've heard you
kind of talk about the human cost of this very complex multi-payer system. So
were there any stories or or interviews that particularly stuck with you as you were writing this book? Oh yeah. I mean
The Shocking Statistics of Administrative Waste in US Healthcare
tons of them. Tons of them. And thank you for pointing out the quantitative side too, you know, because I try to write it where it's like, okay, it's
health policy, you know, but it's also um applicable just to the lay person reader. But I do think sometimes it's
helpful for people just to see the sheer numbers of like how much administrative waste. I think the number of employment,
you know, that's going into this whole industry for this. If you look on any job board, whether it's Indeed or LinkedIn or whatever, you you literally
have America where there's more people employed in an industry to process claims than there are to actually
deliver healthcare. I mean, I think that alone is should be a total joke to any policy maker. You know, this is a this
is not a healthare system. Um, this is a Kafka- like uh, you know, bureaucratic maze. Um, you know, so I think that and
that's inefficiency in spending too. You know, I think for all the talk that insurers say about efficiency, it's actually systemic inefficiency. we're
just wasting money. Um, you know, I think to your point about the individual stories, yeah, tons. I mean, I, you know, like I'd say, you know, and of
course we want to be sensitive to the individual people, you know, so we kind of anonymize names, but I'd say probably the story I've seen most of the time
through running Kerry, the caregiving platform, is an adult son or daughter that's caregiving for a mom or dad, and
they're literally drowning in paperwork. you know, mom got, you know, let's say mom is living with dementia, got
hospitalized, fell. Okay, went to the ER, you know, came back, um, and oh,
here's a ton of bills, right? Then, uh, oh, mom had XYZ surgery, right? Let's say knee surgery, hip surgery, you know,
broke a hip. I mean, oh my god, people are just drowning in so many denials of claims and just getting jammed with
these bills after the fact. Um, I think medication denials are also uh very much on the rise. So, a lot of people are
literally, you know, and I' I've literally have close people that I know that we're caring for that are older
adults living with, you know, metastatic cancer. Um, and, you know, they might have three or four years of life expectancy. And, you know, they're on a
simple medication that they've been taking for months and then suddenly one month it got denied. And then people are
deciding, okay, do I have the money to pay for this out of pocket? Why is it denied? Um, or, you know, am I going to
skimp on food? I mean, this is like really, you know, when you think about real people's stories when insurers are
denying care that was supposed to be delivered, a lot of people who don't have the means are now rationing food or
worried about kind of their housing. And I mean, I think that's like an absolute tragedy. You know, it be it's almost as if these people didn't have insurance at
all, you know, so what was the point? Yeah. Yeah, I want to continue down that that thread because your book proposes
a playbook for being able to fight back um against some of these layers of
bureaucracy and layers of complexity. What is kind of the most single
practical step a patient or a physician can take today in order to kind of fight
back against uh that bureaucratic system? Yeah, I think um kind of the
best thing I would recommend let's say I'll I'll take each side first. Patient side first of all 99% of people that are
denied a claim don't appeal and so only one right and then of those who appeal
baseline about 50% of them win. So first of all do not pay the bill if they deny
never pay that first bill. appeal everything. Appeal, appeal, appeal, you know, and they kind of laid out a playbook, you know, uh, and, you know,
there's appeal templates online. Uh, there's so many things you can do. It's not rocket science. It's some work on
your end. And if you want to craft a customized one, it might take you a few hours. Now, on top of that, we have
built free AI tools for patients that are available free to the public at www.counterforcehealth.org.
You know, so it's counterforce and, you know, they can look it up in the show notes, but there we be happy to help
you. And we basically took a bunch of models. We trained them on a bunchies
and data and we can generate a well-crafted appeal letter for you in two minutes. Now, of course, still review it yourself before you submit,
but that takes 5 hours of work down to 2 minutes and frankly is better than what most people can do on their own in terms of citations. But appeal everything, you
know. Second, and that's just an appeal to the insurer. Second, know your rights and know the whole path. If multiple
appeals to the insurer fail, there's also what's called an external review process. And you know there it varies
state by state you know but look into it on your state you know department of insurance you know reach out to the state insurance regulators they want to
talk to people you know we have active dialogue with them and I think some of them don't even know the magnitude of the claim denial crisis so uh you know
reach out and make sure you use those things that are in your favor for people who escalate to that external review um you know over 70% of them are winning um
so that's kind of amazing and then third worst case if it's a massive bill that's going to destroy you uh take people to
court litigate you know most of the time in court uh will lose. Um, so I think
that there's a multi-step playbook that you know you can do and then at the same time advocate for public action. You
know this system is tragically broken and you know I really empathize that you know people are frustrated. I don't
think what happened in December you know violence is not the answer but it's happening because the system is not
adjusting. So I think the best way to have a nonviolent and peaceful solution is for people to just write letters to
their representatives and make them aware of the crisis that's happening. the magnitude of claim dials and then
people you know government always catches up with a lag but ultimately you know the wheels of justice will turn um
and I think the system can be fixed that way. Um from a physician standpoint I think the answer is similar but slightly
different right the physicians are drowning in this stuff and you know they need to be spending their time actually
treating and healing people you know not sitting there doing this administrative paperwork and navigating this kind of Kafka- like maze. So I think on the
physician side there it's almost an urgency of absolutely use AI tools and
it doesn't matter if you use our tool like you know our tool is customized but use chatpt you know use whatever you can
now some of those have like hypo compliance concerns so you know you may not be able to um but I'd say for patients the absolute number one thing
and and here I'll say especially for patients who are independent or at small clinics they're absolutely drowning even
the ones at the big hospitals and academic medical centers are still drowning but sometimes those people have
massive amounts of staff helping with claims. Um, but I think in all this, you know, there's got to be AI because one
side has weaponized AI and even if you are a large hospital, you know, even if
you're Memorial Stone and Ketering, there's no way you have enough people on your team when insurers is denying
something programmatically in one second using an algorithm. There's no way, you know, with all the resources in the world, even if you're paying people 25
bucks an hour to deal with this stuff, like you're going to go bankrupt. So, you have to use technology. Um, so I'd
say that and then on the on the physician side, I think advocacy is very important because our healthcare workforce is drowning and burning out.
The Playbook: How to Fight a Health Insurance Claim Denial
Um, and I think the administrative burden is going to result in a shortage of clinicians. You know, I talked to,
you know, through KERI, we have tons of students who are caring for the aging population across America, over 40,000
students, and this is one of their top concerns. they see what practicing physicians doing, what practicing
physician assistants are doing, and they're like, you know, second guessing, is this a career I want to go into? Um,
so I think if we don't solve this, we're going to have a massive healthcare workforce shortage. I mean, who would want to do this stuff? So, um, I think
policy action and raising this with representatives is the only way to push for solutions.
Yeah, I really love that that answer and thank you for that Neil because yeah, I I do feel like the the system has become
somewhat perverse in that um the these insurers are almost incentivized to to
deny to hit certain target denial rates or certain thresholds rather than being
incentivized to you know promote and facilitate and support you know fair and
equitable care. So, you know, I think your book, you know, equipping patients, equipping physicians with a toolkit and
with the strategies that they need so that they can kind of follow step by step um how to navigate some of these
these denials is so critically important. And yeah, I just kind of want to underscore that statistic that that
you had had mentioned of less than 1% of all denied claims are ever appealed. um
despite the fact that you know over 40 to 50% of those appeals succeed and um
apologies my my cat is yeah that's awesome but it's so important it's so important
for for people to be aware of those statistics and and to have those strategies and tools to be able to to to
fight back I I wanted to talk a little bit more about you know technology um because you
have also been at the forefront of change when it comes to leveraging innovation and technology to kind
navigate the the prior authorization system and kind of the labyrinth like challenges that it presents. Um you you
you talked about being able to use you know LLMs to to to draft you know peel
letters. Um I also saw that there is uh at Crownforest Health you're you're
working on a voice AI agent that kind of does autonomous robotic you know calls. Can you speak a little bit more about
how you see AI and technology and innovation fitting into this fight back
playbook? Yes. Yeah. Yeah. I think that, you know, it doesn't end with just a letter, right? Because like if you think
about the insurers, a lot of these are roadblock tactics, you know, because
what doesn't get fully appealed through is captured as profit, you know? So, under the guise of efficiency, because
of course I understand the point, right, that there might be frivolous care attempted, you know, to be given. So,
you know, that's why denials exist. But under that guise, the denial rates have
skyrocketed, right? In many of these insurers, you look 10 years ago, 15 years ago, it was like 1% of claims were denied, 2% of claims were denied, right?
That seems like, you know, normal at the same insurer, now it's 15%, 20%. So, you
know, somebody's figured out the scam here that, okay, I can just deny more and say, oh, I don't know if this care
is unnecessary, and then if people just don't bother to fight back, I just pocket it as profit, right? So, and and no one's really regulating or paying
attention here. Um, so I think that's the tragedy. So knowing that cynically
going into it saying hey these people are doing it on purpose you know that it's by design it's not a broken system
it's broken on purpose um you know that okay just writing letters you know as soon as you make LM's good and you know
start jamming a lot of letters these guys will just throw up another BS roadblock which will be oh now you got to call and you know everybody knows
that and I've done that even manually you know a few years ago when I was writing letters it's like okay now you have to call talk to the rep so the what
I found is all these roadblocks create a barrier to patients and physicians. But
let's say on the patient side, it creates both a time barrier of where do I have the time to write a letter. Okay,
great. Counterforce solved that you know took 5 hours of time in 2 minutes. Now, where do I have the time to call and
chase that person down, follow up with the insurance company and see what's the status, talk through, you know, kind of
any specific questions they may have. There's a time barrier to that and there's a stress barrier. I think the
call creates even more stress than a letter does because you have to talk to someone. Now, if you talk to most of
these people, they are very rude. They're very dismissive and they waste a lot of time putting you on unnecessary
holds. So, imagine the like moral harm and the actual harm on let's take a
cancer patient living by themselves. They're already sick. They're already worried about their own mortality. They
got a denial letter. Uh, okay. They appealed it. Now, they got to call and talk to someone who's going to be rude,
dismissive, and put them on multiple holds. like your blood boils when you're dealing with this manually. And many
times they're putting AI on the other line to just make you wait and wait by the time you talk to a human. So, I hate
to say I mean this is almost like a tragedy. Like I wish people didn't have to innovate like this, but we're like, "Okay, you know what? Then screw you.
We're going to put an AI on the other end and build voice AI so that that your friend Maxwell, you know, that's what we
call it like Maxwell, you know, it's kind of a pun. So your friend Maxwell will just call the intern and waste their time, you know, and these voice a
models are getting really good where you can't even tell. So I I kind of view it as like, you know, I wouldn't otherwise do this, but you know what? I I hate the
Using Counterforce Health's Free AI Tools to Win Your Appeal
scam that's going on and I feel bad for all these patients. And the voice AI can take unlimited amount of stress doesn't
care, right? This isn't a cancer patient getting super stressed out. I mean, the stress is not good for patients, you
know, from a talk about healthcare, right? These insurers not providing healthcare. They're actually actively harming the people that are sick by
doing this. So yeah, the voice can do this way more efficiently and critically way more informed because while it's
important to have a model that is writing letters, imagine the real time adjudication back and forth with an
insurer like again it's asymmetric warfare. The individual cancer patient doesn't know all the questions to
answer, right? They can't site medical nec necessity and journal articles on the fly. So they're going to get kind of
bogged down in these calls, get even more stressed and intimidated, say, "Okay, I'll call you back. Go research
stuff." This is something on the fly a voice AI agent can do very fast. So that's on the patient side. Same exact
thing happens on the clinic side. You know, these clinics are drowning in this stuff and even at large hospitals like
physicians don't have the time. Often time they have to get on the phone. Often time they have to just repeat the
same old information. So when you have repetitive knowledge based information that is the best task that can be
outsourced to an AI and when it's this stressful and when people are doing it
that should be doing something else like in this case a cancer patient should be spending time healing a physician who's
treating people should be spending time actually helping patients not you know litigating some BS on the phone with an
insurer this is the perfect thing that an AI can do for you save you time do it
better than you could do it uh and save you stress. Um you know so that's really I think the power of voice AI and I
think that's where this is all heading.
I don't want to spoil too much of the book because I you know I encourage our listeners and I want our listeners to go
check it out themselves but you know towards the end of the book you also propose uh a three layer solution to
healthc care reform. I was wondering if you could kind of just walk us through that proposal and um your vision for
healthcare justice within the United States. Yeah, 100%. I think we absolutely need to get rid of insurers. You know, I
think the idea of this massive for-profit insurance game that exists and and you know, like my background is
unique. Like I'm I am a capitalist, right? I believe in capitalism. Prior to this, I was a hedge fund manager. You
know, I I worked in finance for 15 years. You know, I really believe capitalism moves society forward. But
critically, I believe in capitalism that adds value, not extractive capitalism.
And I think that's a key difference. Most businesses in America, I encourage them to make profit. If somebody adds
$100 of value in the world, who cares if they take $20 of value? Good for them. You know, they created something, they
added value. Who cares if they take $40 of value, right? They're adding value in the world. But I think that you know
when you when you measure the ratio of value created to value captured the
American health insurance industry is absolutely not capitalism. This is not
creating value. Let's let's assume at a in a generous way it creates you know 10 or $20 of value and it extracts 30 or
40. But in my opinion, the American health and insurance industry actually creates negative value by creating
massive administrative burden, inflation of cost, wasting of tons of people's time. So let's say it's creating
negative 20 of value and it's still capturing 30 or 40 of value. Like that's how capitalism collapses, you know. So
when you kind of think about a lot of the younger generation today is like hating capitalism and is, you know, kind
of thinking, hey, maybe there's better system. It's like it's because of stuff like this. You know, most businesses in America are adding a lot of value to
society and bringing society forward. People are inventing cool new therapeutics. Um, you know, I mean, there's been just amazing innovation in
everything, right? In transportation, in travel and all that. And good for them. I mean, that's why we have one of the most advanced societies in the in the
world and in history. But I think when you have businesses like this that are just purely extractive rentseeking businesses that have gone to almost
society, it's like, yeah, it's time to cut that cancer out. Um, so I think that the solution is massively diminishing
the role of for-profit health insurance, especially for a lot of basic care. Um,
The Elder Care Crisis: Why the Current System is Failing
you know, believe in free markets. So I would think consumerizing the market. Patients deal directly to get care and
providers directly provide care without that middle layer. So strongly believe in a consumer market. Why aren't health
savings accounts, you know, given the same, you know, kind of financial and tax advantage benefits that, you know, there are to employers contributing to
health insurance? So heavily believe in HSAs and people making consumer choice and then you know so that's one layer of
it. The other layer is providers. You know a lot of physicians are going direct. You see this with the rise of direct primary care. You see this with
the rise of a lot of functional health. You know I mean there's healthare system is evolving very rapidly where people are just saying you know what screw the
insurers. I'm going to go direct to people. Um but right now that game is harder because insurers have a you know
kind of tax advantage and have just an advantage in how societyy's set up. So if you encourage people and allow people
to unlimited fund HSAs, you encourage and allow you know physicians to kind of go direct and then the third thing that
you have to think for is safety net. You know I do believe that not everyone can do that. So you either have to provide a
universal catastrophic coverage safety net for people you know so all basic normal care like routine medication
routine XYZ is covered and then a major life event happens and there will be a insurer to help you. And you know I'm
kind of ambivalent on you know should that be the government you know I have mixed feelings on that or should it be a robust free market you know I think one
of the and which I think is totally fine what I would say is currently we have neither we have neither government doing
it with kind of just like um hey there's no profit motive and we and critically we don't have a free market we have
massive oligopolistic market concentration and that is terrible you know these insurers over the last 10 or
15 years have vertically and horizontally integrated just look at the series of mergers So, you have these monsters that, you
know, it's why can't I start an insurance company? You know, it's nearly impossible, right? Like I, you know, I live in North Carolina. Let's say here,
you know, a lot of people are dissatisfied with insurance. I'd love to start one and so would a bunch of other people and the free market would solve
the problem because you'd provide better service, you'd provide lower denials, but guess what? You can't. You know,
these guys have corner of the market and there's a tremendous amount of regulatory barrier to entry. So, I think
that if the government one um legitimately enforces antitrust law and
breaks up these monsters, right, which they should, and I don't know where people are asleep at the wheel for the last 15 years. Um and then two, uh
actually lowers the barrier to people starting, then you have a thriving free market of competition and then that
market could provide universal catastrophic coverage, you know, for everyone with government as kind of a backup. So I think that kind of solution
and then of course there's some nuances to you know kind of what should government fund but what should people fund out of pocket but I basically think
this trillion plus dollars of waste um you know that is being sucked away by this administrative like um you know
apparatus would just go away and most people would just go direct. I actually think this is the way medicine used to
be. I think a lot of doctors miss the old days 50 60 70 years ago. Um I think
the relationship quality improves right between doctor and patient. Um and you
know just a lot of this paperwork and noise goes away. So yeah I think that's the system we got to move to and we got to move fast. My final point is the
demographics of the country are very scary. We have a rapidly aging population and the aging population
especially in their 70s and beyond consumes a lot of healthcare. So let's say you're heading into this with a $5
trillion industry. The baby boom started approximately 80 years ago, right? Post
World War II, right? 1945 to 20 25 today. So the oldest of the baby boomers
are just starting to turn 80. Project out the next 5 years, right? Massive population cohort is turning 75 to 80.
their healthcare needs are going to skyrocket and we're heading into that with a completely crap system that's 5
trillion in size, administratively inefficient, wasting a lot of money, health outcomes and life expectancy has
not improved in the last, you know, 10 years or so. So yeah, I think I mean we as a country are going to go bankrupt um
when all these people demand care or all these people are not going to get care, you know, and they're going to go bankrupt. So I mean I think the
solution's got to be fully reform and change the system and get rid of all this waste.
Yeah, this this rise of the needs for elder care I think is a perfect segue into to our next topic. Um, and I would
like to pivot over to to your work at Cara, but just to kind of wrap and tie a bow on that. Thank you again for sharing
insights uh about your book insured to death. I encourage all of our our listeners to go to go check it out.
Yeah, check it out. So, you know, you're kind of speaking to, you know, this baby boomer generation kind of the rise of the need
for for elder care. I I would actually like to spotlight some of the work and pivot over to some of your work at Kerry
Ya where you know you are the founder and the CEO. Um and in a nutshell as I
understand it Kerrya connects those in need of elder care with with college students who are uh you know studying
and training to be to be health care professionals. So, it's a great way to provide affordable elder care for for
those families in need while also preparing those younger students to to to join the care
workforce and and to get the preparation and the training uh that that they need. Is that an accurate description?
Yeah. Yeah. 100%. You know, we're we're connecting America's future doctors, physician assistants, nurses, nurse
practitioners to care for older adults in their community. You know, there is a massive crisis right now of shortage of
caregiving workforce. You know, people are not rushing to sign up to these jobs and quality and affordability. You know,
a lot of the traditional care agencies are just not doing the job. Uh they're charging exorbitant fees. They're paying
the care workers nothing and they're not fixing the caregiver shortage. So, you know, I I experienced this firsthand and
I thought there was something that could be done through technology and innovation. You know, I saw it hiding in plain sight. you know, millions of
wonderful students that want to give back to their community that want to step up, that want to do this work that gives them kind of great experience and
training for future clinical careers and instead they're doing doing Door Dash food deliveries or they're driving Uber
and, you know, they're working at the local coffee shop on campus. So, I was like, okay, let's empower these students to help people in their community. You
know, a lot of people that have gone through caregiving, which I have personally, you know, deeply personally in my family, a lot of people know uh in
caregivers support groups, one of the best kept secrets is that if you're caring for a loved one and you know, want to find caregivers on your own, you
know, go to local nursing school. You know, go to your local university and post up flyers and find some wonderful healthcare students. They're incredibly
reliable. They're so missiondriven and motivated and yes, you know, they need to be paid because, you know, they need
funds. Um, but you know, they'll do it at like affordable rates and they'll do an amazing reliable job. And best of
all, the intergenerational relationships, you know, that that's just awesome. Like older people love spending time with younger people. They
don't feel like they're a burden and they're being kind of babysat, but they actually feel like I'm getting help
while I'm mentoring somebody and helping them towards their path of becoming a doctor, becoming a nurse practitioner,
you know. So I think that society has really, you know, kind of unfortunately over the last few decades, society has lost that kind of intergenerational
bond. And I think that the best and most rewarding part of the work beyond just solving the practical problem is
actually creating um intergenerational relationships across America. It's really cool to see.
And yeah, I just kind of want to spotlight u you know this workforce and the student caregivers. Um so I saw some
CareYaya: An Innovative Model for Affordable, High-Quality Caregiving
interesting stats about the platform over 25,000 students on the car platform. average caregiver rating of
4.9 out of five stars, which is fantastic. And uh only about one out of
every five student applicants are accepted into the program. And I think that kind of speaks to the rigor of, you
know, the background checks and the interviews and the evaluation process um that you guys have instituted. And um I
I've heard numerous stories about students, you know, building multimonth, sometimes year-long relationships with
families, which I think is very unusual in in healthcare. So um really really cool work um happening over on on Kara.
But in addition to that, I you know, I also saw that the company has been experimenting with a lot of uh AI
powered applications and technology to help people better manage care and their caregiving experience. things like smart
glasses and AI assisted art therapy. Can you shed some more light on on what your
team is doing from a technology perspective? Yeah. Yeah. So, you know, thanks for
sharing all that. You know, as as we have now 10 and by the way, the updated number is over 40,000, you know, so we
have the thing is growing like crazy, you know, and it's actually now starting to go exponential, you know, after
building it over the last 3 years, you know, we started with the first couple hundred people. Um and you know we are
finding you know kind of an interesting insight that was we are sitting on the most techsavvy
elder care workforce in the country right like the majority of the elder care workforce in the country run by care agencies you know not to knock them
but they're minimally educated people like less than I think 5% of them have any kind of college education you know
they're well-intentioned nice people but they're more kind of middle-aged they've been doing caregiving professionally for
a long time they're not the most techsavvy and as a result the traditional care industry has a difficulty in transitioning to
technology like even booking and scheduling appointments via app is somewhat difficult. So that industry has
not evolved into the modern era the way that many other industries like Uber have for travel uh or Airbnb or other
right. So I think that's kind of a barrier. At the same time we have an aging population that a lot of
technology is being developed for or could be developed for that they could benefit from but a low tech skilled
workforce cannot deliver. So, Kerry uniquely now has, you know, tens of thousands of America's best and
brightest students who are digital natives. They were born with smartphones and computers and, you know, all this
kind of technology, you know, that I even as a middle-aged person, you know, have to take some time to learn. Um, and
they love bringing technology in the home. So, we pair that with, okay, we have a lot of innovation ideas and what
else can we do to bring tech to improve the lives of older adults? So, you know, we've and and this has been awesome.
It's like the whole work has been grant funded from, you know, John's Hopkins University, my alma mater, University of
Pennsylvania, um, the National Institute on Aging. So, we found kind of like a lot of people who support and want to
fund AI innovation and tech innovation to improve elder care. Um, and then as a result, we're able to just give this
stuff away for free. So, yeah, like you mentioned, we've built like AI powered smart glasses for people with living with dementia to recognize objects and
people um, you know, around them. That's kind of like a nice cool concept project that of course will take years more of
further development and refinement. We've built AI powered art therapy for people to engage in therapeutic art
activities. Uh we actually just won a major grant from the National Instant Aging to develop voice AI companions to
uh both check in on people when caregivers not around. You know, a lot of times the family member is like, okay, I'm having caregivers around all
the time, but I can't afford 24/7, so I want to see what my mom or dad is up to. So, this is awesome to have like
conversational voice. Um yeah, we've built a lot of other cool tools like that. Uh we're building an advanced care
planning um AI bot. Uh we're doing that in collaboration with uh Duke University School of Medicine and National Instit.
And that's something where we find a lot of people don't have advanced care plans because clinicians don't have the time um to get them on everyone. But voice AI
can be a very powerful tool uh to help facilitate those conversations. So I'm very excited about that because students
in home who are digitally native and techsavvy armed with tech tools can now
bring this tech to the older generation. And I think that's where a lot of tech
innovation attempts have been stymied. People build the coolest stuff and then it's like how do you get an 80-year-old
living at home with dementia to use that thing? You know, it's going to fall on the 50-year-old daughter right when she
comes over for a couple hours a day. And you know these family caregivers, they don't have the time. they don't have the time to learn this stuff. So, I think
that's been awesome that by having the care delivery force, you can now
mobilize technology into people's homes and eventually even hardware. And I think, you know, I think the ultimate
goal is aging in place. You don't if you ever heard that term, but a lot of older adults want to kind of age in place. You
know, they don't want to go into a, you know, assisted living facility or skilled nursing facility if they can avoid it. Most people prefer to age at
home. Most people prefer to die at home. The barrier is as you near the end of your life often times due to physical
abilities or cognitive abilities you lose a lot of independence and for your own safety your family members will just
say okay I have to put you in somewhere otherwise you know it can't monitor you and can't help you but technology is advancing so rapidly that between you
know technologies like AI and hardware technology I think you could create a home environment that is more and more
safe paired with techsavvy caregivers who help you navigate that environment and then you could achieve chieve
people's dream of I can age in place and spend my final years at home safely. So I think that's kind of like the goal and
mission and I'm very excited about the potential of all the technology.
This has been fantastic. So uh you know we've learned a little bit about your book. We've learned a little bit about your work kara and counterforce health.
I now want to take a second pivot and and just learn a little bit more about you and and your jour your journey and
and your story because I I think it's a fascinating one and one that would be very fascinating for our listeners. Um
so earlier you you had mentioned you know prior to these ventures into the healthcare landscape that you had worked
in finance at various investment firms and talked a little bit about you know kind of your belief in capitalism but
I'm curious you know how did your time analyzing companies and really thinking about managing investments how did that
shape the way you approach healthcare and and innovation today? Yeah, thanks.
I mean, I think it's been really helpful, you know, so my, you know, I I started my career on Wall Street in
investment banking right out of school and I very quickly went into hedge funds, you know, when I was 23. Uh, very
quickly rose up the ladder and became a partner at a multi-million dollar hedge fund when I was 27 and I managed a
AI-Powered Tech (Smart Glasses, Voice AI) Helping Seniors Age in Place
turnaround restructuring, you know, distress portfolio um throughout the economic crisis of 2008, 2009. And you
know, I was the only person at the organization that had skills in kind of turnarounds and bankruptcies and you know, generated phenomenal returns like
fixing troubled companies. And as a result, one of their investors backed me to start my own fund when I was 31. Um,
and I grew that from 10 million to 250 million by the time I was 35. And you know, I I was really good at it. I
really enjoyed the work. And then just personal caregiving experiences happened to me. Um, so I, you know, literally wound down my fund and became a
full-time caregiver. And that's how I found myself in this industry. I just couldn't believe the unmet need. But I'd
say I'm very glad and grateful for the experience because I learned a lot and I think that by investing in businesses
especially across an array of industries including healthcare but including other you get a lot of ideas of what works and
what doesn't and how how businesses innovate how industries innovate and also how industries decline and I think
that's been almost foundational in approaching any of this innovation work in healthcare you know there are
patterns from other industries that you can apply here of why isn't something XYZ and I think one of the biggest
things missing in healthcare is why isn't anything focused on the consumer
experience you know patient as consumer like nothing is focused on that everybody builds even in caregiving and
elder care you talk to you know in people who've done digital innovation attempts everything is built for the payer you know and the consumer as
patient is an afterthought as in like yes we care about that too um even a lot of kind of like healthcare tech like
these AI tools we're building for patients you know it's We are also then building them for
physicians, clinics and even hospital systems. But we start with the individual patient as consumer and
everybody in healthcare tech tells you no that's not how we roll all the existing startup you know that are
larger the healthcare VCs. So I think that people who don't have the crossindustry discipline or knowledge
often times because they're too much into this is how it's always been they don't realize and they're unable to do
first principles. So, I'm kind of glad I came from outside the industry because I approach everything almost like a child,
you know, with like first principles like, oh, how does this work? You ask a million questions. Then you're like, why
is it like this? And this is a question that somebody who's just come from the game doesn't bother to ask when they're
20 years in the game. You know, they're just kind of like, oh, that's just how it is. And I think sometimes you have to have that childlike wonder, you know,
combined with knowledge of how other things work um to kind of bring change. But I think healthcare is one of the
most, you know, it's one of the biggest industries in America. It's certainly one of the most important in terms of this is people's health. This is people
life or death and it's one of the worstrun industries in the country. So yeah, I think it could learn a lot from
how other industries work. Um, so I think it's been really awesome and I'm I'm very grateful for the, you know, background I've had.
What's next for you, Neil? Are are there any problems in healthcare you're itching to tackle that we haven't
discussed? H that's a good question. I mean I think that um probably frankly one of the
biggest next problems that I'm like looking at and thinking about which I've been you know personally impacted by
through loved ones is the alarming rise of cancer in younger and middle-aged
people. You know both kind of what is going on you know society and really
earlier diagnostics methods have to be developed as well as preventative. It's
just like I have nothing, you know, detailed to share. I mean, it's just kind of like my personal passion. I've been researching it a lot, you know, um
A Vision for True Healthcare Reform in America
but I have my hands full kind of right now on my other work, but it's just something I see a lot, you know, it's something I see a lot and uh you know, I
see people some people trying to, you know, innovate there, but I just think that there's a lot more that can be done. The problem is growing faster than
the attempts to innovate and solve the problem. So, I think that's been another kind of personal passion project. But, I'd say for now, I got my hands full on,
you know, kind of just building awareness about claim denials. I don't even think we're, you know, we're in the first inning of that battle. You know,
between the book and the Counterforce Health Tools, you know, we just had a big feature on NBC News yesterday, like
NBC Nightly News Nationally covered the work and how patients are using artificial intelligence to appeal. And
that that's the first time I've kind of seen a story like that go national. So, I think we're in the first inning of
that. So, you know, I'm going to have my hands full on that. And the elder care, I mean, I hate to say it, I think we're in like the second or third inning of
that. like we've done a lot but that crisis is despite our innovation and other people's innovation the crisis is
getting worse faster than we can innovate because the population is aging so fast and the elderare workforce is
shrinking really fast so people are drowning so I think those are two major major societal problems I can't pick
sometimes which day you know depending on the day you ask me which one's worse you know because I think elder care if you don't solve it I think we owe a debt
of gratitude to the older generation you know that's built the country and we can't just leave them hanging And that's
going to fall on the middle-aged sons and daughters of aging parents. If we don't solve it, millions of people are
going to drown and drop out of the workforce to take care of their parents by themselves. So, I think we have to solve that as a country. And I think the
claim dials crisis, I think we also have to solve as a country. So, I'm absolutely obsessed with those. And so, they kind of go hand in hand, too. So,
so yeah, I think I I I love doing this stuff. And it's like I think that it's a thrill coming from a purely financial
background to do like actual like humanitarian work, you I legitimately feel like you're blending the best of
both that, you know, there's a lot of times a lot of nonprofits um don't scale because they're, you know, just very
like local regional focused and they're always reliant on external funding and a lot of times pure businesses who enter
certain fields will not do kind of the humanitarian work that needs to be needed. So I love kind of like approaching it with that blend of like
social enterprise and you know how can we solve problems in society using the
power of business which is one of the most powerful institutions in I think history that's moved societies forward
but do it in an empathetic way um that helps people um that are left behind. So yeah it's it's been really fun.
Neil, you're a true force for change. This has been a fantastic and incredibly
enjoyable experience. Thank you so much for joining the show. Thank you. Thank you, Andrew. Thanks so
much for having me. I really appreciate the opportunity to share all this with your listeners. I hope if even it inspires one person today, that'll be
worth it. Absolutely. Thanks so much. Thanks.
Cool. So, I'll go ahead and