Aug. 7, 2023

The Uber of Caregiving

The Uber of Caregiving

For Neal Shah, life was going according to plan. Then suddenly, he became a caregiver overnight. Hear how his experience pushed him to create CareYaya, which he calls the “Uber of caregiving.” It’s a matchmaking system that pairs pre-med college students...

For Neal Shah, life was going according to plan. Then suddenly, he became a caregiver overnight. Hear how his experience pushed him to create CareYaya, which he calls the “Uber of caregiving.” It’s a matchmaking system that pairs pre-med college students with families in need of a caregiver to provide companionship and day-to-day support for a loved one.

And Terry and Bob talk about real movement in Congress on the PBM issue. Is there any real hope for solutions? They discuss the nearly unanimous progression of one PBM bill.

CareYaya Webpage

Patients Rising Caregiver Hub

N.C. caregiving business is growing to support seniors

Washington Examiner News Article: Legislation cracking down on pharmaceutical middlemen advances in Senate

Patients Rising Webpage: Patient Stories


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Neal Shah  0:03  
All these years in the hospitals and seeing how many people are dealing with this themselves, how many people if they're not fortunate enough to have family nearby, or family that can take time off from their work, you know, just kind of where all these people are going to do so at that point, he basically just became obsessed and was like, Okay, I'm gonna make it my life's work to see if I can build a better system.

Terry Wilcox  0:20  
Neal Shaw is the CEO of CareYaya, and you can hear his passion for caregiving and his voice. But how he got into the caregiving space is a winding road and a story you're going to want to hear. He shares how that journey led him to create a new caregiving model that provides an affordable solution to families in need. That's up next. 

Terry Wilcox  0:39  
Welcome to the patients rising podcast. I'm your host Terry Wilcox, CEO of patients rising. I'm joined by my co host, who is excitedly waiting for the for the next UFO Capitol Hill briefing. Is Bob Goldberg, co founder of the Center for medicine in the public interest, are they going to call at like an ET come

Bob Goldberg  0:59  
Yeah, he's the UFO whistleblower, you know, the jury's still out as to whether I'm an alien or not, Terry, but at least here on the patient's rising podcast, I can talk to you about not extra terrestrials, but the latest health policy news from Washington, DC, impacting millions of Americans who live with chronic illness and listen, sometimes we talk a lot about what's wrong and how to solve the problems through legislation. But sometimes we get a story from patient advocates or healthcare innovators who have set out to solve the problems in their lives and apply it to patients, caregivers and their families all across the country.

Terry Wilcox  1:42  
Well, and that's exactly what we're going to talk about today. I was lucky enough to sit down and speak with the CEO of CareYaya I love that name, by the way,  CareYaya . And you heard Neal at the top of the show, Neal Shah. Now his journey to  CareYaya  is it's so interesting, his life was pretty much going according to plan. He's in his 30s moved to New York, and he has a thriving career, until the realities of becoming a caregiver were thrust upon him and his wife. Now, here's Neal talking about that.

Neal Shah  2:12  
First, my grandfather became severely ill with dementia, cancer, kidney failure, went on dialysis, and effectively end of life care. But that was a period of a few years where I saw better manage it. And you know, I was helping out but really, she was an educated woman, and you know, is an educated woman and had to basically leave the workforce to deal with his care because of how difficult it was to find homecare help, how expensive it was, how unreliable it was, you know, that was it was creating a toll on her own career. And then after that whole journey kind of ended, she never returned to the workforce, because she took so much time off. And then right at that point, I was at the peak of my career at 35, my wife became severely ill, and went through years of a very severe cancer battle, including multiple rounds of chemotherapy, hospitalization, and ICU, medical coma, and you know, knock on wood, as Now thankfully, eventually, ultimately, finally had a successful outcome. And it's now been in remission for a couple of years. But it was probably one of the most stressful experiences of our lives, you know, to be in 30s, having just finished one caregiving challenge to then be the personal primary caregiver. And I had the same experience myself, you know, managing a full time fairly stressful career while managing her primary care. And we were both living in New York none of us are from there, so we didn't have any family nearby. And it was very difficult to manage and, you know, experience all the caregiving emotions of difficulty in finding care, guilty and outsourcing the care unreliability and care help at home. And I thought that there had to be a better way, you know, how many people are experiencing these challenges, you know, and just interacting with a whole industry that hasn't really innovated since the 1980s or 1990s?

Bob Goldberg  3:48  
Well, the stress of figuring out what to do, and how to manage it all, set him out on the journey he's on today. And that journey led him to create a new way to provide caregiving.

Neal Shah  4:01  
Here's basically what CareYaya is a nutshell, we've created effectively the Uber of caregiving. So we wanted to create a very convenient, low cost affordable solution. So if you need care or help at home, and you're caring for an elderly parent, a spouse with serious illness, even for a child with special needs, you can go online to book care online in less than two minutes. Critically, there's no contracts and there's no fees you pay nothing to CareYaha if we're running the service ever, purely technology platform. And then you get matched with great caregivers and pay them directly at the rates of between 15 to 20 an hour.

Terry Wilcox  4:37  
We'll explain a little bit more about care CareYaya in just a moment. But I mean, just listening to Neil story, it's harrowing. And as I say this all the time when I talk about my story and my family's story and journey with caregiving with waiting for treatments. If you really look at your family landscape, I always say the thing about our stories is that there not extraordinary. They're common. And so many of us are experiencing these right? These issues with caregiving with other things. He's definitely not alone. And he knew that he clearly knew that. And caregivers can change your life and change the lives of a loved one. And as a senior, especially when you lose your capability of being able to drive, and a lot of things, you you lose that companionship because oftentimes your loved ones are working and doing other things during the day. And this is just such a fantastic model. So basically, how Neal describes it is the Uber of caregiving. And what how does that work? What does that mean? So listen to Neal, here's, he's going to tell us about it. 

Neal Shah  5:47  
You know, basically, the unique thing about CareYaya is beyond just kind of like a convenient way to book caregivers online. The novel part of it is, they're all college students going into the healthcare field. So you know, we started in our backyard at UNC Chapel Hill and Duke University. And now we're gradually expanding, graduate all over the country. So we're expanding into different states, different universities. But basically the idea of imagine somebody you know, you know, I think if it's a midlife demographic, listening, you know, imagine your son or daughter that's in college and imagine themselves or their friends who are pre med, who are in nursing school, who are wanting to be physician, Assistant, physical therapists. All of these students, in my opinion, are amazing caregivers. There are currently not in the care economy, because there isn't really a gig economy solution for them to participate in this economy. They're really thrilled to do this work, you know, for 15 bucks an hour, and they get paid directly by the family. So we just created a matchmaking system. So we really wanted to build something where, where you can get great quality caregivers, at literally the most affordable prices in the market.

Terry Wilcox  6:47  
And the most interesting thing, and I believe this is that Neal told me, not only is it cheaper for the person requesting the caregiving, but all of the money goes straight to the caregiver. So there's no middleman. He also shares several success stories of the program like this one. So take a listen.

Neal Shah  7:07  
You know, so we have a gentleman Scott, who's taking care of his dad through Parkinson's. And interestingly enough in this situation, his father is actually at an assisted living facility. And he's been there for a few years. And Scott's observation is every time he goes and visits his dad just by himself, these facilities are relatively understaffed. So there's one person down the hall that's kind of just managing bathing toileting, and just going room to room but not really spending any time with companionship, activities, anything of that sort, sort of status isolated by himself all day watching TV. So you know, in that situation, through CareYaya is sending student caregivers in every day, to hang out with his dad, take them on walks, do activities, play board games, go through photo books, you know, just kind of do activities and do things. And he's noticed a huge pickup in his dad's mood, just kind of overall zest for life. And I think it's become something that is hard to look forward to every day.

Terry Wilcox  7:59  
This is exactly what I was just talking about.

Bob Goldberg  8:01  
Yeah. Isn't it amazing? This is a way where technology creates opportunities for community. There may not be a QALY assigned to all this, Terry. But I just know from my Dad's experience and your experience, and what Neil's told us about CareYaya the touch points, creating touch points is so important, so valuable, and he's doing it in a scalable fashion. It's very, very cool.

Terry Wilcox  8:31  
And it's also when you think about the young people on college campuses, who are perhaps majoring in caregiving or the medical field or something, and they're looking for these opportunities. You know, I think it's fantastic, and it's good for the seniors, and it's good for the students.

Bob Goldberg  8:49  
And one last thing, Terry, we asked Neal, about the future of the caregiving industry, and what he expects to see in the years to come.

Neal Shah  8:59  
I really think the future is a heavy amount of technology to come into caregiving. You know, I think that there is a big care equity issue here. And if you can't get help at home, you're gonna have way more hospitalizations, which is costing the healthcare system more money, and it's actually bad for people's health and just population health in aggregate. And if you do get good health at home, you can keep people at home longer and keep them out of institutionalization or facility based care, reduce risk of falls by you know, 70 to 80%. Get early warning signs for what's going on with them. So I think the long term vision is, as healthcare moves back into the home, which I think is happening, the caregiver, especially a tech savvy college student caregiver, that's going to be a future health care professional. We want to turn that as a community health worker.

Bob Goldberg  9:42  
So by creating an affordable model for families, it fills the coverage gap that insureres in Medicare have been unwilling to cover for patients and this is a really, really important point.

Neal Shah  9:53  
You know, private insurance never really understood I think Medicare never really understood it that all of these payers have, you know, you have ignored the psychosocial impact that comes from home care and improved outcomes, mental health, behavioral health, even clinical health. So I think it's been like very undervalued by the payer system. And because the local care agencies have viewed it as they're never going to get reimbursement, they've built their entire businesses to cater to the upper echelon of the population, like top 5% of people in society can pay these like 35 bucks an hour to get a caregiver. So I think the whole like care economy has not focused on the payer, and the rates are way too high now. So I think that actually, the biggest opportunity with CareYaya is that if you can build something that is maximally affordable, that is nationwide, that's a tech enabled solution that really isn't providing medical care. But there's a lot of medical stuff that you can improve, you know, in terms of fundamentals about your health, that a caregiver can improve caregiver can help you move your rug prevent a fall, a caregiver can be there in a moment of isolation. So you'd have to go back to the hospital caregiver can bring technology to him, I think we build that right, rapidly build it all over the country, and then go approach the pair's, I do think there's a good chance that large health insurers will start reimbursing and I think one day Medicare will start covering.

Terry Wilcox  11:09  
I think that this would be some of the best money spent. Oh, yeah, in coverage. I mean, but there's a lot of things I think we spend. And I'm when I talked about, we talked about insurers and payers, whether it's Medicare insurance company, or, or whatever, I think we spent way too much time trying to focus on how we're going to not pay for things, rather than really focusing on the things we should be paying for, and keeping people healthier, you know,

Bob Goldberg  11:40  
The things that matter are covered, and they're not measured. And we've talked about that. But the impact is something that like what CareYaya is doing is it enhances human dignity. And that's essentially what healthcare is supposed to deliver at the end of the day. So I'm actually hoping it doesn't get covered by insurance system.

Terry Wilcox  12:03  
I think we're talking about caregiving in general, Bob, you and I both know, there is a path that's marching, whether you like it or not, from a policy standpoint on either side of the aisle, marching towards a free market, more accessible, more affordable, more transparent system.

Bob Goldberg  12:24  
This is a good example of what happens if you just set aside all the regulatory stuff of a license shares, and you just let people get together and care for each other. It's affordable, it's scalable, and it's effective.

Terry Wilcox  12:40  
Yeah, because this is what most people need. My mother in law doesn't need a nurse in this home. We don't even need a home health aide, whatever the qualifications for that, as are, and I'm sure it's like a lot of paperwork and some big giant fee or, but she doesn't need that either. She needs this nice woman who comes three times a week and takes her shopping and helps her go get her hair done and get the dog grow. Like that's what she needs. Yeah. And this is the perfect thing for that. And that's what many seniors need, and families need. Thank you so much to Neal, for joining us today. If you want to learn more, head to the shownotes.

Terry Wilcox  13:21  
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Terry Wilcox  13:56  
Now it's August, which means lawmakers are back in their own districts for the August recess, though I would argue that they took off before August. They took off. Why wait? Why wait, let's take some extra days. Because we've gotten so much done. We've worked so hard. We just

Bob Goldberg  14:17  
We have those UFO hearings and what more do you want?

Terry Wilcox  14:21  
So while things are slow, we wanted to catch you up on some good health policy news from Capitol Hill that unfolded right before the members left. Now there has been a lot of activity on several pieces of legislation to reform the middlemen of the prescription drug industry, all of us know the pharmacy benefit managers or PBMs. They are the culprits behind inflated drug cost. Now prior authorizations and burdens and so on. I call these benefit design issues or not even just benefit design issues. But utilization management is the you know technical term. The Senate Finance Committee voted nearly unanimously to pass legislation regulating PBMs as part of the modernizing and ensuring PBM Accountability Act. So they passed out of committee 26 to one.

Bob Goldberg  15:11  
Unbelievable. So this doesn't eliminate rebates.

Terry Wilcox  15:15  
No. But this does eliminate the ability for them to tie. Yes, the pre rebate price to what the patient pays, which is exactly similar. It's just semantics really. But anyway, yeah. But it allows that to be accomplished. So the patients are not being charged, on what you know, on their pre kickback price. So it's got a lot of bipartisan support. I'm very hopeful for this. It's not perfect, but nothing ever is in Congress.

Bob Goldberg  15:46  
Yeah. Once you gain momentum on this, hopefully, other things that we've been talking about the quality ban, more transparency, etc. All these things incrementally can make life better for people with chronic conditions. 

Terry Wilcox  16:04  
And look, you and I both know, the truth is Bob, there's more bipartisanship on healthcare issues than isn't there really? Yes. And it is it is an UFOs. Well, of course, I guess, and UFOs. But there is a lot of pro patient support on both sides of the aisle for many things that would make the system better, especially for those patients that we talk about all the time, I say the ones that use their health care monthly, the chronic and rare disease patients. So I'm very hopeful that this is the beginning of you know, sort of cracking some of those things open so that we can create a more affordable and accessible system for Americans. Yep. Folks, thank you for listening to today's episode of the patients rising podcast, feel free to pass it along to friends and family.

Bob Goldberg  16:50  
And we have more episodes in the way that you don't want to miss. So make sure to follow the podcast on your favorite podcast app.

Terry Wilcox  16:58  
We'll be right back here on Monday with another new episode. Until then, for Bob and everyone at patients rising. I'm Terry Wilcox, stay healthy.