Shara Cohen on Fixing the Most Broken Piece of Healthcare: Caregiving

[0:00]  80% of care in the home is provided by a family caregiver. The the system falls apart without the involvement of family members. And so um I think we are still in the early learning and and acceptance by health plans and um and health systems and providers that you really this is a key stakeholder that is not a you know a nice to have. This is not this is not the fluffy stuff that feels good about healthcare. It is that it is truly the delivery of care. And until we address um wholeheartedly and holistically what challenges family caregivers, we're we're further putting um patients at risk. Um so so that's the that's the

[0:51]  problem we're trying to solve. Um the the the company itself was born out of that personal experience from our founders and um and so we're on the quest of how do we help healthcare organizations recognize the issue create a a solution and a support and implement that in a way that actually draws out that that workforce um and makes them feel a part of of um of what what's happening to them and for their their loved ones.

[1:42]  How's your heart going today? What's going on? My heart's going pretty good today. Um, I just had a really lovely weekend in what is warmer California with family and um, yeah, my my I'm I'm riding that wave into the week. I love that. Well, one of the things I think would be an amazing conversation uh for us to kind of dive in here today on the podcast is a little bit about what the current state of healthcare is, but also how we are thinking about how technology kind of plays in a space that has been, to say it lightly, a little bit slow to adopt new pieces of technology and innovation.

[2:21]  Um, in our previous conversation, I talked about how my big aha moment was when I started my first company, our tellahalth company back in 2014. I was trying to innovate in that space and I was like the writing's on the wall. This is what we need to do. Video is going to be a thing and nobody believed me. But I know that you have a history right in healthcare technology. So how have you kind of seen the years unfold that we're currently in where technology, EMRs, AI, all this different type of stuff is coming together um to be able to kind of enable patients to be a little bit more impactful. Hey Kitty, what's going on?

[2:52]  Surprise guest on this. She she's got an opinion apparently. Um, so, um, and I hate to be that crazy cat lady, but you just can't control what of course happens. So, um, so yeah, slow is a good a good, uh, descriptor. Um, you know, I think I think we talked about it last time. Um, this notion that being early sometimes feels a lot like being wrong.

[3:15]  Um, and I had a similar experience early on. this is like the late 90s, early 2000s and had this idea about bringing a a curriculum to physicians that um had been previously on Scantron and we thought, "Oh, well, why don't we just put this on the internet? People will love it." And um and in an industry that is still using fax machines, uh 25 years later, um being early often felt like being wrong in that case, too. Um, I would say, you know, the the the ambition is always faster than the reality. And I'm really heartened by um really interesting applications of AI

[4:04]  and and um and those kinds of technologies that can make teams more efficient, can make uh the delivery of care, ironically, more human. Um, I think ambient listening in clinical settings is is uh really interesting and helpful in sort of helping the the providers focus on the patient rather than their documentation. I mean I think there are lots of great applications but we we live in a highly regulated appropriately I think regulated um industry and so sometimes our ability to adopt them is just so much slower. Um it's it's so much slower for health care organizations not just to to adopt but you know they have really Byzantine

[4:54]  contracting systems and and processes and things that just they can be really difficult. And so I think it takes a lot of fortitude and um flexibility from uh from service providers and innovators. Um, and it takes finding the the the top 5% of organizations that not necessarily the top, you know, the top in the industry, but those that are good at innovating and have the strength of culture to try new things and to um and to to experiment where there's good reason to. But, you know, they have to they have to move out on on the tiniest of limbs. Um, I think you you got to find those those uh diamonds in the

[5:42]  rough, I guess. I mean, there's a saying that I like to repeat with my team, which is like change the incentives, change the outcomes, right? And forever there's always been a lack of incentives to be a little bit more consumer centric in healthcare. And I think that's where we're kind of at where I mean, especially because of the pandemic, right? um people were introduced to a brand new type of I would say consumer centric accessible health care system being able to kind of use tools like asynchronous chat being able to hop into an er EMR a patient portal using teleaalth things like that do you think that that was a catalyst for I would say the future generations of what health care providers and healthcare consumers expect when it comes to how technology is going to be kind of you know configured to meet them where they're at with easier more accessible ways.

[6:31]  I think that there I think it I think you're right. Well, I certainly wholeheartedly think you're right about you change the incentives, you change the the um the actions. I mean, I think in in my business, focusing on the family caregiver and um and realizing that there there is never a time that somebody says to me, "We don't need family caregivers or this isn't important or you know, none of that, right? we are we're in the business of mom and apple pie. Um but providers who who would say yes, I see caregivers in my practice and I know they need help don't really have a way of helping them until now CMS creates a billing code and they can they can bill for that service

[7:18]  and now you start to see okay we can adopt it. So I think you know it's a really like present uh example of what of what you're describing. I think that the adoption of technology and um and think just like we're you know there was no use for QR codes until you wanted to order something at a restaurant after the pandemic. Um I think particularly teleaalth and virtual visits everyone agreed was a good idea.

[7:47]  We sort of tinkered around with like can it be can it be built for in the same way that a real you know in not a real an in-person visit would. Um I think that sort of broke open a bit of a seal. Um and it I think we have further to go. I don't think um you know I think that you could everything about my healthc care provider has seen more about of me re in reality and on in documentation.

[8:21]  And yet every time I go to them, it's like I'm a whole new human, right? Netflix knows everything about me and everything I like and everything I don't like. And so I think I think there's still some distance to go on that consumer experience and I think we've got very limited channels, right? Everything has to go through mostly Epic in that consumer experience. So, um, miles to go before we sleep, but I think you're right that that there's more receptivity and more innovation happening in the last, um, five to seven years than than in the last 15. Um, part of that I think is a is a funding issue, but um, but yeah, I agree with you.

[9:00]  Yeah. I mean, when you have when you've got a this is kind of what we had to navigate back in 14, we started the tell company. It was like, okay, but like how do we bill for it, right? And there was a code uh code uh I think it was G3014, which was an originating site facilitation fee. And so for hosting the teleahalth interaction, you had the ability to bill for that. And that was a mechanism that got people to kind of think about those things, which was really interesting. But that's what drove the most adoption for us, which was how do we build for it? And there has to be a mechanism that allows for people to do that. And so I want to I want to do something really quick which is going to be um I want to pull up your website. So the parallel website says caregivers are a hidden force. Now let's talk a little bit about caral what the inspiration behind the brand and the

[9:48]  organization is in itself but also what does this mean? Caregivers are a hidden force. Um yeah absolutely. So something north of of one in five adults are serving as a family caregiver. They might not identify with the term. They might not describe themselves with that phrase. Um so we do have we do have a language uh limitation. Um but they're the backbone of the healthcare industry. Um they are the backbone of healthcare delivery. Um the the issue and the reason that that the mission that we're on is to recognize that um they are navigating an increasingly

[10:37]  fragmented system that is largely unfriendly to them that puts all sorts of obstacles in the way of their involvement. um pays really no attention to their ability to perform the responsibilities that they've taken on at out usually out of love and and and care. Uh but it's a job that you know we describe as everything from the janitor to the CEO of of a family and um and they're untrained, unpaid and didn't didn't apply for the job. And so the idea of um of for parallel is to recognize what makes caregiving hard. Um address those foundational causes so that caregivers

[11:27]  can be more resilient, feel more confident, feel supported, and more capable of caring for their loved ones. And the hidden workforce um uh headline is really about acknowledging that this isn't about um I mean sure it is the right thing to do um but more importantly 80% of care in the home is provided by a family caregiver. The the system falls apart without the involvement of family members. And so um I think we are still in the early learning and and acceptance by health plans and um and health systems and

[12:15]  providers that you really this is a key stakeholder that is not a you know a nice to have it. This is not this is not the fluffy stuff that feels good about healthcare. It is at it is truly the delivery of care. And until we address um wholeheartedly and holistically what challenges family caregivers, we're we're further putting um patients at risk. Um so so that's the that's the problem we're trying to solve. um the the the company itself was born out of that personal experience from our founders and um and so we're on the quest of how do we help healthcare organizations recognize the issue create a a solution and a support

[13:04]  and implement that in a way that actually draws out that that workforce um and makes them feel a part of of um of what what's happening to them and for their their loved ones. My first experience um about recognizing how important the family caregiver was was when my uh I was 18 years old and my father got a call on a random Tuesday and it was the doctor at the hospital in Washington state. We lived in Detroit at the time and he said, "Hey, listen. Your mom is about to go on hospice, right?

[13:41]  you need to make sure that all of her, you know, belongings are together and make sure everything's in line because she's going to be transitioning here pretty quickly. So, what does my dad do at the age of like 40 three years old? He drops everything, flies across the country, is there at the bedside with his mom, but he had no medical background. He had no understanding about the complexities of what an interdisciplinary hospice team was going to look like. He didn't know what the transition expectations were. He also didn't know how to communicate these things to his family. And so for the first time he found himself in an unfamiliar position which was he was the coordinator, he was the caregiver, he was the communicator on the family's behalf and he was also the person who was curating what the end of her life was going to look like and had no previous experience before that Tuesday.

[14:25]  And I think about how we even have statistics where like 10,000 people a day are turning 65 years and older, right? So, we need to start enabling people with the tools and the resources and the technology so they can be the best version of themselves as they go through the inevitably scary experience. And that's why I love what you guys are doing. It's so important. Yeah. Thank you. And thanks for sharing the story. I mean, I think that the one thing you left out about your dad in that situation is he's also the son who's having the having to face the emotion of this is happening to his mother. And I think, you know, the the the reality that we have to try to get people to to wake up to is it's not just about how do we explain to your dad and train him on what all these things mean, but also

[15:13]  tend to his well-being. Because the emotional part makes all of those logistics harder and all of those logistics make all the emotions more fraught. and and it it is um in some ways we we are starting to recognize you know this idea that we've introduced billing codes is an acknowledgement that they that caregivers are um are doing are taking responsibilities but all of it is focused on how do we train them not how do we enable them and so I think that's that is um a key part of it the other the other thing that I'm um somebody said that I can't take credit for this, but somebody said it uh to me a couple weeks ago at a conference.

[15:59]  We've been talking a long time about uh for a long time about the baby boomers. Um now all of the baby boomers are 65. We've been talking a long time about people a you know 10,000 people a day aging into Medicare. Well, we're getting to the point where 10,000 people are not turning 65, but 10,000 people are turning 85.

[16:18]  And that is a whole different set of circumstance on who is supporting that that wave. So, we're, you know, we we do a lot of work um particularly in Medicare and with um Medicare Advantage plans. And when you're turning 65 or you're in that 65 to 72ish range, um you probably caregiving for a parent who's still still with you or for a spouse.

[16:50]  And so, you're sort of in your dad's seat of like what is how do I navigate this? and what is it doing to my own wellness? Um, but then, you know, cast it forward in 20 years and you're in that 85 plus range and now you're dependent on a caregiver and um and that's, you know, that there is a there's a whole lifespan in Medicare that happens that um that really has a special relationship on both sides of that coin on how caregiving impacts them. So, um, I think I I'm just going to I'm just going to have a long-winded agreement with you. Again, if the Heart and Hustle podcast has ever sparked any idea or made you think differently, do us a favor. Make sure to guys share this, post it on LinkedIn, or

[17:38]  even text that nonprofit friend that you just have. Whatever works. This is what keeps the conversation going and allows us to just grow this community together. Seriously, we appreciate you. There's one of so when we think about technology right naturally it's very easy for our brain to go to the place of well if we just keep inventing different pieces of technology we're going to completely lose the human element of care right so how do you guys think about using technology not as a replacement but as an enabler right to create a better sense of human connection because I think that that's an important conversation we should double tap on as well. Yeah, I I love that conversation because there's um I mean for particularly in in our line of work, there's nothing more human than

[18:27]  being a caregiver. Um and so I think we have to acknowledge the humanity, the emotion of it of it all. Um I think the the the beauty of technology is, you know, it can be a really good connector. you talk about your dad as like the curator of information and communication back to to the rest of the family. The enablement of that um is so much more streamlined and you can access information. You can you can do some really amazing things, but you also have to know what to do. And um and there is so much time and and learning and and learning curve of how to navigate caregiving challenges. So, you know, we've got to we got to figure out how to

[19:16]  pack up all of our stuff. Or somebody's getting discharged and they can't be discharged home, so they've got to get into a nursing facility. and what are the right requirements and you're dropping somebody into highstakes situations that they're totally unfamiliar with. And sure, you can search and read a bunch of reviews and do the do the kind of research that is appropriate for the the importance of the decision, but you don't have a lot of time and you're not that familiar typically. And so, um, so yes, tools are helpful, but it's also really important.

[19:54]  And what we've found with caregivers is they, um, we can save them a lot of time when you put an expert in their pocket who they can explain their situation to and explain who their mom is and what's important to her and um, and the and the cultural considerations that you're dealing with and the financial considerations that you're dealing with.

[20:16]  And candidly, you know, 20 to 30 plus percent of our cases are with people that start with the the some version of I don't know what my question is. I just know I'm at the end of my rope. And and so we have to acknowledge that that's sort of the state of caregiving right now is that most of the time people feel unfamiliar and lack confidence. And that's a place where I think I think we don't want to replace that moment with technology. We want to sort of virtually wrap them in bubble wrap or give them a hug to say it's going to be okay. Let's sort of break it down and let's come up with some steps that are going to help you in your situation. Then we, you

[21:02]  know, we may be handing you back to technology to manage some of that as the as the um as the challenges have have uh deescalated. Um the other thing that I think is really important about application of technology and blending with a human um relationship is allowing the humans to focus on the humanity. So you know we talked earlier about um uh ambient listening in the clinical settings. The beauty of that, I mean, one, it's it it's so accurate and and helpful um from a job satisfaction for the provider's perspective, but also it allows the provider to turn from having this conversation with you to having

[21:50]  this conversation with you and it reinforces the humanity. And so, you know, a lot of the work that we're doing is around how do we take documentation or reduce the documentation load for for our team um so they can focus on the conversation that they're having? How do we take the resources and recommendations that are appropriate for each individual conversation that they're having and insert it into their workflow without them having to search? Right? These are all like little AI applications or or automation workflows that can that can reduce the the backend work for a for for us a care advocate for a human so that they can focus on the relationship

[22:38]  and out of the relationship comes so much learning and trust and sharing. Um and it and then on top of it, caregiving is really isolating. People retreat into um retreat may not be the right word. Retreat might be um glossing over what you know people get get um overwhelmed and and cut off from their community uh their personal community. And so it's really important to to to create human uh connection um for for caregivers whether that's with our team whether that's with a support group whether that's you know really giving them respit so that they can go out and and tend to themselves um you

[23:27]  know we I also heard this from somebody else but have stolen it uh relentlessly which is technology can't give you a hug and and healthcare is an inherently human business that is built on uh you know effective solutions and really outcomes driven uh solutions have some sort of understanding of that that human element. Um, so I I think that we can't understate it and um and I think that we can't hide behind the technology. And so, you know, we've really prioritized you call our team, our team picks up. you know, it's not we're oh, we're not gonna like have have a bot or or um a phone tree before you can talk

[24:15]  to a human because, you know, the I'm at the end of my rope person really can't doesn't need that doesn't need that in their life. I think about um where we came from. So, back in the day, right, I always used to hear stories about what the doctor in the community represented. It was somebody who knew everything about your family, knew everything about you, everything about you, Cindy, everything about you. Johnny, you're playing in the basketball game this weekend. I saw your aunt earlier today, like XYZ. Everything was relationship based. Then then to go back to my earlier statement, right, we changed the incentives. We changed the outcomes. We started thinking about how much um I would say productivity and billable CPT codes we could push through a system.

[24:59]  So, your doctors eventually went from being here with you to being here with you. Right now, we see technology. My girlfriend actually is a physician's assistant in an ortho clinic. And they have an ambient listening documentation system that she literally says, "Kenan, I come home or I'm in the office. I hit the go button. I put it in my pocket.

[25:17]  I'm able to be here the entire time to build a better relationship." Right? And it's just interesting how we're seeing that technology is being an enabler to bring us back towards the human component of healthcare because it's a people-to-people business at the end of the day. And I think people are yearning for that more so than ever, which is so cool. But I didn't really expect it to happen as quickly as it really did, you know, with AI. I think I think that's the real flip. I think that um I and I have no data behind this except except observation is that I do think that it has shifted to um at least on the front end of care delivery. It has shifted to a replacement strategy into an enablement strategy. And I think I think that's

[26:06]  um that's more not only more effective um but more fulfilling uh for everybody. I don't think the you know you never I would venture to guess never having met your girlfriend that she likes it better to just do this. She's uh she's incredibly empathetic, right? And she's all about relationships. We're actually watching a show right now for everybody who's tuning in watching and listening today. There's a show on uh on uh HBO right now, HBO Max, called The Pit. Have you heard of it? I have, but I'm squeamish, so I'm scared to watch it.

[26:39]  So, so there's nothing like really gory in there, but it's just a documentation and like kind of like a a chronological timeline, right, of like a 12-h hour shift inside of the ER, which is really interesting. And one of these doctors gets uh a little bit of a stern talking to because they call her slow-mo. And they're like, "Well, why do you have the name slow-mo?" Because you take too much time with these patients, right? because we are getting pressed through administrators, through executives to be able to kind of push more people through the system. And she was like, "Yeah, how am I supposed to understand what their true needs are if I don't have the ability to establish a relationship with them?" And it seems like the younger generation, right, of leaders and doctors and people who are coming into the space want to feel that human connection because so much of our personal lives takes us away from all of those things. And it's like we have the ability to zigg when everybody else is zagging back towards the human element, which I think is just, you know, a reemergence of just the connection that

[27:27]  we're all yearning for, especially in healthcare, you know. Yeah. Yeah. Totally. Totally. It's um so many physicians that you talk to, you ask them or health care professionals generally, you know, why did you get into this? And it's always, I mean, more often than not, story of somebody in their family went through something or um or you know it was just sort of a fabric of their life and and how their family you know I have a family of doctors and this is what we talked about around the the kitchen table. So um I think that's I think it's spot on and encouraging, right? It's heartening u because we've gone through real um sort of the I don't the

[28:17]  private equitization of of uh of healthcare and like you know massive mergers and how do we just squeeze all of the efficiency out of now that I also I say that but I recognize that hospitals and health systems are low margin businesses that are really um they have to do that right like I I'm I'm I'm totally empathetic to the the struggle of how you deliver care and um and particularly, you know, in in the very present moment where funding sources feel very tenuous. Um it is uh I it is a hard hard place to be in to say, oh, you know, we want to slow everything down.

[29:03]  Um because that's just not it's not the that's not how the incentives work. Um, I do think that highly encouraged by the ongoing tuning around value based care performance and investment there. Um, we haven't cracked it yet, but that starts to shift the how do we, you know, how do we find the low acuity or low intensity experiences that can really promote better health?

[29:35]  um you know that that's a that's a good set of alignment um for sure. Yeah, I'm really interested to kind of see what the future of, you know, valuebased care um getting a little bit more into like a proactive mindset of healthcare rather than reactive. You know, we are in layman's terms just like data machines. We put out so much data every single day through when we wake up, we hop onto our device, data is flowing through that thing. We're consuming data, we're putting out data, our Apple watches, everything else that we're where even my bed tracks like my heart rate at night time and things like that, which is interesting. And I just think that we're going to get to a place with the enablement of AI, right, that actually helps us be a little bit more proactive in managing our own health. Yeah. Yeah.

[30:14]  And what what would be, you know, so interesting, and this is I we're starting to see this creep up, is how you create interconnectivity between those data sources. So, we're so used to looking at, well, what's the clinical data and the health data and what is that telling us? But if we could start to connect what financial decision-making looks like as an early predictor of of cognitive decline, um, then you start, you know, what are the spending trends? Um, now I started talking about how things are highly regulated and we have to be careful about where the data goes, but you're right that there's there's um there's real power in that and people smarter than me know how to like create these connections between different data sources. Uh but tapping into that I

[31:04]  think you can get um you could also you could go terribly wrong from an ethics perspective but but done right let's stay on the positive and the optimistic you could get really proactive about um about early intervention and um and and not only is that lower cost but better quality of life and and um and lower intensity of interaction with the healthare system at all. Um so those kinds of um innovations I think are are the most exciting. I recently hosted on a separate podcast with my uh my buddy Dante. We uh have an all podcast called All Innovation and we were talking to the creator of the all-in-one camera phone solution. A guy named Philipe Khan, right? This guy is obviously um

[31:51]  very wealthy these days um because one of his devices is in every one of our pockets. and he uh has a company now uh that has partnered with Tempropedic where they're using their AI strategy to be able to I would say understand macro data sets of sleep patterns and he said one of the things that we're looking at doing is we've had people who have had heart attacks, strokes and even passed away while their data is actually being you know curated and gathered from these systems. So something that we're looking at being able to do is just like you said is what data patterns can we see that might have happened six eight months ago in our HRV so our heart rate variability our breath rate at night time the amount of sleep that we're getting are we actually getting into those lower levels of sleep and deep sleep that help us actually recharge and you know heal the body and so it's just really interesting to think about how

[32:37]  people are thinking about all this data and how we can be more proactive because it would be amazing to know that like hey over the last six months we've seen a couple patterns in your sleep history that you might need to be a little bit more aware of that could cause some downstream effects. And if your health care provider and trusted resource had the ability to be proactive and say, "Hey, listen. We should do a sleep study or figure out what's going on with like your vitamin levels." That would be a really cool place to live in, you know, a great society. It would. It would. I think that and and in the meantime, let's also respect and honor the the human connection that you know, we we talk about um the the family caregiver is the best remote patient monitor there is.

[33:24]  The scale, you know, that you put in somebody's home because of a um a CHF diagnosis is only good if they step on it, right? that the and yet we talk to people every day who say, you know, my we found this and this and this with your mom and it's like, yeah, I told you that six months ago or you know, I I often use um the example of my mother who um you know, if if if I knew who her health plan was or had a had a way of uh or who her physician was, I would call them. I mean, this is this sounds terrible because I could find this out, but you want to know who's a fall risk? My mother, right? I'm constantly in the in the why is this rug

[34:14]  in this place with this with nothing tacked down. So, you know, that is something that every health plan talks about. I wish we knew more about fall risk in our in our um population. caregiver will tell you, right? The family member will tell you exactly what's happening. And um and I think the the issue is how do you prioritize and create a strategy for reaching that non-technical um alarm system or sensory system because we also in addition to like how do we better appreciate changes in our own um chemistry or or sleep patterns or

[35:04]  whatever that we can't notice. There are plenty of things that that um we're all watching with our own two eyes, but nobody's asking us or nobody and we don't know to to to tell. Um, so I think I think there is a there's a there's a piece of of yes and right how do we how do we get better connection of data but but also still listen to what people say um because they they're the fastest path to to finding out the things that that we want to find out. Yeah. I mean I think about this in twofold and my mind went to a weird place while you were talking there. I was like, you know, RPM devices and AI pale in comparison to the intuition of a caregiver or a loved one.

[35:49]  You know, like it's easy to see the patterns subconsciously in what's happening with somebody who you truly love. And that data is incredibly rich for you to be able to leverage to help the life of that individual. Yeah. Um I want to talk a little bit about the mission, right, of doing what you guys do because in a lot of organizations and a lot of industries we talk about healthcare, it's like yeah, that's a nice to have, right? They must feel so good to be able to say like we want to enable family members and caregivers with the tools and the education they need to be able to care for their loved ones. But there has to be money behind this mission as well. In our previous conversation, you said something to me where you were like, you know, there were um I want to say it was two nuns, right, who you might have had an interaction with where you said no money, no mission or something like that. What was that? Yeah, there was a it was a um Catholic health system and and the so in the boardroom there there

[36:39]  were they always had uh the nuns who were on the board of the the health system and they were um that's what they would say. It's no money no mission. They were they were not kidding around. Um and maybe that goes back to the like the thin margins that that that hospitals have to work under. Um but yeah, if it's um people will tell will be able to tell now that I just steal sayings from from other people. I try to I try to credit them. Another one um that has has served me well over over a career of trying to to do the right what I hope is the right thing in healthcare is um it's all just interesting cocktail conversation unless it drives a financial outcome, a clinical outcome or meets a regulatory requirement. So I have I have somehow

[37:27]  found myself in um a couple decades of work in patient engagement and now family caregiver engagement which can easily slide into interesting cocktail conversation unless you're you're measuring something out of it. And so, um, I think and maybe the lesson for any, um, you know, any business, which sounds so basic, but if if you can't figure out how the how the money flows for your customer and how how you can help that, um, you're in trouble. Um and so you know as good as as whatever you're you're selling is um so for us yeah that that it's very easy to feel uh or to to on a cursory level say it's a nice to have but the

[38:16]  fact it goes back to your you know one of your first questions about why a what is a hidden workforce um the or why a hidden workforce and um you know we have um what what I would you know there are there are sort of like what are the easy nice to haves of a really satisfying enriching experience that fits into cocktail conversation right that that there are all sorts of reasons why organizations care about that but um but I don't I think that's a nice to have what becomes more of a a need to have is maybe back to the to the discussion about um about uh remote patient monitoring or the the caregiver as the remote patient monitor. We h we are

[39:06]  constantly interacting with people on behalf of a a health plans member or a health systems patient where from a risk adjustment perspective from what the health plan understands that that um that patient or that member's health to be they think they're healthy but they have a family caregiver who is working really hard on their behalf. easy indication that there is something wrong. And we're collecting diagnostic information that would say these are all the reasons why they are probably not healthy. And from a risk adjustment perspective, they need a they need an assessment or we need to get them into primary care for um for a better coding or for coding coding them up. Now,

[39:53]  there's a lot of attention in risk adjustment and and fraud and abuse and and I'm I'm not trying to wade too far into that topic today, but but you you can start to see very quickly how you have a caregiver who's in crisis or at least in need for a reason and it is an indicator of the health and wellness of a member or patient and that's where the intervention needs to happen. Um if you think about serious illness um most people you know going back to your dad's example um most people don't have never heard of paliotative care and so or think if they've heard of it they think it it's hospice or that it's you know quote unquote pulling the plug. Well

[40:40]  supportive care can be a really coste effective higher quality of life solution where appropriate. education of the family, the the family caregiver is often the obstacle to getting that in place. And so there are really specific scenarios where I think healthcare organizations could think differently about what role the family caregiver is playing, how hidden they are, and how much they need them to like they need to bring them out of those those shadows because they're um they're the key care partner. Um, and so that's, you know, that's the the quest we're on is let's identify those paths where it's not just a nice to have we're going to do something as a as a member satisfier.

[41:28]  You're going to get the member satisfaction. that halo effect is going to come. But the real reason is because you know they're if a caregiver is exhausted or depressed, the likelihood that they're their loved one is going to the ED more than they need to is pretty high. Um 75% higher, right? So th the these are things that um I think getting recognition that the caregiver is a therapeutic agent is um more than just a you know it's nice to have family around is is really the the the move from the shift from nice to have to a real recognition of of centrality for the the family caregiver. Well, I mean, it's so easy to understand why so much of your

[42:15]  heart and hustle, right, is behind this mission and what you guys are doing at Carallel. I literally cannot thank you enough for spending so much of your such valuable time and your energy, right, trying to advocate for the people who truly need the support. And it's not just the patient, but it's everybody else who surrounds them, right, who creates the outcomes. So, as part of our tradition here on the podcast, our previous guest wants to ask you a blind question. All right, this is the thing that I was most worried about on this.

[42:42]  So this is your question. All right, so how do you create legacy not for yourself but for those who you want to be successful behind you so they can lead in a sustainable and more impactful way? Think about this like your kids. How do I think about legacy? Um, I think that, um, weirdly I, so I'm gonna I'm gonna draw a weird parallel. Um, some you talked about the pit. Somebody just, um, just turned me on to Alone. Have you Have you ever watched Alone where they drop somebody in the wild a bunch of people in the wilderness?

[43:26]  And one of the things that I that I was as you were saying that that just struck me is most of the the convers the the dialogue. So for people who don't know what this is, people are dropped into the wilderness, no almost no resources, and the only communication they can have with the outside world is to say, "I want to go home." So they're they're out there for for weeks at a time. And so, and they're talking on uh on um recordings that they're making. So, it's really like an inner dialogue that you're listening to. And the inner dialogue is often about family and parents and legacy and what gets passed down. And all of the um all of the lessons seem to be by example. It's rarely, you know, oh, this

[44:16]  person would tell me this or t, you know, directly instructed me that. It was more about I watched them do x, y, or z. And so, I think um, you know, I'm not really constituted as a person who thinks that um that I'm trying like I have any business teaching anybody anything. Um, but I do I think that you never know who you influence and I've gotten to a point where I'm old enough that people who have surprised me have said, "Well, you did this and it meant something to me." And positive and negative, by the way. Um, and so I think, you know, for my kid and for thinking about legacy, I guess it's about

[45:03]  um doing the right thing when it's the hard thing. You know, there are there are plenty of times we get decisions to make where uh you know, it would be a lot easier to keep it to yourself or not disclose or whatever the case might be. And and and that's the time to to do the right thing. Um and and I think just just try to to keep the hustle, you know, the um the the energy and the when you get punched in the neck just to keep going is the thing that that um that you know I think a lot of people I've I've found respond to. Um so I'm going to keep trying to to to tell that tell that tale.

[45:51]  Well, I can't thank you enough seriously for coming on the podcast. You know, once again, easy to understand why you're the definition of heart and hustle. With your experience and working in health technology and innovation and what you guys are doing at Carol now, it's so cool to be able to, you know, be here with you right now because I know the future is bright and I can't wait to have you back on the episode for another time. But seriously, thanks for joining us. Thank you. Really fun, Kenan. And I I I appreciate the way that uh that you're bringing these conversations to light because they it's it's um it's inspiring to listen to the other to the other sessions and and um so thank you.

[46:26]  Absolutely, guys. We'll catch you in the next one. That's the pond.