EP 14 CAP Karin Underwoodv2
[00:00:00] I asked her. Now, if I could give you one thing to improve your health, what would it be? And she looked at me and thought for a second. And then she said a friend, even though I was so excited about using technology to help make progress on this issue, having the human component was one of the most important things I could possibly do.
Welcome to cause and purpose startup edition. The show about entrepreneurs, launching new organizations, innovating, disrupting, and pioneering new paradigms for change on the front lines of some of the world's greatest social challenges. I'm Mike spear and today's guest is Karen Underwood. Karen is a Stanford social innovation fellow and the graduate of fast-forward nonprofit accelerator program with a long history of work in the social sector, Purdue organization, Rano health, which you'll hear referred to in this episode by its founding name.
Coach is an accessible mobile platform built to provide life changing diabetes. Self-management trading to low income Americans with chronic disease. If the model works, Karen hopes that Rano health will scale to serve more than a million people relying on Medicaid for their healthcare needs. Thank you for being here.
We're excited to have you on the show. I appreciate you joining us and taking the time today. Yeah. Glad to be here. I'm actually really curious, you know, to learn about. What life was like growing up, you know, what your family dynamic was. Yeah, absolutely. Um, well, you know, I'm one thing I'll say is I'm from a town, a small town in Pennsylvania called Westchester and, uh, very important to buy growing up story, I think is that I'm the youngest of three children with loving parents and, uh, for any youngest children out there, you know, that means that you get a little more freedom slash a little bit less supervision than the older children.
And so I think in terms of, uh, being willing to take risks and feeling like I had a second. Stability around me that was really provided by my [00:02:00] older siblings, thanks to them. Um, and it really helped emboldened me even from an early age, just to try new things. I had a little bit of like follow my brother and sister fever and then try to do even more.
And so actually one thing that kind of got me into in a way was thinking a little earlier about, um, service projects. And so this started out through my church and through, uh, my high school, but early on, I got involved in, um, a project, you know, in the city of Philadelphia. So not too far away from where we lived.
And I just remember these early interactions with. It sounds so, you know, naive now, but, uh, we would drive in and do this volunteering with, um, kids who are, you know, in kind of like a, an orphanage slash a childcare center. And we weren't allowed to leave anything in the car. And they just said, oh, even a quarter left in the car, someone could break into the car because they would want that quarter.
And that shocked me as a child. I just remember thinking like, wow, what kind of world is this? That even a quarter is so needed, that that would lead to. Break-in. Um, and I also remember then later in high school getting a little bit more into, um, service projects locally and getting involved with a halfway house for women who were getting rehabilitated in our town and going from being homeless to also getting the support to actually like, you know, get back on their feet.
And I similarly remember going to these, um, one of the awards ceremonies they had for women who had made it through the program and just women sharing these intense stories of man, I was with someone who, uh, completely took advantage of me financially. And then when we split up, I was on my own and I ended up homeless as a woman in this town.
And so I think just there were so many, like little moments like that. There were just like, wow, the world is so much bigger than my, um, like comfortable upbringing. And then I also just had such an amazing [00:04:00] experience with the support of my family to be involved in. Every sport, every activity beyond that.
So I'll save you all of the like swimming stories and things like that. But, um, but yeah, that's a little bit of, you know, growing up and just getting glimpses of this bigger world and then entering kind of college and beyond ready to know and learn more about. I feel like that experience of at a young age, being aware of your car could easily be broken into.
You really could take that two ways. You could totally buy in on the stigma and like be afraid of people in that situation or have compassion. And it seems like you had the more compassionate sort of take away from it. I'm wondering how you felt about it at that time. Why you think you reacted that way and kind of how that informed your later.
Yeah. You know, um, I was, I've won. I love your reflection on calling it. People who are homeless, not homeless people that kind of respect there and the credit that you give me for big wise. Well, I don't know. I mean, it'd be easy to be afraid. It sounds like, you know, at that time you were teenager, pre-teen something like that.
And you could easily just be afraid of homeless people after that. I don't know. No, I think it's true. I think I was processing it for a number of years and trying to figure out, like, what does this mean? And I, I actually remember, um, the, just the shining example for me is I had a, um, advisor in college.
So in college I also was involved in some homeless work where we were helping support a food, a soup kitchen in St. Louis. I went to school in St. Louis, where does, there's just a huge economic divide. Um, and. Like many cities, a sizeable homeless population. And I got involved with, um, a center and one of the, the director of that center, uh, I remember came to a meeting at our university and when she came to the meeting, she, uh, said, oh, I'm sorry, I don't have my computer today.
Uh, I'll have to take notes by hand and I might be missing a few things. And we're like, [00:06:00] oh, Lou, like what happened to your computer? And she's like, oh, my house got broken into last night. And I lost my computer and I a huge number of things, but it's okay. I'm sure they needed it more than I needed it. And I'm lucky enough that I, you know, have the resources to get a new computer and like, you know, re replace these things.
I'm not, I'm not worried about it. And I think that just like stood, I'm almost hearing up talking about it. I've actually reconnected with her at least recently on LinkedIn and told her what an impact this story had on me, because, um, it just showed me. Actions speak louder than words. She, uh, showed me this compassion in the face of loss that I think really embodied, like what I hope to embody and was a shining example for me as a college student of how you can, you really choose your reaction to all of the scarcity in the world and choose your reaction to what could be a threat, but also, um, could be an opportunity Trinity, to show someone compassion.
Yeah. I think you mentioned how some of your adventures outside of the U S gave you different perspective on poverty and living situations here and just seeing sort of grappling with that injustice. Absolutely. So after college, yeah, I, uh, you know, I did a short self-made study abroad to, um, a trip in Latin America.
That was an amazing trip. The chance to back back and. I came out of that trip with a few like fun realizations. One is just always say hi to every person who enters the office when they enter the office. That is like the office culture. When I volunteered in a few places. Stop. And when someone came in, you would you'd greet everyone in the office.
And I was like, this is so un-American. I love it. But another takeaway was just that for some of the stuff that I was interested in helping with, uh, from that trip, or I did some work on HIV and aids, like I really had to be embedded there to make any real progress. So I decided I came back to the U S after that [00:08:00] trip, I worked at a health tech startup for a few years.
And then I took a job at a global health, um, nonprofit called one acre fund. It's a social enterprise that works in east Africa to help small holder farmers increase their income and improve their lives. And that was really a transformational experience for me. Um, I would plug one acre fund to anyone looking or listening to this podcast.
I'm such a huge fan of the work. And you know, one thing I loved was that I was living in rural Kenya for two years, uh, really firsthand interviewing farmers, building products, working with local teams. Um, and I think I thought that. All the time while I was there. How even being in rural Kenya, I had, you know, walls up around our compound and how it's still so hard to truly access, like the experience of the people that you're working with.
But the, the ethos there was like, anytime I needed to go sit in a farmer's house to understand their situation, I had kind of the license to do that. And I think it just gave me such a tangible, like so many tangible experiences that I still think about today, about what it truly means to live in poverty and not have the money to, you know, uh, put covers on your.
Um, on your wooden furniture in your house or not having the money to have a family portrait. So you only have like the posters up on the wall that are provided by, uh, the companies that are trying to get their advertising out and just what it really means at this micro level to live with without, and, um, how there's just so much we could do to change that.
If we, if we wanted to try, what, what really drew you to the healthcare aspect of it? You know, if someone gave me advice, I remember when I was working at a health tech company in DC and debating, should I leave this. Successful startup and, uh, go to Kenya where I have never worked in global health before.
Uh, I talked to someone who just said, you know, I also made a big [00:10:00] shift early in my career, and I was worried that the threads wouldn't tie together, but they did. And now I'm in this amazing tech democracy job. That was the person I was talking to. And so his advice was kind of just trust that the threads will come together.
And I feel like in a way, what I'm doing now is so, you know, is a perfect. Thai and of all the threads I've had throughout my career. So really the focus on technology, the focused on, on health, the focused on working with low-income populations who don't otherwise have access to resources. And so, um, you know, I think that has been the thread.
And then I think on, on the health side, um, you know, my mom worked in healthcare and I think I saw from her just how personally gratifying it was for her to work on that through her career. And so I think she was more on the health kind of health it side. She did a little bit of government work towards the end of her career, but I can't deny that that was hugely impactful for me is an area where there is just so much opportunity, so much meaning and then, uh, you know, so much need, well, what did you get from her that was, you saw it was so fulfilling in her life.
You know, I think she was in the early stages of. Uh, maybe it's just also hearing about some of these health healthcare terms that are intimidating to Everett else. So, uh, I'll try not to use too much jargon, but, um, she was in the early stages of helping define some of the, um, requirements for the Obamacare rollout and what it would mean for healthcare systems to share data with each other, the company she worked for that she was a math major, so she wasn't originally healthcare, but she ended up at this company that did health systems storage.
And so she then worked at the, at the federal level to help define what's called meaningful use, or what would it mean for these health systems to talk to each other in a way that would improve and patient care. And I think I [00:12:00] saw, um, through her and then through some of the people that. And the federal level when she did that work, she's this like deep passion for, okay.
We need to change patient care. I met nurses who had then entered some of these, um, kind of leadership levels. And so I think I just met a series of inspiring people. My mother included who were, um, had combined kind of this like empathy with this leadership capability and then we're, we're really trying to drive change.
And so all of those things together, um, was just such a inspiration for me of that was a place to really, um, you know, focus my career, you know, on a personal level. Like what drives you to want to improve health outcomes for? Yeah, it's a good question. And I don't like, I feel like, uh, I also don't want to let myself off the hook here.
Um, you know, yeah. Uh, I think when it comes back to like what drives me on a daily basis to do the work that I do, it's really CA. It still comes. It's like the team that I worked with in Kenya or the teams that I worked with in Myanmar and just seeing the capacity of my teammates and the gap that, uh, the education we had accessed or the resources that we accessed, how that dictated so much of our lives and how I had access to things that like, they would never have the capability to take advantage of and then feeling that I need to do everything in my power to equal equalize that gap.
And that isn't tangible in the way that like it's tangible that, you know, um, my close family member recently got released from the hospital with diabetes and with a huge prescription of insulin. And I had no ability to know how to manage it and ended up back in the hospital. Three days later that actually did happen like last week to me, [00:14:00] um, It doesn't feel tangible in that way.
I think it just, it's just like in opening your heart to some of these issues, little by little, you start to care more and more about people that maybe aren't your close family, but are like deserve care and, um, deserve opportunity just as much as anyone who is in your close family. And I think that's been a process of tying some of those intellectual pieces, like the classes I've taken to just these real experiences that have really touched me and that, you know, drive me to do this work.
I know that you're very cognizant of the gap between what for a middle-class folks have versus what people in developing countries or people here in the U S that are just, you know, below the poverty line or whatnot, the, the gap in, in access as well as the outcomes that leads to, I love to talk about that.
You know, like I think this is something I think about all the time. So, um, you know, one, uh, reason for focusing. For starting to think about chronic disease and type two diabetes, although type one diabetes, as you mentioned is also something that requires a huge amount of daily management and support, um, is just seeing that, that gap that you mentioned.
And I'll take it back to my relativity moment, which is that if you are a wealthy American. You have a ten-year longer life expectancy than, than low if you're a poor American in the U S and that's greater for men. So it's about 15 years for men. And then with COVID-19, it actually has increased even greater for people of color it's increased that that life expectancy has gone down for everyone, but disproportionately for blacks and Hispanics.
And so that gap, there was some really incredible research done by Raj Chetty. That was a big influence on me. Who's a economist at Harvard now who runs an economic inequality project. And, and that research showed that that gap is driven. Surprisingly, not as much [00:16:00] by zip code or by the access to health care that you have the biggest drivers of that gap.
Um, you know, that raw income inequality, but also just healthy behaviors. So do you smoke, do you exercise on a regular basis? Do you have access to healthy food? Are you eating healthy food? And that is what dictates the length of our lives. And so seeing that, you know, really made me think about, okay, how do we make direct progress on that core hard issue?
Some of it's the food system, some of it's, you know, um, but if you look at, if you look at kind of disparities among chronic disease, people who are low income smoke the most have the highest rates of smoking and similar for, um, kind of healthy eating behaviors, things like that. And then I think when it hits the healthcare system, um, there's just for this relative who came out of the hospital recently, He had, you know, received all of this information and then just very little, no support or follow up to know what do I do with this?
What, what does that mean for me? Who's going to check in on me. Am I supposed to do everything myself? And I think that's what we see with people who are part of the program that we offer, which is they come in, not even always knowing what their diabetes numbers mean for them and what to do on a day to day basis.
Based on that they come in, not even having the realization that they can do things day to day, that could have an influence on their diabetes or on their health. And then third, not having much hope that there is anything possible. And so one thing that I'm passionate about is just directly making progress on kind of this health inequity that's been exposed by COVID, but in a way that truly respects every patient's own journey and recognizes that we need to meet patients truly where they are and starting just with like, what's the first step towards addressing some of these underlying conditions.
That's really the inspiration behind coach [00:18:00] me, right? Yeah. Well, I would say I knew this big systems problem, and then, uh, I was like, well, this. Hard to fix. Let's see, what's possible. And I spent hundreds of hours interviewing people who are on Medicaid. So the health insurance that covers 70 million plus low-income Americans.
And in those conversations, I expected to find one thing, which is, oh, I can't find access to a doctor. And what I heard over and over again, um, was actually a pretty different, we just heard, I heard a lack of empathy from the system feeling that they, someone could go into the doctor with one problem. And the doctor, you know, had something completely different to talk to them about.
And they didn't feel like they got their needs met. And now knowing more about, you know, the community clinic, uh, kind of constraints and capacities providers feel the same way they want to meet those needs and just have limited capacity to meet all the needs that a patient brings in to them given the health conditions that people are facing.
And, and I remember one person I talked to in these interviews, who I asked. You know, if I could give you one thing to improve your health and she had a chronic disease and it had been, you know, she wanted to do something about it. If I said just one thing to make a change, what would it be? And she looked at me and thought for a second.
And then she said, a friend, like, I want someone that will know my name when I call them. And I want someone who, when I'm going through a rough time, I can reach out and I know they'll be there for me. And that really told me that even though I was so excited about using technology to help make progress on this issue, having the human component was one of the most important things I could possibly.
Do because at the end of the day, having a chronic disease is an incredibly lonely place to be often. We don't feel like we can talk to other people about it, [00:20:00] or we don't feel like we can prioritize ourselves in making, you know, in helping put our health first. And so that was a huge inspiration for how, you know, I chose to start and build, coach me, was making sure at the center of it.
And this is true today that like we are a friend to the patients that we work with. Hmm, what's coach me all about what's the model that you guys are following. Yeah, so we are a digital health coaching platform for chronic disease for type two diabetes. And we work with, uh, low-income Americans. We specifically partner with community clinics to help us access patients that are most in need of support.
And then in a 12 week program, we provide weekly coaching calls with a certified coach with lived experience. We also provide daily tips and glucose monitoring to help people understand their own condition and start to learn themselves how to manage it. And our model is based on the UCF. University of San Francisco's clinical model around health coaching, which is through their center for excellence in primary care.
And you know, Dr. Bodenheimer from that team is one of our, our advisors. And what we're trying to do is take it digital. So help people do it from their homes. Um, our program is currently called healthy at home. So we help someone, they can be sitting on their couch and working on their diabetes. They can be walking in the park and talking to their coach.
We want to really meet people where they are, because you know, in community is where you're dealing with your chronic disease every single day. And so that's kind of the program that, that we're running now. And I'll, uh, add in that we've brought in a bunch of other kind of health experts and also experts in tools like motivational interviewing to make our program even stronger and improve it over time.
How did you identify, you know, what the program should be. You know, early on, it was really about let's follow this UCF [00:22:00] model. Let's take a digital and let's provide the UCF training to each of our coaches. Let's provide it for the period of time that a lot of the research, um, shows because they have a lot of great evidence backed studies, randomized control trials, showing that this works, and then let's just do it remotely instead of doing it in person, because we know that, that it can reach more people.
So we started, uh, really based on the evidence and we've built from there. And I think, um, you know, the other piece is. When we were doing that, our very first patients, uh, I was coaching. I am a USCSF certified health coach. So I was in the clinic in person, coaching them with like this, this piece of paper, uh, that was our health coaching sheet and helping them talk through things.
Um, I am a. Decent Spanish speaker. A lot of it was in Spanish, uh, and that was our first set of interactions was just month one. Like, let's see if we can help people make progress on this condition. And then over time, you know, we tried text-based coaching, but we saw that the text only probably didn't really provide the level of connection that we wanted.
So we switched to calls instead. And we also switched to, okay, what if we don't do any in-person meetings? Does that work? And so over time, we've really just evolved from that first in the clinic in-person conversation, where we were meeting with someone into this digital model where we're able to work fully remotely, um, with across states, but still build that same level of connection and trust that we had, uh, in those first early visits.
Yeah. It sounds like you're pretty right now, at least laser focused on diabetes specifically. Is that right? Or is that a misconnect. We are focused on, on diabetes. And you know, that originally came because a lot of our clinic partners just see diabetes as a really kind of key issue. But diabetes is just one of many chronic conditions, not only that we want to impact, but also that our [00:24:00] patients currently have that they're struggling with.
And so even as part of diabetes, we're having conversations about chronic pain and we're having conversations about, you know, some of the mental health challenges that, that patients are struggling with. And so diabetes, I would say is our entry point into a larger conversation of really trusting someone to talk about these health issues that are holding you back.
And so we're hoping to grow into more directly supporting hypertension, high blood pressure and other conditions, but that's kind of where we're starting at the moment. It seems like directly or indirectly, you have a very user centered design approach to the whole thing. Can you talk about that a bit more and kind of how you see that continuing to influence them?
Absolutely. I would call myself a enthusiastic and relatively unskilled user center design person. Exactly. Yeah, exactly. Yeah. You got to start somewhere. I was such an analytical problem solver before business school. Then I went to business school and I thought I would continue with this logic based approach.
And I took one class from the design school at Stanford and it completely blew my mind. I just in week one, I wrote. Even though I had sold myself as knowing what design thinking was. I didn't know anything about it. And by week 10, which is the end of the class, I had put so many hours in and just felt like I had this new ability to use empathy and creativity to solve problems that I had never had before.
So I think that has been a constant, constant, like part of how we do things and how we've built things at coach me. And so that is why I was the first coach it's I wanted to understand firsthand are we providing a solution? That's truly like meeting the needs of the people that we work with. And, um, you know, one of the first people I worked with was one of the more motivated of my early clients ended up by the end of the [00:26:00] time that we worked together in our program, she reversed her diabetes.
She had diabetes ahead of time. And then she ended up in the pre-diabetes range. And, you know, when I asked. What did you, uh, appreciate about our program? Like, you know, what, what, what was the experience like for you? She just said, when you're diabetic, it's like someone puts a sticker on you and you just have to walk around with this sticker.
That always says I'm a diabetic first. Like I can't escape this. And through this program, you took off the stickers. And I'm will be internally grateful for just escaping this label that I thought I had to live with forever. And I think, you know, beyond, um, the health impact of, of river reversing your diabetes, which is, you know, huge in terms of years lived and your just your ability to really be there for your kids, your grandkids, just having someone have that personal impact of escaping this label that had been put really stood out to me.
And I think things like that have driven every stage of our development process. Now, I think a lot of our user centered development comes from doing relatively, you know, qualitative feedback on a regular basis from the patients we work with. And also just deferring a lot of the internal decision-making that we have to our coaches who are closest to the patients that we work with.
Um, but early on, I think having those early kind of touch points really helped inform me around what the solution needed to. Uh, how are you guys funded and how do you see that scaling out over time? Yeah, so we received early support. I was actually a Stanford social innovation fellow. So when I graduated from the business school, I was one of two graduating students that received, um, funding to launch a nonprofit, which was coach me.
And so I pitched a perfect model with perfect, huge scaled growth cause it's business school. So you have to show up, I'm going to change everything in one year and then nothing goes as you think it will. So, [00:28:00] uh, I'm glad that Stanford understood that too. Um, but yeah, so that's, that was the initial funding.
And then I raised some follow on funding. I was part of the fast-forward accelerator, which was a huge support. If there's any tech nonprofits out there, let's do this, I really encourage you to apply. Um, and then some additional kind of foundation funding from the California endowment gave us a grant, some individual funders that have been hugely supportive.
And I think what's, you know, exciting. A lot of what we're doing is taking what we see as the best of tech innovation and bringing it to people on Medicaid. And so I've been really lucky to have some aligned funders who just see that, you know, we are looking to solve this big systems problem of how do you work with the healthcare system and build technology.
That's not just for people, but build it with the partners. And so we've had people who are. For us to solve that problem and think about scale, um, through this big complex system, but one that if we, you know, solve and, uh, figure it all out, there's just such a huge potential for this to be an embedded change.
And so that's our kind of early funding. We've had a few, a little bit of earned revenue through projects that we've done. And then going forward, we're hoping to transition to a kind of sustainable earned revenue model, where we're finding a way to, um, either build directly to the health care system, or also earn some revenue from some of the services we provide, uh, just so that we can continue doing the coaching.
We want to do providing that and then really covering our costs so we can reach more people. We don't have to go too far down the rabbit hole, but I'm curious about, you know, what your personal experience was like through, through some of those growing pains, as well as you know, how you had conversations with, with donors and foundations.
About the challenges that you faced through the growing? Yes. Uh, absolutely. Nothing goes. Do you think it will help? I would say early on like, you know, we got our first clinic partnership and I just [00:30:00] thought. Bang down the doors to come sign up for our service and then no one was banging and we were trying to do some outreach and no one was really answering.
And so to your question about user-centered design, we did some interviews pretty early on where we just said, why did you not say yes to this? Like we know that, you know, once you're in, you'll like it. So what happened? And people just said, you know, I was afraid that it costs. And I said, oh, we really marketed that it would be free.
And they said, you know, I'm just so afraid of being charged anything at all that I thought I'd show up to the clinic in a few months and they'd have a bill for me and I wouldn't be able to pay it. And so that really influenced how we do recruitment and how we talk about like, why the program is free.
That we're a nonprofit. And I think just little insights like that, God instantly helped us get through the barriers of like what is really holding people back. And so I think all that to say that slowed us down a little bit when no one was gagging down the doors to get to our program, but also helped us build the better kind of recruitment model we have now.
And I think, you know, the thing about funders that I've seen, I, I would be curious to swap stories with other people who joined this podcast, but I've just seen, I am always more worried about the progress we're making than the funders are that we are working with. If we're providing. Honest updates. And if I am sharing the insight of what's happening and how hard I'm working on this problem and showing kind of the step-by-step, I would say, you know, funders are that, that we've had the privilege of being part of this.
Like they get that. There's a lot of things to figure out and that you're doing something that's never been done before. And that there's many steps. And, and, you know, even when I've gone back to some funders, it's been great to have them say, Hey, you should talk to this other organization. Cause they had a similar problem.
Maybe they can help you figure it out. And so one of my biggest lessons, I would say since launching is just, how do [00:32:00] I not think I have to do everything alone? How do I go back to the supporters I have, whether that's a funder or an advisor, or even just other, um, organizations that care about this issue and how do I rely on them to help me solve some of these problems?
Because I think that's the shared impact is, is really where it all comes from much more than, you know, trying to own and do everything early on. And I would say if you're early in your career, it can feel like you need to take it all on your shoulders. But you know, working with others is really where it's at hidden charges hospital.
Transparency has been a real topic of conversation lately just in the healthcare space in general. And I'm wondering, I've been fortunate not to have to deal with this personally, but I'm aware that, you know, you go for something seemingly minor, potentially let alone something major. And there's all these like random charges that you just weren't aware of.
I'm wondering, how does that influence actual outcomes from. When I hear hidden charges, I think of trust with the system and jumping up on a high horse that I don't know if I have the position to be on right now. I think, you know, when I look at, uh, the most relevant part of this right now is the COVID vaccine and how, you know, people of color because of missing misinformation, spread on Facebook and on other social media platforms, aren't getting the vaccine at the same rates and that the response is really some communities mobilizing to do more door to door outreach, to dispel some of those myths.
And I think when I look at this health equity system and kind of this whole topic of health equity, and then where the healthcare system comes in, I just see that there's such a gap in kind of the resources and the support that healthcare providers are able to provide through what they do with their limited interaction.
With patients and then the need to, to have that trust, to feel like they can go to the physician when they need to, and they won't have to pay extra. And I think there's a lack of transparency. I mean, you using the exact right word, a lack [00:34:00] of transparency. Um, because as a provider side, there's no real incentive to provide that transparency.
There's no benefit. And so in a system that's so strapped for resources, it's very hard to prioritize building that trust, making sure people know that there isn't any hidden charge. And, you know, even my family member that I mentioned who came out of the hospital recently, they got a letter from a kidney doctor, which is kidney complications are, are really big when you have diabetes.
And the initial reaction from my family was like, is this. Are they going to try to bill me for more money? And we're so used to that happening in the financial space. I don't know, you know, why we should think less of that threat in other spaces. And so it's really real that like building that trust is kind of a missing piece in the healthcare system.
You know, it just strikes me that it's, it's a, it's an alignment issue because if your objective as a healthcare provider is to create good health, then then having trust in your own system would lead to better health and wellness outcomes for patients. I think they are probably incentive to do that. A real-world example of that is a CVS pharmacy a few years ago.
I mean, their mission statement is something I don't, I forget what it is hand, but it's something around creating good health, right? So they made the choice. Some years ago to stop selling cigarettes in all of their drugstores. And it's a, short-term hit on profits for them, but their stock ended up going, going up and actually they're wildly more profitable now than they were before.
So I'm just wondering if you'd agree with that. You know, that there really isn't a sentiment in sort of a longterm thinking model versus like a quarter to quarter model and what you, what you think the access point might be. If any, to help large providers find a path to transparency where they actually do see that they're incentivized to do that.
I love that point, like the CVS example. And I agree that in the [00:36:00] longterm, everyone agrees everyone's onboard. You know, we need value-based care. We need to take care of everyone. We need population health. Um, and I think where it breaks down is the longterm versus the short term of I'm getting a hundred people calling me about flu vaccines every day.
And probably a lot of them right now are these like, you know, wealthier patients that want to show up at my community health center. What do I do about that? So there's this influx in the short-term that breaks down the ability for providers to provide that access. Um, so I think you're right. And I think the transparency is probably just.
It's exactly what we experienced, which is like, you don't even know that that is the blocking factor for people, unless it's your explicit goal to be inclusive and get every single possible person who could come into your clinic to come into your clinic. And the providers we work with, they have. You know, an endless stream of people coming into their clinic, looking for care.
And so the, the capacity that they have to do that extra outreach and say, here's everything you need to know. Let's put it all online. Let's be open about it. It's just not currently part of the kind of model of what they get paid for what they have, uh, you know, from a financial perspective in the short term, where they are able to help, you know, raise the funds really to pay for those providers to then deliver the high quality care that's required of them.
So I think, um, you're right, that the more these bigger systems such as, you know, the health plans, the health insurance companies start making long-term investments that, oh, we actually need to. Target people earlier on in their diabetes care before they end up in a late stage where they're, you know, going cycling in and out of the hospital constantly, the more they make those investments, the better their really margins will be.
And the better all of our health will be. And that's where we're trying to target is making that case. That that's, that's something that [00:38:00] needs to happen early. You're right. About the alignment I in business school, I spent a lot of time arguing that, uh, we should get rid of the short term, uh, reporting for, for corporations, how bad short-termism.
This is a big thing in the financial world is, uh, for even our, you know, even a lot of companies in the financial world. So I I'm with you on the dangers of short-termism sort of use your phrasing though. I feel like that's something everybody knows, but for some reason there's no change. If everybody knows it.
Why, why is nobody actually making the change? I'm wondering if you have any thoughts around the block.
While we're on the call here. Well, a good question. Now there are people making change. It's like, look for bright spots, amidst the darkness. I think that's what we're trying to do. So aligning with physicians that are really pushing this forward and saying, it doesn't have to be this way, we can do this better.
Um, and so we've started to find those people who are pushing for that change. Um, and then I think, uh, you know, in terms of, uh, why healthcare isn't changing, there are just such big, like structures in place that are keeping it the way it is. And a lot of that is federal level government, like federal level, state level government, the way that these systems are paid and it is coming, it is slow.
It is policy change, but I think it's slowly happening. We're moving towards. A better system. And you know, one thing that we really see is just, there are so many levels in healthcare. It's so easy to lose that design thinking mindset at every level of the system. So I talked to a colleague who works at a CMS, who's the big healthcare government system.
And she said, you know, we actually tried to do some design thinking and we talked to some patients on Medicaid and we realized [00:40:00] they think the star system that we rate health plans on, they kind of think that's insulting because star ratings are, you know, why do I need stars for my health? It should be something more professional than that.
But that kind of like direct feedback from the patient is so, so rare. Whether that's providers directly asking patients, what did you think of the care I provided or insurance companies asking or the federal government asking? You know, I've seen healthcare bills that come out that say, we don't actually know if low income patients have Felton's.
That's a big pushback. We got when we were initially pitching this work. And, uh, the answer is that almost everyone has smoked phones. Most people have smartphones, but what's missing is do they have the tech literacy and the digital skills to actually use those phones in order to access telehealth? And I think this is also kind of something we've seen is that if you walk people through those onboarding steps, one by one and help them navigate that people can use video calls to talk to their doctor.
It just takes a little more handheld holding for people who have never done that before. Um, and you know, who need a little bit more support to, to get to the point where they're able to use that technology. It's good to hear you say. I think that, um, it's sort of an inertia complexity problem, um, versus like, you know, this intentional sort of discrimination and, um, abuse of power, I guess on behalf of the larger.
Mm. Yeah. I mean, I think I'm not like talking about the historic, just like racism, inequity in our country that affects everyone that affects how any person, you know, uh, does their job takes care of patients. The fact that if you're, you know, a black doctor. Just one of 7% of doctors that are black, but if you're a person on Medicaid, 35% of people on Medicaid are black.
And so your chances of seeing a [00:42:00] doctor who looks like you, that you can trust are just so solo and really disproportionately low compared to other groups. And so I think, um, I cannot deny that there's real, real reasons for this like systematic mistrust and distrust of the system that, uh, you know, I think what you're hearing and what I'm saying is I really do believe everyone is doing their best and like trying their hardest, but you know, just the context and the system that we work within is, is meaning that, you know, some people are viewed as assets to that system and worth investing in and some Americans.
You know, I kind of talked about this earlier, but some Americans are viewed as not worthy of investment and they're not assets to the system. And I think, you know, that is where we see. Every day that the patients we work with have so much to offer and so much motivation and potential, and that to be told by the world, I think this is even true with chronic disease.
If you have type two diabetes, people are essentially telling you, like you got this because you ate like crap and now you're fat and now you, you know, deserve this condition. And that is not true at all. First of all, like there's a huge genetic disposition to having type two diabetes. And so there's so much that's out of your control and then beyond.
I think the conspiracy theory that I believe it is why don't we talk about how, you know, there's the ability to use your lifestyle choices to change so many of these conditions, you can reverse your type two diabetes. If you look at the, you know, some of the Ornish model or even the keto diet, there are people who are doing it every single day, and that's so true for other conditions as well.
And it, you know, there's the potential for, to influence Alzheimer's and all of these seemingly intractable conditions. And so I think, you know, where I'm motivated to [00:44:00] remove that shame is around helping people feel like you're not a failure. If you have a chronic condition and you, you do have hope. And so I think, you know, that's where for me, like the work we do is really about it is about the health, but at the end of the day, it's about that whole.
You mentioned that your mother was sort of early on in the Obamacare, uh, set up and research. I'm curious just to hear your take on like the one payer system on government, subsidized healthcare and kind of what you see is the future of healthcare in this country. Whether it's whether it is a resurgence of Obamacare or whether it's something else.
Yeah, well, I am not your ultimate health policy expert, but as, as my lay person, couch, couch observer, uh, I will say that, you know, best case for the U S to save money on health costs and deliver better care would be some sort of. Single payer system. And, you know, if you look at the UK, that doesn't necessarily mean that individual providers would be employed by the government.
It just means that we would say, Hey, we're going to pay as the federal government for all of the care that gets provided so that we can choose where to prioritize care and not. And then providers would still be, you know, capitalists, independent, uh, you know, people that are billing much like our Medicare system works today.
Um, so I think that to me feels like a win. And I think there's so many permutations of that in other countries like Germany or like Switzerland, where they just have much better outcomes and much lower healthcare costs that we could learn from. What I love about Obamacare is it took the ACA, it took what we have now and said, how do we patch work, add on to that in order to turn it into something that's as close to, you know, these more, um, kind of universal systems as possible.
And I think you're seeing you're, you're exactly right. It kind of paused under Trump. You're seeing some exciting, um, rollouts right now, of things that were part of the ACA. So the patient access provision, as of later this year, everyone will have access to their own health records through an [00:46:00] API that's provided by your health insurer.
And that's a, that's required by law. It's going to be be there in July. And so that's something that, again, it took longer than we thought first, we had to get all the hospitals on healthcare. You know, we paid a lot of money to get all the hospitals to have digital records, and now we're making it accessible, but it's happening.
And I think there's further kind of rollouts that will continue to advance that ACA work. Um, you know, I think one thing that someone in the health policy space told me was that. ACA 70% of what was in that bill were fixes that we knew we needed to make in healthcare for the last 40 years. Because before the ACA we hadn't passed health reform and 40 or 50 years, it made it an amazing achievement that.
Got passed at the beginning of Obama's term. And then so many of those things like the preexisting access for preexisting conditions, we just, all sides agree that it needed to happen for a long time. And so, you know, that is so exciting of how far it leaped. It really took us forward as a country in terms of the health care we're providing.
Um, and then I think, you know, there's some pieces related to what we do such as Medicaid expansion, or that was originally expected for all states. Now, um, about two thirds of states have expanded Medicaid to make healthy adults part of their Medicaid program. And we would love to see that happen for everyone.
To us. It's a no brainer that if you want to keep people out of the emergency room, keep people, you know, give people a consistent source of care, get them covered, get them some insurance. But I think, you know, ACA, I would say will have a long tail effect where with Biden being an office now, and also with some of the coming changes that are happening, we're moving in the right direction.
And one of my personal mottos is progress, not perfection. And I would say that applies to everything in healthcare, but, um, is maybe a good, a good saying for the ACA and kind of progress on some of the policies. I want to circle [00:48:00] back to fast forward. Uh, you know, how did you discover fast forward? What about what you were working on appealed to them and made, made them think you guys were a good fit for the program and what'd you guys get out of it?
Yeah. Um, yeah, fast forward again. It was a great experience. It was early on for us. So we were in the first stages of launching and I think what appealed to them in applying was just this. Maybe the big vision of even from day one, when I was in the clinic, you know, um, health coaching people, I was fully committed that we're going to reach a million patients on Medicaid, and we're going to have a huge impact on health equity.
And we're going to do it as a tech non-profit that is really committed to finding ways to scale while, while designing around accessibility and inclusion. So I think that was one piece, um, in terms of what brought us into the program and, you know, healthcare can be a hard place to make a tech non-profit at times just because there's a lot out there.
So maybe it was the audacity that, uh, got them excited. And then on our side, you know, I was so excited to have, um, uh, a community of really mission-driven people. Um, like Lisa, who you talked to before, who were just talking about these social issues, but also at the combination of how do we use tech to solve them and, you know, coming out of business school, I think there's so much focus on how do I use tech to solve problems that has an, just a ever turn up into the right, in terms of profit and, uh, and having a huge return financially.
And it fast-forward, it was people who were looking for up into the right, but the return was impact, not the return on financials. And so I think seeing just that crew of people that we got to be part of the program with also the financial support that fast-forward provided and then the access to mentors was all huge value adds for the program.
And, you know, I remember early on having a conversation with Shannon who leads the [00:50:00] program. And I was telling her some, uh, challenge that we were going through and how to orient our product. And she just said, look inside your heart. Like, what are you, why are you in this? Who are you doing this for? And how do you build this around the patient?
And I've never forgotten that advice. I think anytime I'm facing a tough decision, I always try to look inside my heart. And I think having that encouragement from a nonprofit, you know, a nonprofit organization that's helping spur nonprofits forward has really kept us mission aligned over time. Yeah.
It's even clear just from the branding of coach me. I would say that, that you're, you know, you're, you're trying to balance those two ideas. Was that intentional or was it just kind of a natural by-product of the work? Like how do you think about that balance in your own mind and how does. Uh, apply to the, you know, the work that you ended up doing on a day-to-day basis.
What I think of, and I still, I stole this from one acre fund when I got to one acre fund, their, one of their mottoes is farmers first. And so I got to an acre fund and I had worked in health tech. And so I had this cool idea for using SMS to engage farmers in some new solution. And the ops manager just said to me, like, love this idea, how will this help farmers?
And I was like, oh, I hadn't, I hadn't thought about how it would help farmers. That's a great question. And so I think like day to day within the team, the question is like any product improvement we make, how will this help patients? And, you know, the one thing I've learned about solving systems issues, as much as I can speak to this it's that if you're really going to address some big system to help patients, you also have to find ways to help every other part of the system.
So, you know, our internal goals I can share with you our first, it was to make patients love us. And now we're making providers love us. And then next we're going to make health plans love us. And so the idea is to, you know, provide what we're doing by. Being patient first, as you said, it helps every part of the healthcare system, but we have to have the language to communicate that in the way that [00:52:00] people will understand it.
And so you'll see our current kind of website and branding is a little bit more geared towards the healthcare system. That's going to help us reach those patients. And it's going to help, you know, scale the work we need eight websites. I think, I think that's the answer. Can you give us a little elevator pitch on one acre fund?
You know, tell us kind of what it is and why you think it's so impactful. So one acre fund, I'm glad you asked that. So they're a, you know, social enterprise based in east Africa and it was. You know, started with a mission to help low-income small holder farmers grow their way out of poverty. And so they have kind of a three pronged model to do that.
They work directly with farm families in rural parts of east Africa, but also now India and west Africa. And they have a three-pronged model that involves helping people learn modern planting techniques, access, improved seed, and fertilizer, and then accessing markets where they can sell those products.
And while I was working at one acre fund, we were seeing in the Kenya program, really a doubling of income in a year. So a farmer would go from earning something like, you know, maybe $300 a year on their crops to making potentially 600 a year. Can you imagine. $300 a year for all of the crops that you've worked all year to grow.
Um, it's mind blowing to me. And so that doubling of income was just huge for the farm families that we worked with, whether that meant to send kids to school or to, you know, Pay for an expansion of the farm or make some investment that was important to them. And you know what I loved about the one acre fund model, there's a lot of conversation about micro finance and is micro finance good or not.
And what one acre fund was doing was asset based microfinance. So how do we both give people those loans that they pay back over time, but also give them the tools they need to be successful. And so we had field officers that were meeting weekly with farmers in the field to provide training really this [00:54:00] high touch model that was giving people not only that funding, but then also the, you know, the actual kind of tooling to be successful.
And they've grown a lot, right? When I was, I ran health programs for one-acre fund. So I wasn't directly at, into the agricultural work, but you know, they've moved into, uh, supporting child nutrition and they've moved into realizing, wow, we have this network now. I think they reached a million farm families, um, about a year ago.
And so now they're saying, how do we. Incredible network of a million farm families in rural areas and get out other impactful solutions like solar lamps and like nutrition programs and things like that. Um, and so I'm such a big, you know, um, fan of the organization. Andrew you and who founded it is a huge personal role model for me and has been a supporter over time.
And so I will plug one of your fund whenever you want me to. Are they based here? Are they like where's our home office. Okay. Yeah. So they do have a us office in New York, but actually the headquarters is I think, officially in Rwanda. Um, one thing I really admire and influenced me was, um, that a lot of the top leaders in the organization are actually based in the field.
So not even in the, the cities, uh, so like Nairobi the capital of Kenya, but actually field-based, um, senior leadership. And so Andrew himself is based in Rwanda. Um, and I know that with COVID and all the challenges, they see a huge, um, kind of threat around agriculture and making sure that there's the kind of food available, uh, in order to keep and prevent famine happening.
So they're really thinking a lot about that, right. For coach meat. Um, how are you guys tracking your impact? I mean, how do you measure. Yeah, so we are tracking our impact on, you know, I would say, I always think of impact in terms of the number of people served and then the depth [00:56:00] of serving and the depth of impact that we're having per individual.
So on the numbers basis, we're tracking health outcomes. So we're trying to understand. The period that people are working with us. Are they measuring? Are they improving their diabetes from a clinical basis? So for diabetes, you measure A1C. We also measure daily glucose numbers. And so we're able to see on a daily basis, are you making changes to improve your condition?
And that ends up being a good predictor of those longer-term clinical measures. And then I think on T layered on top of that is just people sharing. You know, what were the impacts of us working with you? So when people say, you know, from my coach, I learned these communication skills, and now I'm coaching all of my family back in Mexico on how to improve their disease.
That's something that touches us personally, and that maybe is a little harder to measure, but we know that sometimes the impact can go beyond that direct measure that we look. Um, and then in terms of our current work, we're actually running a randomized controlled trial with a group in Indiana to try to understand versus a control group of low-income patients who are working with us.
What's the tangible impact that we can measure. And that's both, both in terms of the health outcomes, but also hopefully the financial outcomes of how does this, you know, does this have an impact on the healthcare system and how much money it can be saved by putting people? And we talked about earlier health for all and health earlier in the process.
So that's some of the ways that we looked at measuring impact. Was it a huge investment or was it something that you were able to figure out how to do given your, your size and stage of development? Definitely an investment of some sort. But I think in healthcare, I think it might be specifically unique to healthcare, but in healthcare, like control groups and randomized controlled trials are the way to show that something is effective.
And so we were lucky enough to find actually an aligned physician who came to us and said, Hey, I'm in this fellowship post. Um, you know, after becoming certified as a physician would [00:58:00] love to do a project with you where we show that this could have an impact to the clinic I work at. And so kudos to that physician because she has driven all of the backend of submitting to IRB, of getting all the approvals of setting up the labs.
It has been. Huge uplift on her part. And then on our side, you know, being the partner that could be adaptive, respond to the needs there. So I would say like with most things like finding the right partner who knows how to set up this trial has been critical for us. And then even right now, what we're working on is how do we publish this study in a way that can really get the word out there and get this disseminated.
And that is a whole nother can of worms. I didn't even realize is a thing. So I'm working on like going back to Stanford, where I have some connections to leverage some linkages there and just finding people who are really generous. People who are committed to our mission, who are volunteering their time to help make it happen.
Yeah. That's really interesting. I agree with you. I think, you know, culturally, it's something that's just a part of healthcare in general, but I feel like organizations outside of healthcare could figure out ways of. Of doing a trial like that for whatever their area of impact is. Yeah, no. And it's, I mean, I'm think for us, it's going to be such an amazing opportunity to learn the impact, but also to have more rigorous data around what is driving our impact for different individuals in our program.
Do you have plans like to do studies that are more longitudinal, you know, 10 years check-in on how patients are doing that kind of thing? Not yet, but I've been thinking more, you know, we want to have a coach me. Alumni group of every patient that's ever been through our program, like getting to continue to be connected to things.
So I think you're giving me some good ideas. Um, what we're looking at right now is people who are part of the program can continue to track their glucose numbers with us, um, at no cost on an ongoing basis to help just continue [01:00:00] the management of their condition. And we have a few people who have been on that tracker for about anywhere from six to 12 months at this point.
So what we're interested in trying to understand is, you know, can we potentially have just a long-term measure of, are there, is there health continuing to improve over time? And then from a clinical perspective, also going back to our clinic partners and just seeing, Hey, is this make, is this moving in the right direction?
Are we continuing to see people improve their condition beyond the time that we get to work with them? What's next for you? And. So, yeah, we are currently working on building partnerships with health plans to really help us reach a bigger scale. So we have some early evidence, we're getting some more validated clinical evidence with our randomized control trial.
And then we're hoping to reach, you know, a thousand patients by the end of this year, through working directly with health plans and really deepening our impact on each patient we work with by continuing to improve our program. And so, um, we're excited about how those conversations are going and really finding partners that are aligned with the, the impact that we're trying to have.
Um, and just excited to, to reach more people and think more about how we, you know, use our technology to bring this to scale. What do you think is the most important cause humanity can be addressing right now. W we have to say climate change right. Has been the most common answer so far. Yeah. Yeah. That would be my first thing.
I think the other one to me is just. Outside of healthcare. Uh, The, the criminal justice system remains one of the top things that I think about on a regular basis. And even the deeper I go into understanding, um, kind of human behavior and behavior change and, and, and mental health and all of these things.
The more I realize how deeply unfair it is that we keep people locked in a cage for their entire lives based on what. Choice that they [01:02:00] make at some point based on a series of like events and external circumstances that happen to them. And so I think, and, and the fact that it affects, you know, our black and brown Americans, more than anyone else just feels so deeply, deeply unfair.
And, you know, I think there's been a, like such a, a meaningful focus on that in the last few years. And it remains something that if I could wave one magic wand, like I wish I could just fix that for our country and get us to a place of really compassion and healing and just a better way to, um, you know, help people regain a place in society and really be an active part of contributing to our side society, as opposed to being seen as people who are taken away from it.
I wonder if. Through coach me. There's an opportunity there. Have you, have you thought about engaging prison clinics and things like that? And it's such a good point. I haven't, we haven't thought much about it, but I think I'd love to think about how we could have some ability to help out the people who are in the prison system.
And, you know, I advise a little bit of startup that is working on people who are recently released from prison, helping them get access to Medi-Cal. So get on onto health insurance quickly because often there's just a gap that hap that happens there when you leave the prison clinic system. So we'd love to see more solutions and more like overlap between those spaces.
What would you like to have accomplished when you look back? It's like, well, it's like one or two things real. Like if you look back on your career, it's like, Hey, we, you know, uh, accomplished something really meaningful. Yeah. My personal goal that I think about every day is to change the lives of a million Americans on Medicaid and.
That can be through coach me. It could be through, you know, playing in the health policy space and making a piece of policy that really I know from the work we've done here will, [01:04:00] will make a tangible impact on lives. And I think if I look back, you know, at the end of my career, if I can do that right now, that would be enough.
That would be something that I could be proud of and feel like I was able to do something beyond, you know, to make the best use of the resources that were given to me. But. I've got time left. So who knows once I do that, who knows where it'll go, but I think, you know, that's the one that comes to mind.
And then the other one that I always think about is how do I do it with a community that's like diverse and connected. So, um, really having a network around me, I always think about who do I want at my funeral? And I don't want it to be just people who look like me. I want it to be bringing together people who are from all different backgrounds and, and really feel like they're connected to me, um, because of who I am and not what I look like and that kind of thing.
The million is a wonderful goal. I, I have a sneaking suspicion. You may have to revise that at some point in the near future. Uh, so along those lines, give us a plug. How can people support what you're doing and, uh, you know, coach me and the project. Yeah, absolutely. Um, you know, would love to talk to anyone who's interested in supporting us with donations.
You can make a donation at our website, www.coach, me health.org. Also, we're always looking for a range of skilled volunteers that are interested in helping us get smarter at data, helping out with engineering, helping out with marketing, any piece where you feel like you're the expert and want to really make progress and help us make progress towards health equity.
Um, and then if you're a provider in the healthcare system and working with low-income patients, we'd also love to hear from you and see if there's a way that we can support your work and give you a tool kind of beyond the clinic or beyond the office to help, um, support patients with diabetes. So [01:06:00] get in touch, you can find our info on the website and always feel free to reach out to me directly.
As, as a young founder, what, what advice would you give to someone else? Just starting out on the entrepreneurial journey? Uh, thinking of starting their own organization first, I'd say I've learned so much through experience and you will too, and that's okay. Just take it day by day, learn from what's happening to you.
You know, just listen to what people say and accept what's comes. So I think that's the first thing I would say. And then I think the other thing is just know that you are not alone on this journey and I would really encourage you to find other aligned partners, uh, that want to support you, work with you that want to join your team.
Like really. Even though you care deeply about this social issue and, and have your vision of how to support it, the way that you're going to truly achieve it is by bringing a team together that can help you get there. And so spend time early on building that team of people who are in it with you and your journey will be so much more fun.
Um, first of all, thank you very much for your time and the insights and sharing your story. I really appreciate it. I think it will add a lot of value, I think, to the audience. And please come back anytime. We'd love to continue this conversation. Talk about, you know, dive deeper into some of the issues that we've not had a chance to dive deep on and, uh, certainly share any updates that you guys have a coach me as you hit announcements or inflection points or new challenges who knows.
We'd love to, uh, talk through it in a podcast or, you know, again, this is sort of what I love doing. So, uh, if there's any way I can support you guys directly in the work that you're doing, please don't be shy. Oh, well, I so appreciate that. And I, I heard from your, the way you think today, just how much you're thinking about what's the thing I can do to support organizations.
And then how can I help people understand how to have the most social impact with the giving that they're doing or founding their own social enterprise. And I so value, I think that's a needed voice in the space. So because it is [01:08:00] really important to help people, you know, uh, just have more guides of how to make some of these decisions for themselves and then work on these big issues that we need more people working on.
We need more, more smart people working on the, for sure on the big issues. There are a lot of us out there, but, uh, always need more help so much. Absolutely. Thanks so much, Karen, this has been a great conversation. I've really enjoyed getting to know you a little bit and hope to continue the conversation over time.
So good luck. Same here, Mike. Thanks so much. We hope you enjoyed meeting Karen and getting to know Verano health as much as we did, and we look forward to introducing you to more startup founders. As the podcast grows, please join us next time when our guest will be Larry ghast. Larry is the VP of development at Moisha house international and international non-profit organization.
That creates meaningful, welcoming communities for Jewish adults in a post-college world. Larry and I met originally on a 10 day trip to India with his previous organism. The joint Jewish distribution organization or the joint for short. And I followed his career ever since he has tons of great insights to share, no matter what size your organization is or what cause area you might be working in causing purposes of production and moonshot.co on behalf of myself, Karen and our entire team.
Thanks so much for listening and we look forward to catching up with you again soon.