YouSaid · the spoken record

Zachariah Reitano

lines on the record: 44
first: 2016-12-27
most recent: 2016-12-27
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“We actually have local partnership folks who just work with hospitals and skilled nursing facilities and social workers and community faith-based organizations so that we are really present and can help people where they need care most.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Tying that to a familiar brand actually does instill a lot of trust on behalf of the family and the consumer. So I think continually aligning and also pulling those organizations who have created such knowledge about caregiving for these individuals with specific diseases, those are all mechanisms that really, I think, help but still nothing really replaces a conversation with your doctor.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Since you like trust, it all comes down and all comes down to trust. How do we ensure as much trust as possible for a customer base that might want to pick an agency that has like 10 years of experience?”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“So, in healthcare, rewind 50 years, and there was communities, and you would actually see your physician maybe at the grocery store or at the soccer game. We don't live in that level of society anymore and integration. We live in an online world. And whether it's honor taking it to retail to be in the community or our caregivers in the community or actually being part of a broader sphere of local resources, that's what healthcare actually is. And that's what makes it. Work when it does work, of course”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“So the then really was the fee for service reimbursement system. And the now is value based insurance design. And so the now looks like if I'm a physician, then I'm going to have 30% of my Medicare reimbursement at risk, financially at risk, that in order to earn that 30% Of the 100%, right? So I'm going to get 70% out of the gates, but I have to earn the extra 30% to make myself whole, then I need to reach these quality metrics and these targets. And so putting more responsibility and ownership on the physician and really on the community level, because it is so locally driven. And we all talk about healthcare being local.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“That I can get paid and feel like a really good physician and make a bunch of money. So it's kind of flipping that model on its head and aligning new payment models that actually account for the quality of care based on, you know, maybe 5,000 Medicare beneficiaries that are assigned to you as a physician. And your job is to keep the level of quality the same, but reduce the cost of care over year over year on an annual basis. And so we put forth a lot of initiatives that really introduced this notion and worked with a ton of physicians and hospitals to co-create these models that exist today. But Medicare and Medicaid, I think they do get blamed for a lot of poor policies that have been designed for a time that made sense then and have never been brought up to speed.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I mean, today historically it's been reimbursed not only in a black box as you alluded to from a beneficiary standpoint, but it incented physicians to actually just get more tests, like order more tests. They got paid on the fee for service side. So I order this, I get paid, I order this, I get paid, as opposed to what is the output. Right and the value, and what's the patient experience? And are we actually fundamentally making healthcare better as opposed to just utilizing more of it?”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“I had the fortune of being on the ground floor of the Center for Medicare and Medicaid Innovation, which was formed as a result of the passage of the Affordable Care Act. And we had this unique authority and we had $10 billion over 10 years to really transform the way Medicare and Medicaid was reimbursed and kind of to dispel.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“When I think of Medicare, like when my parents were old enough to get Medicare, it felt like a very like a black box. We're not exposed to it. And as it is, it's a very confusing labyrinth thing to understand. And you come from the centers originally, from the Centers for Medicare and Medicaid Innovation. Talk to me about that.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“We actually hip a compliant. Then, you know, fine, I have all this experience on Medicare and Medicaid in United Health Group and all the clunkiness, truly clunkiness of healthcare. And it's so refreshing to be on this side of the table and really partnering with organizations who are bound by the bureaucratic processes of the healthcare system because of how they're reimbursed, whereas we are not. When I'm talking to hospital CEOs and other folks that are truly understand kind of this transition to value-based care, it's awesome.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, kind of riffing on the notion of this HIPAA complexity and being HIPAA compliant. I remember one of my first days at Honor, I went to Cam, one of the co-founders and lead engineers, and I said, we need to fill out this data security form for this hospital that I want to partner with. And he looked at that and I said, oh, do you think we can have this done in like six months, right? Because that was the timeframe I was used to from my other employers. And he's like, we could have this done tomorrow. Really speaks to actually how we can transform the space in a quicker, more reliable manner than kind of the cluckiness of the general system”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“I would say it's a combination of factors since now we have a lot of really talented folks who come from either the care side or the health system side. But it's like most of the founding team did not have an experience in caregiving whatsoever. That's definitely a benefit to some point, right? Because you don't have specific biases that people in the field might have had for a long time.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“To try to provide that, and that's an add on. Yeah, that's what we concluded when we started out. There are so many problems that we need to start completely from scratch. Like every little interaction needs to be done in a different way on all fronts. If not, it's like we can't keep putting patches on an already broken system.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, and then part of that fragmentation that also works in our, how do they call it, and our advantage is the fact that we have the possibility to not only open up the market, consolidate, and improve the user experience altogether, but also we have the possibility to grow with newer generations as like a trustworthy new brand that grows with them. For their needs as they age”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I mean, what's interesting about it as well is that it's a systemic problem because of the fragmentation that'd be so difficult to solve structurally. I'm not one to actually substitute software for structural solutions necessarily. But because the software can play this role where you can cut across all of that. You can sort of solve for that, which is really fascinating.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“It's also like from a user perspective, like the customer is really in a dire situation. It's usually they need help really fast. And it's like very stressful, very emotional time. So it's important that you can give somebody really great personalized care that's actually tailored to what they need.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“I was just thinking when you were talking about even if there's like some kind of yelp. Review system to help you like rate and review the burden is on you to have to do all that research and that work to sort of figure it out.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, but they deliver it in the old fashioned way, which is essentially you get referred to by a medical professional and you get this pamphlet or you pick a pamphlet out of like a hundred different pamphlets that all look the same and they all pretty much offer the same things, which is a very dubious process, very opaque, transparent process about getting a care professional. So once you've decided on which vanilla pamphlet you go for, you call one of those agencies and you get connected with an operator over there. You have some intake appointment and they try to find a caregiver for you. Machine learning software that essentially takes the profile of patients and matches that with the skills and a whole bunch more metadata of our care professionals in order to find the right match.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“It could be any of those things. And we have our frequent utilizers who go back very, very frequently to the hospital, and oftentimes utilize the ER as a source of kind of primary care because there's been no primary care identified for that individual.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“You can't always borrow on past repeated practices to make that easier and scalable. We have an entire generation that's so mobile native. We have different expectations for what you expect in your user experience. You can't just like, no one can afford to dismiss that. When I think about how bad most apps are in the, I mean, hospital websites, like they're terrible.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“You kind of do because if you've seen that software, it's pretty shitty most of the time. I mean, it's like our cell phones are 10 times better than what they have to use. I think this is a really interesting idea to pivot on is that when you are starting something from scratch and you're building, you're literally remaking a system through like this new type of software and then the service you're delivering at the same time, you do have a blank slate and you can kind of invent it. But that means when you're doing things in that first principles way”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Exactly what you get to see the two sides, you get to see the things that we take for granted, like picking up a glass off the table, which is often a very hard feat for customers. But you also see the side of the CarePro who also is working to feed her children, usually wants to pick up her kids from school. So it was like to be able to use what we use in real life and critique that and adapt the way we built that product. That's just really important. It requires like a different level of empathy. I've seen empathy was like the big word or the big trend word.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Most of us have been spending most of our professional lives designing applications behind the screens within offices in front of whiteboards. And those methods are very, it's a very cultural process that doesn't necessarily apply to the problems that we're trying to solve on a larger scale here. So you won't know what a care professional feels like when they're going to a customer unless you actually do that.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“So I actually started my design career at the Dutch Cancer Institute in Amsterdam. I was part of the team that designed electronic patient registries. And that was a time where design and healthcare was not more than an afterthought. So it came at the very last step just to make it a little bit more appealing and user-friendly, I would say. For me as a designer, designer, founder, it's one of the most interesting parts is that we get to redesign the way we deliver healthcare with Tabula Rasa.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“I mean, there are so many. It's pretty obvious that there's many, many, many different complex problems in the industry as a whole. Like there is no way that we can approach this with one perfect solution in mind because that's just going to be impossible. I think one of the biggest challenges that we have as a whole is explaining what home care is in general or what options are available to people who don't necessarily want home care. I mean, there's creating a category or creating like an a light at the end of the tunnel in an industry that's extremely complex. It's been relatively untouched by technology or by high quality design and has been mostly like a reaction to a growing problem rather than something that's been tackled globally from a business”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“But also works on a person who's never used a smartphone for their work in their life. Most of our care professionals haven't used phones in order to do their work. Like there's no Salesforce for caregivers or no Photoshop for caregivers. So it's like most people in Silicon Valley are very used to having all of these amazing tools in order to do their jobs, right? But our care professionals use Facebook. They use WhatsApp. That's about it. So how do you design an interface that collects this super crucial medical information and how do you make that usable for somebody who's never used that before and make sure that it appears at the right moment?”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, HIPAA is not as much as a design challenge as is more an engineering and security challenge, but it's more designing an experience that where the smartphone screen doesn't come in the way of the person-to-person interaction. When our care professionals in the home, we prefer them not to whip out the phone. So how do you design an interface that is fluid, is contextual, mentally pops up at the right without the”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“And the challenge is really big, actually, because we're now collecting very privacy sensitive and super important information, like in the home, because we have all of these care pros going out with smartphones. But the challenges are like, right.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yes, exactly. We actually have the good fortune of being in the home and seeing that and capturing various data points within that. So we actually use our technology platform to capture about five different indicators of health. And this actually really allows us to have increased stickiness with the healthcare kind of system like the hospital and the payers and the clunkiness of it. But we can capture this data and we capture it on sleep, pain, mood, appetite, and bowel movements.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“This meat space, this retail space, one of the things in the healthcare sphere that I think about when I have my healthcare centric hat on is all of the healthcare providers really want insight into the home. They want to know, did that person get out of bed? They want to know is there a rug there that they're going to trip on? Is there fresh food in the home? Who else is?”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“And by the way, I think that's a trend that a lot of all companies will be facing in the design world because you have a lot of online to offline type of seamlessness happening. I think you're going to see that over and over again. Like how do you bring the physical into the digital, the digital back into the physical and keep like sort of reinforcing? The tooth, so they're not like these two separate discrete domains that are sort of interwoven.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Designing the Walmart experience specifically was kind of funny because we went from a completely offline system, right? It's like home care happens completely offline and through the phone and we digitized the core components of that in a good and scalable way, which where we're at right now. And then the trick was to take all of that and bring it back into meat space somehow, which is kind of fascinating.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, yeah, yeah, but we've fed this into the core culture of honor that in order to solve something specifically, whether you're a designer or an engineer, it really doesn't matter. Everybody kind of does this. You really own the subject matter of what you're trying to solve.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Some of them are better designed than others, but they are out there. But also educating people about what home care is, what the possibilities are, not necessarily honor, but just, you know, the aging process. Yes, exactly. It's like what happens when you need a little bit of help, you know, or when you get sick to do this or what solutions are there to your problems? We started a partnership with Walmart where we opened up care education centers inside of specific Walmart stores in Texas. We have Walmart senior products inside of the stores over there that are available for demo and people can just come in and have a chat with us, have a coffee, there's community events happening there as well. We basically help them out with any questions that they have around home care.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, not just that. It's like omitted from the whole process. Like when you have these bracelets that look like huge chunks of plastic around people's necks or arms in order to alert the family when they fall, I mean, of course, that's important and that's a really important case. Fall prevention is an important thing, but it's kind of degrading putting a collar on somebody who's already not very mobile, only for peace of mind of adult children, for example. So there's a lot of”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“And you go there and there's a whole bunch of different brands. I would guess there's a couple of brands specifically tailored at women that are pretty much the same brands as like menstrual products. For men, it's pretty much all over the place. There's no real brands that pop into your mind immediately. But that whole experience is just very, it's just awful. Like there was an older couple sending next to us that was trying to figure out which diapers to get as well. And ultimately, after 10 minutes, ended up not going anything because they just felt awkward standing in front of it too long. And then, you know, once you get to the point where you need to get adult briefs with adult briefs comes diaper rash, for example. But there's no diaper rash cream in the adult diaper section.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“But then once someone does secure this type of care, the activities of daily living, Can include things like helping them take their medications on time, bathing them. Making sure that they get out of bed and that they know exactly what day it is and what time their appointments are and who's coming next. So all of this support that is around them so that they maintain an independence.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Entirely for someone to come into their home So, you know, 70% private pay, and in that other remaining 30%, it's either long term care insurance or medication. So, this is again kind of a classic example of Folks who are in the middle income level of America probably don't have enough savings to pay for this level of care.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“So after people get dispatched from a hospital and go back home, they recover faster in their homes because they are accustomed to that space. It's a comfortable space that they've been living in for years and it's like they feel relaxed there. It's a much better environment than it's like a post op facility or it's like a cold hospital.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“And if you are the sandwich generation, as you describe, where you have younger children and aging parents, I know a lot of folks, and I'm always struck by this because I always ask myself, like, I play this mental game with myself where if my parents had Alzheimer's, like I would never put them in a home. I would take care of them because I love them so much. But the reality is, if you have a young child and you have an elder parent who you care for deeply, but they're forgetting critical things like leaving the stove on and forgetting really important things, or it's actually creating a real palpable sadness in your children. You may have to make tough choices. And I know a number of parents that I've asked this question, especially because they come from the Indian community where it's almost unheard of to put your parents in a retirement home, they say like they had to make a tough choice at a certain point. And it's such a guilt-wrenchingly difficult thing for them to do. I mean, there's so much emotion around these decisions.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“The image that comes to mind for me at one of the things I used to always be struck by when I saw in the Indian community, there's a lot of extended family. I was always struck by how some of the senior citizens would have like a small little suitcase. And it had all their worlds belongings in that one place. And I always wondered, like, how did you go from this huge home into the small little suitcase? And on one hand, there's this very beautiful kind of like free yourself of your material possessions idea behind it where you don't really need all those things. On the other hand, it's very sad to think about having your own home and then having to leave all that behind and then literally like have your life be in like a tiny small little suitcase or a box.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“They personally can't. So then our care, you know, the caregivers, the American people. Whoever they are in the world Guilty that they can't actually provide care to their loved one. In the timeframe that is needed. So the home is really the central place, and it's where the senior wants to be. And we know that 90% of people want to age in their home.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Take it for granted. I think of international, you know, you have like a setup, we have extended families all living like five generations in one house. And here you have a situation where, as you mentioned, like where you have a sandwich generation or you have like kids who are in one city and parents in another. And like the home is the center of it all.”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source
“Care Center for Research in Washington, D.C. First of all, I think that we're facing a really interesting moment in history, both the fact that people are living longer, although some technologists would argue that we need to still stop and halt aging altogether. We're also in an interesting time where because of the mobility of people, they're not in the same systems. And if you could kind of break down like what is the system? I mean, that we're in right now, how does it look?”
2016-12-27 · a16z Podcast · a16z Podcast: The Realities of Aging / When Healthcare Is Local · IDENTIFIED FROM THE TRANSCRIPT · source