Unlock the secrets of transforming healthcare with Jay Desai, the visionary CEO of Bamboo Health and Patient Ping co-founder, in our latest conversation. Embark on a narrative that transcends Jay's leap from policymaking to pioneering entrepreneurship. His insights into the Affordable Care Act's ripple effects reveal how legislation can catalyze industry-wide change, while personal anecdotes peel back the curtain on the drive and resilience essential to innovating in a complex field.
As we journey through the healthcare landscape, Jay helps us tackle the intricate transition from fee-for-service to value-based care, dissecting how this paradigm shift affects everything from provider incentives to patient outcomes. Technology's role in healthcare evolution forms a core part of our discourse, as we juxtapose the slow pace of change against the cutting-edge advancements that are reshaping how care providers connect and coordinate. The tales of challenges and triumphs shared illuminate the realities of steering a company through acquisition, team integration, and the relentless pursuit of impactful growth.
Finally, Jay opens up about the human side of healthcare innovation, from the profound responsibility of creating change to the fulfillment found in working towards a mission-driven goal. We reflect on the balance between intense entrepreneurial efforts and the allure of advisory roles, along with a touch of nostalgia for college days and the ongoing quest for personal and professional satisfaction. This episode offers a candid look at the intersection of healthcare policy, technology, and the entrepreneurial spirit, sure to inspire and inform anyone interested in the future of healthcare.
Bamboo Health - https://bamboohealth.com/
Website: https://www.position2.com/podcast/
Rajiv Parikh: https://www.linkedin.com/in/rajivparikh/
Sandeep Parikh: https://www.instagram.com/sandeepparikh/
Unlock the secrets of transforming healthcare with Jay Desai, the visionary CEO of Bamboo Health and Patient Ping co-founder, in our latest conversation. Embark on a narrative that transcends Jay's leap from policymaking to pioneering entrepreneurship. His insights into the Affordable Care Act's ripple effects reveal how legislation can catalyze industry-wide change, while personal anecdotes peel back the curtain on the drive and resilience essential to innovating in a complex field.
As we journey through the healthcare landscape, Jay helps us tackle the intricate transition from fee-for-service to value-based care, dissecting how this paradigm shift affects everything from provider incentives to patient outcomes. Technology's role in healthcare evolution forms a core part of our discourse, as we juxtapose the slow pace of change against the cutting-edge advancements that are reshaping how care providers connect and coordinate. The tales of challenges and triumphs shared illuminate the realities of steering a company through acquisition, team integration, and the relentless pursuit of impactful growth.
Finally, Jay opens up about the human side of healthcare innovation, from the profound responsibility of creating change to the fulfillment found in working towards a mission-driven goal. We reflect on the balance between intense entrepreneurial efforts and the allure of advisory roles, along with a touch of nostalgia for college days and the ongoing quest for personal and professional satisfaction. This episode offers a candid look at the intersection of healthcare policy, technology, and the entrepreneurial spirit, sure to inspire and inform anyone interested in the future of healthcare.
Bamboo Health - https://bamboohealth.com/
Website: https://www.position2.com/podcast/
Rajiv Parikh: https://www.linkedin.com/in/rajivparikh/
Sandeep Parikh: https://www.instagram.com/sandeepparikh/
Hello and welcome to the Spark of Ages podcast, where we're going to talk to founders, innovators, ceos, investors, designers and artists I'm talking game changers about their big world-shipping ideas and what sparked them. I'm your host, Rajiv Parikh. I'm the CEO and founder of Position Squared, a growth marketing company based in Palo Alto, california. So, yes, I'm a Silicon Valley entrepreneur, but I'm also a business news junkie and a history nerd. I'm fascinated by how big world-changing movements go from the spark of an idea to an innovation that reshapes our lives. In every episode, we're going to do a deep dive with our guests about what led them to their own Eureka moments and how they're going about executing it and, perhaps most importantly, how do they get other people to believe in them so that their idea could also someday be a spark for the ages. This is the Spark of Ages podcast. In addition to myself, we have our producer, Sandeep (Parikh), who will occasionally chime in to make sure we don't get too in the weeds with all that jargon. That's right. That's my job. I'm sticking to it. We're going to make it happen. Today. You're the jargon remover. The jargon removal engineer, please.
Rajiv Parikh:The healthcare. gov website was launched 10 years ago, on October 1, 2013, in perhaps what was the worst go-to-market rollout in history. That was pretty bad. They should have listened to our other podcasts, I know. Had they just brought in AJ or some of these other amazing folks, it would have been more successful way more successful. It's been over a decade since the landmark legislation was passed and it began its implementation. Today, we're hoping to explore the impact of those laws on our collective health and understand its impact on a leader who found his spark because of it.
Rajiv Parikh:Jay Desai serves as CEO, chief Executive Officer at Bamboo Health. Bamboo Health supports more than 2,500 hospitals, 37 payers those are insurance payers 7,800 post-acute facilities, 25,000 pharmacies and 45 state governments. Bamboo Healthcare's collaboration network brings together both physical and behavioral healthcare, connected to more than 1 million providers and touches more than 1 billion lives. Previously, he co-founded Patient Ping and served as CEO before Bamboo acquired Patient Ping in 2021. As co-founder and CEO of Patient Ping, Desai led creation of solutions to empower providers to transform our healthcare system into one that provides high quality care at a lower cost and connects healthcare providers across the country with real-time notifications to better coordinate care.
Rajiv Parikh:Jay has spent the past decade as a healthcare policymaker, executive and investor. Prior to Bamboo Health and Patient Ping. Jay worked at the Center for Medicare and Medicaid Innovation, where he helped design and implement value-based care payment models funded by the Affordable Care Act, also known as Obamacare. Jay Desai earned a Master's in Business Administration in Healthcare Management from the University of Pennsylvania's Wharton School. He has a bachelor's degree in Business Administration from the University of Michigan and is a Coro Fellow. In addition to all that, jay has also become an angel investor, making seed investments in healthcare-related startups. He's got a badge for being in the Health System Transformation Task Force. Do you think it's shaped as a stethoscope?
Jaay Desai:Yeah.
Rajiv Parikh:The cool snake thing. Oh yeah, like the medical bat. Yeah, I just always wanted a badge for the job I was doing. All right, let's jump to our interview with Jay Desai. I'm thrilled to have Jay Desai with us today. He's a brilliant entrepreneur in the healthcare space, an area that I was aspiring to get into years ago and found that I wasn't smart enough to do. That's why I'm really excited to have Jay with us, because not only has he found a way to get into this incredibly complex and incredibly beneficial space, he's actually built a very successful business in that world. Jay, thank you for joining us today. Thanks for having me. Yeah, also, I just want to point out that Rajiv is starting out pandering to you. You may not be able to notice, but, rajiv, why don't you lean back a little bit and show off your panda?
Rajiv Parikh:Yeah, so for those of you listening at home Rajiv is wearing a Michigan shirt, the pandering's working. And the reason is not only was I really excited about chatting with Jay today, but I've been paying into Michigan. My son just graduated from Michigan Law School.
Jaay Desai:Amazing Congratulations.
Rajiv Parikh:Yeah, Very excited. He loved the school. The law school is incredible. These stone buildings are just the libraries over the top and we've gotten to know a lot about Michigan. Like Zingerman's best sandwiches in the world.
Jaay Desai:Best sandwiches in the world.
Rajiv Parikh:Miss Kim amazing.
Jaay Desai:Amazing pickles.
Rajiv Parikh:Korean restaurant Pickles. Yes, they're big on pickles. All the little coffee shops there just love going out there and seeing them.
Jaay Desai:Yeah, those are the fancy grad school spots. When you're undergrad you don't really go to the $8 sandwich place. More than 350 down is kind of where we exist. How much is the pickle? The pickle probably now, probably the cost of a really good sandwich that we can get at like Jimmy John's. But the law school library is insane. That's where we would go to get the serious studying done. Yeah, when we actually wanted to go study we'd go to the law school library.
Rajiv Parikh:It's really really pretty, the amazing place. Everyone that I know that has gone to Michigan really loves the school. It's a lot of times you hear folks when they go to a state-sponsored school you never know what you're going to get. But Michigan is just incredible passion around it.
Jaay Desai:Yeah, it's big enough where you can kind of be whoever you want to be and kind of create the world that you want to create with the friends that you meet, and they do a lot to make it feel small. So like there's, you know, where you don't feel lost and kind of the crowd, and then there's just like a lot that kind of ties the school together, mostly obviously sports, but even if you're not a sports fan like me, it's still super fun.
Rajiv Parikh:Yeah Well, my son was not a Michigan football fan, surprisingly.
Jaay Desai:Yeah, but he did.
Rajiv Parikh:He was only because he was going to law school, but he loved the place, so that's where he met his fiance to be and just amazing. So let's chat a little bit about. Well, when you did go to Michigan, that was an out of state school right For you. Yeah, so you were in Illinois.
Jaay Desai:Yeah.
Rajiv Parikh:Now were you like in. I think I've read a little about your background. Was it a heavy Indian community or not really.
Jaay Desai:Yeah, big Indian community in Wheaton Illinois. It is a heavy most churches per capita in Wheaton Illinois so it's a, it's a heavy kind of religious. So devout, yeah, devout community. But also a lot of Gujarati immigrants kind of found their way to the Northwest suburbs or the West suburbs of of Chicago.
Rajiv Parikh:Right, we're three Guju's on this podcast. Huh, that's right. And then on our producer also Guju. Oh my God. Good you representation going on here and good you representation, that's right. We're going to do our virtual Gurba Ras later. Yeah, for sure, we got this podcast.
Jaay Desai:The viewers, and that's.
Rajiv Parikh:Indian folk dance yeah, for free. Everything we get is for free. What got you into healthcare? Why? Why did you decide healthcare was a place to go?
Jaay Desai:Guilt, definitely guilt. I just wanted to be a doctor, you know, and I think I was never really you know. So I applied to like I think it was sort of destined, from the moment I was out of the womb that I was, you know, going to become a doctor, and that was kind of what, what sort of the gravitational force influencing what it is, that my preferences were.
Rajiv Parikh:Did your grandfather do as mine did, which is every letter he would write from India. It would say doctor, doctor, wow, you basically have Dr J.
Jaay Desai:That's pretty. That's pretty explicit. I think my family, yeah, they were pretty explicit, but they used some other ways of just mine and so, yeah, I mean it was always like we'd be with my cousins and somebody would be injured and my parents would be like so what should we do?
Rajiv Parikh:You know, asking an eight year old asking you, yeah. So the only the only tools they gave you for your birthday were, like doctor tools.
Jaay Desai:Yeah, yeah, and you'd be able to steal stethoscope for your five year olds. Yeah, exactly.
Rajiv Parikh:You know fake x-ray machine. Let's do an x-ray.
Jaay Desai:Operation was big in our house.
Rajiv Parikh:That was it right yeah.
Jaay Desai:So I wasn't very good at standardized test taking and I applied to all of the direct medical school entrance programs and I didn't get into any of them and I was like 14 of them or something like that. There's just like rejection letter after rejection letter. I don't know if it was like me generally rebelling against wanting to do that or if I just didn't have you know kind of what they were looking for. But I think that experience, particularly seeing my peers get in one, built a chip on my shoulder and also it. You know, I think it was sort of one of my early experiences with rejection that created a lot of fire inside of me.
Rajiv Parikh:But I mean, what's amazing about your background in that is that you basically pursued healthcare related opportunities even right out of undergrad right, yeah, right.
Jaay Desai:Well, so when we were young and we go to Chicago you know I was in the suburbs we go to the city there was this one street, or South Street, where the board of option exchange was and I just was like in awe of the people wearing suits and walking really fast and talking on the phone and like just it just was like that pace of the way that people operated. So I think I just saw a lot of chaos. I felt like at home and you know, like Indian families can be really chaotic and I felt like that was just a more organized, functional, highly productive. It felt like it just I was so drawn to the pace of business when I was young, so it just kind of like I was like I want to be there doing that.
Rajiv Parikh:So was there an influence there too? On the business side, was there like some influence? You saw people moving quickly, but your father was a pharmacist, right?
Jaay Desai:Yeah, my friend was a pharmacist, you know when you ran a pharmacy business right.
Jaay Desai:Yeah, he had a pharmacy was a small pharmacy in South State of Chicago. It was like a family business, you know, or like I would say, like more of a small business, and my dad would leave at nine in the morning from home and he'd have the mornings with us. He'd be home by 5pm and you know it was stressful because there were days where, you know, the business wasn't doing super well and there were times where it was doing a little bit better and we felt that in our house. But yeah, I know healthcare was kind of just an influence. But you know, and so my parents I think my mom had an opportunity to get into med school but it was hard for her because of some of the things in her life, my dad too, and so they were just like we're going to now give you, you know, make it here. You were going to sort of relive the things that we didn't get to do through you, you know, like the way to mess with a kid.
Rajiv Parikh:But it, you know we're going to suddenly and overtly influence you to go down the path. And was there this notion of you saw their medical issue and you felt you could just do it better than them?
Jaay Desai:Yeah, I know. So the combination of like business and the pace of business and me liking that, but then the guilt that I was living with of like not becoming a doctor made it seem like the business of healthcare was kind of where I should go. And out of college I had a job at an investment bank where I was, you know, working on industrials and transportation and other companies selling like parts. I was like this is just not enjoyable Like we're working on it.
Rajiv Parikh:It's freaking boring. Yeah, it's just moving. I'm moving shit around, I'm moving shit from here to here and we're trying to make a buck off it. That's kind of boring.
Jaay Desai:Yeah, but healthcare was like. I still liked thinking about the business part of it, but with healthcare was just more complicated. So when I started seeing the connection between government regulation policy and how that impacts how people get care, I was like this is super interesting. I saw politicians talking about healthcare policy. I saw, you know companies thinking about their strategies based on what the healthcare policy was and then I saw how that was impacting on people to live with care. I was like that whole spectrum feels very much in the flow of like the discussion and you know there's real influence here.
Rajiv Parikh:Oh, that's amazing. I keep coming across this term when we were doing our research on UGA, like what is value based care?
Jaay Desai:So right, in most instances, up until, I would say, like 2020,. I'm like 2015,. Let's say, you go to the doctor and the doctor gets paid, and so you go to the ER, the ER gets paid. You go to the hospital, the hospital gets paid. So that's like a fee for services If you deliver a service, you get paid a fee right Now. What the incentive in that system is to do more services right? It's just like if I can get the person hooked on an opioids that they keep coming back for prescription, I make more money If I go to the ER and then I Curing is not a part of the equation.
Jaay Desai:Yeah, keeping you out of the hospital is not really part of the equation.
Rajiv Parikh:Like preventive care. It's not part of the incentive. Yeah, hold on. Oh, let's get a whole bunch of tests done.
Jaay Desai:Yeah.
Rajiv Parikh:Oh, but the doctor, the physician group, actually owns the testing center. Right, let's do more tests.
Jaay Desai:Yeah, I know. And you always have that thing in the back of your head, Like my mom just had a hard kind of an angiogram she needed to do. And it's like while you're doing the angiogram, they're going to stent you if you need a stent. And then you know, before you do the angiogram, like you know, they do the CT scan and it's like there's just a strong pull towards doing more and you're like, do they really need this? Like, is this necessary?
Rajiv Parikh:at times, Like the breeds mistrust.
Jaay Desai:Yeah, it breeds. It's like the transaction between you and your car mechanic. It's like you have no knowledge and they're just like you're going to need to get these 15 things done. You're like how am I supposed to answer that question? You know, there's this information asymmetry, so that's a fee for service system and I saw that firsthand because I was working as an investor in healthcare companies. And you just see that like if you're the management team of you know, let's say, radiation oncology center which is delivering cancer therapies, the incentive was so strong to just do as much as you can for the patient. Sometimes that's the right thing to do, but sometimes it's despite the patient, but in service of the business.
Jaay Desai:And that, to me, was like this is f**ked, like this is so messed up Like the fee for service system is rewarding more care, which a lot of doctors are good people that are trying to do the right thing and that's within that context. It's still, you know, the right care, but a lot of times it's just not. It bred a lot in a various actors. It's also is a big reason why we see that US healthcare spend per capita is higher than every other country, but our outcomes are not.
Rajiv Parikh:Than everybody else. Right, it's something like what it's 18% of GDP. When I started my medical device company way back in 2001, it was 12%, and that was shocking because about 30 years before that it was 8% of GDP.
Jaay Desai:Yeah.
Rajiv Parikh:Right, so it just keeps getting more and more expensive compared to what we have, right.
Jaay Desai:And so if you look at like the root cause of that, it's like hospitals and these things. These hospitals like Mass General, brigham, you know, or like UCLA or Cedar these are organizations that are stood up as the beacons of our community you know, we have our babies there but in many instances they're just committing straight up extortion, just like taking money out of education, taking money out of our defense system and just pouring money into healthcare because they know they can crank up the money by billing more, by just billing more, and it's not because they're acting in any other way other than what's in their interest, based on the way that the incentives are set up. So value based care is about changing that. It's saying like, why don't we actually change the incentives so that we reward people to keep them healthy, yeah, to prevent these bad outcomes from happening, to keep them out of the hospital, to keep people safe and managing you know it's sort of rewarding managing their own care and the affordable care.
Jaay Desai:This is sort of not that publicly spoken about under the Obamacare, but there was a lot of sort of public discourse around the individual mandate Like we got to. You know, everybody's going to be forced to get insurance. There's a lot of public discourse around the health insurance exchanges. You know you're going to be able to buy an individual policy on through your state fund.
Rajiv Parikh:The idea was to get everybody under some level of care. Therefore, we can drive the cost down. You will be able to keep your own doctor. This is my best, obama. We're going to do our best to make sure that you get the best healthcare that you possibly can. It's just like those pauses.
Jaay Desai:Pauses in the nasal. Pauses in the nasal.
Rajiv Parikh:And he loves saying and and and Like draw and draw.
Jaay Desai:So there was a third part of that affordable care act as we talked about. There was the mandate, the exchanges, which is again we've got all the headlines. But value based care was another big part of it, which is like we're going to change the incentive so that people get better quality care at a lower cost. And when you talk about healthcare, there's usually three big pillars to it there's cost, there's quality and there's access. Access is like get people insurance.
Jaay Desai:Quality is like we want the highest quality healthcare in this country, which means we got to invest in innovation, we got to build products, we got to build, you know, medical devices and drugs and there's the cost equation and usually you get two out of three.
Jaay Desai:It's hard to get all three because, like you get higher quality, you can get more people on sure, but how do you actually do that at lower costs then? So you know, the affordable care act spent a lot of energy trying to figure out like what's the way actually building infrastructure where you get all three and the cost part of it was what I was working on and you know, when I graduated from business school and I saw that, like all this thing that was so frustrated about with the P for service system. The affordable care act was talking about a solution for that. I was like sign me up, I'm all in on that. So value based care was something I got to be a part of actually designing the incentives, putting these programs out there to get doctors to feel like they're rewarded for doing the right thing.
Rajiv Parikh:Amazing. So then this was during business school or after business school. I think you worked at the centers for Medicare and Medicaid innovation, right?
Jaay Desai:Yeah, exactly, I went there right after business school, which?
Rajiv Parikh:is a nonprofit. It wasn't a for profit.
Jaay Desai:Yeah, it was. The guy was the only guy who paid the tuition at business school and then went to a salary that was lower than what I was getting paid before business school. But I was so moved by the mission and I also thought that, like being part of this is only going to be beneficial for by long term career. And then I also thought, like the people that I was going to be surrounded by, because there were so many people across the country who are working on little pilots in their kind of respective regions trying to get the same exact principle around value based care done. You know again whether it was like a small pilot that was happening in rural Pennsylvania or something that was happening in the county of Texas.
Jaay Desai:There was a big article published by a tool go on day about some experiments that were happening in the county of Texas and how to reduce total cost of health care and higher quality they all. It was like a magnet. Everybody came to the, to the Washington DC, as part of this. For the correct to say, like I want to now scale up this program that I was working on in my kind of local community because the innovation center had this very specific mandate. They had $10 billion of funding through the ACA and they basically said to the innovation center if you can find programs that keep quality at least the same and reduce the cost, you don't have to go through Congress to change the rules for how we pay Medicare. You can just get an actuarial certificate that it's reducing costs and do it Because before, like, if you want to change the way that doctors are paid, literally have to take it to Congress and it's very hard because that's the way Medicare were.
Rajiv Parikh:the reimbursement rates were set by Congress Exactly.
Jaay Desai:And so being able to just make sure, pass an actuarial test and then scale it nationwide, was this like incredible moment for health services researchers, for people who were in this like all saw the same issue around fee for service health care and how that was the barrier to the problem and we can change it. And so I was. I was sort of researching this at at business school and even before that I was like this is sort of messed up. I heard about small little pilots that were happening across the country and when that dropped I was like this seems very exciting. And so, you know, I went there along with a lot of other people across the country and it was just this amazing Like there was incredible people there. People are still my friends and stay. You know we've gone from the government to go do incredible things in the world. It's one of the best alumni groups that I'm a part of it's amazing.
Rajiv Parikh:So you saw these incredible innovations, yeah, and then you saw that opportunity and that you hit a certain point and said, ok, now it's time for me to start a company in that area.
Jaay Desai:Yeah, so we were making all this progress on shifting the incentives to make. So, just to put it really simply, what we did is we made primary care doctors basically like little insurance companies. Let me just simplify this for you. Like, if I'm a primary care doctor before, all I cared about was when the person came to my clinic, right, they came for their manual wellness visit, they came for some flu shots, they came for some vaccines Maybe they had a you know a cold.
Jaay Desai:That was like unusually difficult. So they came in and then I don't really deal with them any other time other than when they come back. I don't really think about them. They're sort of out of sight, out of mind. But when you put the money in their bank account like let's just say that Cindy, over the course of his, is going to cost something like $3,000 a year in health care expenditures total you know total health care expenditures and you do that based on a cohort study of, like everybody who's in, you know, the 40ish age range and you know people who have hit similar Democrats.
Rajiv Parikh:How dare you yeah, how dare you duck my age?
Jaay Desai:Who have insulin insulin?
Rajiv Parikh:By the way, three grand is cheap.
Jaay Desai:Yeah, the average actual cost for like a 65 year old is $10,000. But, like for South Asians, who basically all have cardiovascular disease and prediabetes, like it's probably higher it's probably higher.
Rajiv Parikh:It's not that lippertour.
Jaay Desai:Yeah, it's not lippertour. Yeah, so we would tell the insurance company before you make money every time they kind of crank and ring the cash register from a visit. But instead we're going to give you all the money and if you can keep the cost below what we think their benchmark should be, you keep the money, and if you spend more than that you have to write the government a check. Now, all of a sudden, their incentive is saying I got to keep you out of the hospital, I got to keep you healthy. I got to keep doing enough that you know. So I can't not spend anything. I can't just skimp on care. I have to keep you out of the hospital and keep you healthy, but, but, but not too much, because I want, you know, I have the incentive to keep the cash.
Jaay Desai:So when that happened, primary care doctors were like wait, like I don't have any tools to do that, I don't have any tools to do this work, Like I need to like get the data on who's the riskiest. I got to prioritize certain patients who are like pre-diabetes, so I want to keep from getting diabetic. I got to, you know, somebody's got cancer. Then I got to make sure I have like much more monitoring, protection, support so I can figure out what's going on with them. And one of the things that kept coming up was, like I need to know where my patients are. Like if I'm if I'm now responsible for a panel of a thousand patients and they're showing up at UCLA and other ones at Cedars and other ones like you know they're seeing in Colorado and they fall and break their hip and they end up in the ER and you know University of Colorado, Like that's my opportunity to like make sure that their meds are reconciled, that the doctors are screwing something up and you know that afterwards I make sure that they adhere to their medication therapy.
Rajiv Parikh:So, like the problem, the problem is the system wasn't well connected together, like the promise was there. If you go to the same hospital, the same doctor at the time, yeah, potentially. If you the idea is like, right, you had a doctor, that was your doctor, you didn't go to a bevva specialist, they didn't refer you out to 30 different places. Or if they did, they're in the same community, yeah, and that's just not the case anymore.
Jaay Desai:I think people still weren't getting their second opinion. My uncle told me I should go to this GI doctor, so they'd go there. Sure, but those doctors had no incentive to work with each other, like there was absolutely no incentive for them to collaborate or coordinate, because they actually were making more money if they didn't collaborate. And so what happened was let's just use UCLA as an example they made it really really hard for you to go outside of UCLA because, like, all your information was in UCLA but people still did, like you could. You know your OBGYN would be somewhere else and you know you'd have a private doctor somewhere else, but there was no incentive for them to coordinate. And I think with the ballet based care, there was now an incentive to track when your patient went somewhere else and then follow up after they went.
Jaay Desai:And that happens, like I think there's statistics around the number of doctors that we see. So the average American above the age of 65, which is a Medicare eligible person sees seven doctors per year. Wow, seven different doctors, seven different doctors across four different like organizations. So you might see one doctor that's outside of it, and you know, imagine if you've got cancer you're at sort of at the end of your life where you've got, you know, corrobidities across your kidneys and your you know diabetes, like you're going to probably a dozen doctors you know in any given year, because you've got multiple conditions that you need to manage.
Jaay Desai:Those doctors aren't on the same systems. The data doesn't flow between the system. It's a pain. It's a pain to manage. You have to start over every time you go from one place to the next. You have to take your information over on a DVD or a CD. Like it's insane, yeah.
Rajiv Parikh:You know, that's it. That's the thing. People were sending discs over. It was crazy, right, they're bringing it like. I remember when I had neck or back problems, I'd have to bring my disc.
Jaay Desai:Yeah, you know I still have a CD and I bring it with me. Yeah, it's crazy. You have to get them to fax the records from one place next. That still happens.
Rajiv Parikh:So it feels like there is maybe a revolution going on in the industry right Towards more digital technologies. There's like AI, reading MRI scans and using the cloud. I mean, is that happening more Like what's the ecosystem looking like today, or actually is that what you saw in terms of starting up your company? Is that? I see this cloud effect? I see this ability to network. I can connect all these pieces together. I have the notion of electronic health records that was mandated by this notion of accountable care organizations and now you have more. Is that? Is that what you saw? Back then?
Jaay Desai:I wasn't a tech guy coming into this industry, what I saw was that there was these primary gear doctors who were starting to take responsibility for the financial outcomes for their patients and they didn't know where they were and they couldn't track when they showed up and had a healthcare event. And I was like that's a problem that needs to get solved and so I sort of built around that specific problem and I sort of all the other noise. I didn't really it wasn't really in my purview.
Rajiv Parikh:So your idea was let me alert everybody. Yeah, that was your idea.
Jaay Desai:Yeah, let me just a little bit. Which is a powerful thing, like hey something happened.
Rajiv Parikh:Let me make sure everyone in my world knows no it's that something happened.
Jaay Desai:Yeah, I will say, though, that kind of send me to your point like at the time this was 2011, 2012, like there wasn't like all the hype around AI and medical images being sort of scanned by robots, and like all that wasn't really a thing, but there was like an emerging kind of healthcare technology industry that was starting to get a lot more visibility and traction. But I'll tell you, like there's the hype, and then there's like what's actually happening within hospitals and doctor offices and there's a huge disconnect. Like, if you like, all you're doing is following, like the help tech, digital health news and you're in about like AI and all these machines sort of automating away like physicians and their their jobs. That's not what's happening in the ground. Even today. You know, there's a lot of promise, there's a lot of opportunity, there's a lot of excitement, but we're still existing in the world. We're faxing medical records and we're, you know, bringing CDs from one place to the next.
Rajiv Parikh:Today, it's not auto translation, it's not auto note taking. Yeah, it's. All.
Jaay Desai:this stuff is still happening in little pockets and kind of super cool, yeah.
Rajiv Parikh:So it's needed then to you know, share the information or use the technology and then still kind of contain it within a value based system. Like how's that possible? Going forward?
Jaay Desai:Yeah, I mean I think that all of the right things are happening. The incentives are changing. Leadership, like all leadership that was hung on to the fee for service way and paper charts is starting to age out and it's being replaced by young leadership. So cultures are changing. At health systems, at provider practices, they're adopting technology, that the pace of technology development is accelerating like crazy. There's a lot more venture capital and, you know, money flowing into funding digital health innovations. You know the academic research organizations have always been kind of very supportive of some of the changes that are happening. But a transition is happening. Not any used to be largely focused on new molecules, sort of building new pharmaceuticals and medical devices. That's sort of moving into health services and digital health technologies and things like that, which is really cool to see. So all of it's happening. But the pace of innovation on healthcare it's not like you don't see transformation of this industry happening, you know, at the pace of like workflow productivity tools or like web conferencing.
Rajiv Parikh:You know like it's more like a generational shift.
Jaay Desai:Yeah, and it's for good reason. Like, look, there's this thing called the Baldrige Award and the Baldrige Award gets awarded to the health system that has the most tightly wound processes. You know, because it's like you go to the hospital, you get checked in, you know, from check in you go to the waiting room, you go for the waiting room, you go to the triage. From the initial triage you go to the, you know, go to one, and it's like the entity that has the tightest processes around. This typically saves the most lives because, like, it's a process and a people business.
Rajiv Parikh:Right Because it reduces errors, right. This is kind of the whole statistical process control came out of, like Kaizen right, that was what Baldrige was about was enabling that and that's being applied to healthcare, like let's make sure we root out any source of error at any particular step, which is a wonderful thing because when you go, you feel like you're being every step along the way your health is protected.
Jaay Desai:You don't want to, you know so when you now try to jam digital technology in there and you work, flow innovation people like dude chill.
Rajiv Parikh:You're busting my process.
Jaay Desai:You're busting my process which is organized around keeping people alive. So I do want to innovate. I do, but it's a little slower. It's just gonna be slower and that's a natural process of innovation in a high-states industry, and I think that's the right thing, that's the right pace, at which you know we're moving, at the pace that I think the industry is ready to move and a lot of the right things are happening.
Rajiv Parikh:Do you feel like it's going to bend the cost curve? I mean, there was a recent article about this right Medicare, not just negotiating drugs but there was an article about how the cost of Medicare per individual has actually flattened over the last few years. It hasn't risen as spectacularly as previously expected. It's hung up around $12,000 a year per patient and it was supposed to go to something like 18 to 20 by now. If you just looked at things linearly, some of it they're saying well, is it because of ACA? Was it because people are getting preventative care? Was it for other innovations? Are people starting to live healthier, Are they, or are we just letting people die faster? I mean, that's another way of solving healthcare, not putting them through a hospital, just letting them die faster. What's your thought about that?
Jaay Desai:I mean I'd like to think that it is because of all the efforts that have been made over the past 15, 20 years since the ACA and even before that. But there's a lot of health services researchers who say the investments in care coordination that we've been making aren't necessarily making our healthcare costs lower, but they are making healthcare quality higher. I think it's really hard to do a large-scale empirical study top down to say have we actually bent the cost curve as a result of all these efforts? But I've been in this industry now for 15 years working on specifically cost curve bending efforts, both as a policy person as well as an innovator. I have reams and reams of anecdotes of how this is actually impacting and there's also regional studies around how this is impacting cost and quality. I would like to believe that the sheer volume we have almost 15 to 20 million people in these value-based care programs now compared to zero or some million 15 years ago.
Rajiv Parikh:Are you happy about that? That level of 15 to 20 million versus 300 million?
Jaay Desai:No, oh, I should say 15 million of the Medicare P for Service population.
Jaay Desai:The Medicare sorry, sorry, that's a really good number. I don't know what it's, so I should qualify for that. There's Medicare Advantage, which is essentially a value-based care program. A lot has shrewd me around that, but that's essentially a value-based care program. And then on Medicaid there's a lot more people moving into value-based care and then on the commercial side it's probably a similar percentage. So overall I think we're over 300 million. I wouldn't be surprised if the overall number is close to 100 million. It probably mimics the percentages that were added in Medicare.
Jaay Desai:That is a terrific number and the way that it actually manifests practically for a person is like. I remember I was at Montefiore in the ER in the Bronx looking at their value-based care initiatives. They had an iPad with a list of names of people that were in a value-based care program and basically, if somebody gets discharged after a surgery or something like that and they were on the list they get the name of a care coordinator, of a nurse. It'd be somebody who they can reach out to to coordinate their care. She'll reach out to them. She or he will reach out to them depending on what's required to make sure that they're staying on their plan.
Jaay Desai:If you're not, you just go off and you're left to fend for yourself. You got to get the help that you need. That's a very concrete description of what the change is. Now, if you've got somebody who's like you out on speed dial after you've had a surgery, then you're probably going to not come back to the hospital for a $10,000 visit because you could sort of deal with it while you're at home. But that's the change that's happening for 100 million people potentially.
Rajiv Parikh:And they're actually helping them with making sure they stay on the meds because a lot of people compliance, no matter how beneficial it is. Compliance is really poor for taking your medications, doing the right practices, just checking in on them. You have a whole bunch of cases like this, I know, in your company.
Jaay Desai:Yeah, absolutely yeah.
Rajiv Parikh:I want to kind of zoom out a little bit. And so before we had the blue wave in 2010, the term preexisting condition meant something very different than it does today. Can you kind of talk about how government regulation, the ACA, obamacare paved the road for innovation in healthcare and overall, just like the role government has to play in innovation?
Jaay Desai:You mean just like getting more people in the risk pool? Now we have unlocked something around innovation. I don't know, I didn't actually thought about that.
Rajiv Parikh:Yet I'd even sort of relate it to, because they're in and tools like what your company's building, where you're creating networks, are more valuable. It's all about network effect, the capabilities your company's building, bamboo health is all about organizations and hospitals and doctors, all connected together.
Jaay Desai:So because you're not being excluded, it enables a network effect and therefore we can more effectively innovate on them Totally and I don't think I've ever connected the dots between like before we had a bunch of people who were healthy, who weren't covered by insurance. Now we do. So there's a larger pool and therefore we get more innovation on the care coordination side. It's a really interesting question. I think there's just more dollars flowing and insurance sort of bank accounts to be able to sort of spread across a larger pool of people and therefore they can invest in the highest people more, because there's just more money to fund the initiatives for the highest people.
Jaay Desai:But I'll just say, like your coordination generally isn't required for most people. If you go to the ER, you break your thumb, you get a cast, you go home, it's like you're fine. You don't need a care coordinator, you don't need somebody to sort of deal with you, you don't need like you're fine. But if you're experiencing homelessness, you've got substance use disorder and you're really struggling to sort of get access to any primary care doctor, well, I mean, you know there's a real opportunity to support that person to just get them off their feet and get them healthier or at least like keep them from falling through the cracks. And so when you have a larger reserves to fund some of these innovations. I think that probably you know makes sense. But yeah, I mean, these topics are on access versus cost versus quality, tend to get siloed, but there are definitely interrelated. Like you need to all the people and there is full to be able to get the dollars to fund the quality initiatives and the quality initiatives if you improve on those and they reduce the cost initiatives.
Rajiv Parikh:So they are related, Jay, since you live in this healthcare world and you were talking about helping to reduce cost and quality of life. Something like 60% of healthcare cost is in the last six months of life.
Jaay Desai:Is that true? It's a large percentage, yeah.
Rajiv Parikh:Okay. So I've observed a lot of folks like in California and Oregon, I think, washington. We have that ability to terminate our own lives if we have terminal cancer, right, and so when you decide to do that, they give you some drugs. You have to get certified that you're of some mind and body and you can go. But there's a lot of people that go through dementia. They go through all kinds of issues. I've seen family members who you know they're in diapers at the end of their life and they can bear. They're barely aware of where they are. I don't want to be there, right. I don't want to be in that mode for two, three, five, 10 years. So here's my idea we create a score for how we expect our quality of life to be, and as soon as we breach it by a certain percentage, we get to terminate ourself. So at the time when I don't I'm not aware enough to know I want it, but I want it. What do you think of that?
Jaay Desai:The principle around that. I'm into. It's clear it's a score, I don't know. This reminds me of that book being Mortal, the Tugol Gwande book. It's if you ever read that book.
Rajiv Parikh:I haven't read it, but I read his Kyrae Complications.
Jaay Desai:But I thought he did a really good job of being like like you've come with a proxy for the number.
Rajiv Parikh:That's right.
Jaay Desai:And I think what you're trying to do is actually manifest that as like a score that you can use to communicate to authorities and you know, and just say, like this is something that we've all agreed upon and so we should be allowed.
Jaay Desai:But I liked his thing of like you know, I think they said his dad wants to be able to, like, watch a game and eat a bowl of vanilla ice cream and if you can't do that anymore, that's sort of at the end. You know it's a good proxy for like comprehension of you know information, being able to use your own hands to, like you know spoon, you know some ice cream in your mouth. So I don't know, I like the principle of what you're saying, but the political discussion around this is the same as the political discussion around you know abortion. So it's just it's the same debate, you know, kind of at a different life stage and if people are going to be firmly in strong way against it. So I think it might be a state level reality that could happen. But you know, I like the principle.
Rajiv Parikh:I guess then they won't allow me to do the next part of it, which is the way that I die. I kind of I'd like to be put on an airplane. You know how suddenly you and I did the skydive thing.
Jaay Desai:I want to skydive. Skydive.
Rajiv Parikh:Without the parachute, and I get the thrill of falling, and then it's quick, it's beautiful. How about we send you up in one of the Elon Musk or Bezos rockets and just send you into the earth's atmosphere from there?
Jaay Desai:So that you just like, you just become ash.
Rajiv Parikh:Yeah, you, just your ashes spread over the entire world and then I'm in every holy river. That's right, that's right. Yamuna Interplanetary death Nile. I'm in every frigid river, all right. What is Bambu Health's like company mission right now? Like, maybe you can talk about, like, what are the challenges you're dealing with now and where is the company at on its journey?
Jaay Desai:So I sold Patient Ping in 2021 to Bambu Health, and Bambu Health is the parent company, the company that I originally founded and I was just kind of around on the sidelines helping them out for about a year and a half. After I sold my company, about seven months ago, I stepped in as the CEO of Bambu Health and I came in with a pretty specific mission of what I thought this company could become, so we're in the process of moving in that direction. So if you go to our website doesn't really tell the story that I'm about to tell right now Ooh an exclusive Spark of Age is exclusive drop Spark of Age.
Jaay Desai:No, I mean, I'll tell you like, I went to a Vipassana meditation back in it's like January or February and a big part of a Vipassana meditation is around suffering and the root cause of suffering and suffering is largely anchored in, you know, through this school of thought. It's anchored in craving or aversion. So if you organize, like you're, all of your mental chatter into, like what it is, it's either craving or aversion applied to the future, craving or aversion applied to the past, unless you're actually in the present. So meaning I have something, I want something that I don't have right now, I'm trying to avoid something that I'm not currently in right now. So that space between what you have right now or what you're craving or what you're avoiding, that is misery, right? That's sort of the-, suffering, the root of this.
Rajiv Parikh:We're getting Buddhist now. Baby Right, Okay.
Jaay Desai:So I was at this Vipassana meditation thinking, you know a lot of the conversations around suffering and like the world and you know how we have a lot of suffering in this world, which is a big part of the Buddhist teachings and how do you sort of liberate yourself or at least like, dedicate your life towards the reduction of human suffering? And one of the things that I was thinking about a lot with bamboo, health and our products is that we deal with people when they're at their extreme moments like highest moments of suffering. So when somebody goes to the ER, they're in the ER because something has fallen apart in their lives, especially if they're, like, really in the ER for good reason. Now, if they're like you know they're kids, you know like hypochondriacal kids, you know like that's different.
Rajiv Parikh:Well, even they're suffering, in a way right Even they're suffering the only reason you go to a place that says emergency on it is because you feel you have an emergency Right. Well, stated.
Jaay Desai:Thanks for the correction. Yeah, that's exactly right. It's like you're there because the stories of human suffering that are experienced in the ER are just so tragic. And you know we also have other products that deal with people when they're calling 988 because they're suicidal. 988 is an ulterior 911. So if they're calling that, like really their life has hit right there at these crucible moments in their lives where they're just like I need help, and our products that's all we really deal with is when people, we will notify you when they're in the emergency room. We'll give the provider some information on their historical utilization of controlled substances when they need a new controlled substance, like this opioid crisis that we've got. This is a chronic pain crisis, Like we are in pain as a country you know, and so like.
Jaay Desai:People are coming in to get a painkiller, they're suffering, their lives are filled with suffering and they're trying to heal it through a pill. And it's just a part, a tiny part, of like what's underneath that Okay.
Rajiv Parikh:So you're in Vipassana meditation. You're having this Don Draper kind of. You know, season Fally started for the spoiler alert you know moment where you're like you know, you're sort of understanding the world's suffering. So like, how do you then relate this to bamboo health and what you guys do? Right, yeah.
Jaay Desai:So the story that the guru Goenka was telling about was a woman who had her husband and her two kids died in a tragic accident, and this woman in India, which is she lost her mind.
Jaay Desai:You know, she run on the streets naked, completely lost her mind, and she, you know, she found the Passana meditation as a way to, like, you know, respiration, focus on sensation, move through the you know, move through the sort of thoughts that you're having in your head and focus on the sensation that there's a manifest in your body, and it sort of allowed her to calm down. So she found a tool to reduce for human suffering, right, and in my mind I thought, wow, we detect people in their extreme moments of suffering. If we can help even a small fraction of them, get access to a solution, a remedy that's going to support their and heal their suffering in some way, or at least reduce it, what a service that we can bring to the world. So, basically, what I came in to do is say and actually I did this when I, when I first started as CEO I changed our mission to reducing human suffering. That's our, that's our mission now at bamboo health.
Rajiv Parikh:That's awesome, that's cool.
Jaay Desai:We detect people during seminal moments in their lives, meaning in the ER, when they're having a suicidal crisis, when they're coming in for control substance prescription. That's what our existing products do. We've got amazing products to do that and we're building a care navigation hub now. So anytime we detect somebody who's in a moment of suffering, we'll try to find them care. We'll try to find them services. We're focused on people with moderate to severe mental illness or moderate to severe substance use disorder. So people who have opioid use disorder or they have alcohol use disorder or fentanyl is a big issue.
Jaay Desai:Now I've heard about this new thing called crank, which is like a weird concoction, you know, sort of a concoction of a number of different highly addictive substances that's causing people to die. It's sort of the new crisis that's coming out there. So it's on substance use disorder and then on serious mental illness, that's anybody with a major mood disorder, major anxiety or depression, bipolar schizophrenia. Those are the main conditions that we're focused on. They show up in the ER. We're going to find them, we're going to assess them and then we're going to get them into care, and so that may be substance use recovery. That may be a care manager at a value based care organization. It may be a virtual substance use recovery program. There's a number of providers that are coming up. It might be crisis stabilization.
Rajiv Parikh:Or just send them to our dad, just send him to Sidhir Parikh, who's a meditation and yoga teacher. I mean, he's got the best breathing exercises.
Jaay Desai:Really the best promocule. I mean, there's all kinds of remedies out there. It could be psychedelic assisted therapy, it could be the process of meditation, it could be.
Rajiv Parikh:Sidhir's Sidhir Ramadhan Nataraj Yoga Center. Baby Just look for them on YouTube produced by my company's videos. But I think it's an amazing thing that this comes a little bit out of the root of the company, right, which is you had this, apris hey. Apris, yeah, APRIS, right APRIS yeah, you had APRIS and that was in the behavioral health area, for I think data records right In that area, and then you have the alerting capabilities, and the alerting capabilities coming out of what your company brought to it when it came together and now you can use it to signal those situations and help people connect the dots.
Jaay Desai:Yeah, absolutely. Apris is an incredible company. Their foundation is in. I'm going to butcher this story, but the founder of APRIS is an incredible guy. He's done an amazing job with the story. The business he built Like he was.
Jaay Desai:He was a young guy in Louisville, kentucky, and was driving home one day and he heard on the radio about a woman who was a victim of domestic abuse. Her ex went to jail and then was released from jail. But she was never notified of his release from jail. He waited a week until her I think it was her 18th birthday was inside her kitchen while she was coming home and then he sapped her to death and he was like how did she not know that this person who she was a victim of was released from jail? How did she not know that?
Jaay Desai:And so he built a system now where if you're a victim and somebody was incarcerated, that you would be notified of that person potentially being back in the community and potentially causing a risk. So he built that and he's built that across multiple states. That has sort of grown from just the victim identification notification system to like the breaking bad days where mass was sort of pretty rampant you could detect that somebody was probably endeavoring to cook a lot of meth, that they bought a large volume of pseudofed from a pharmacy over the counter. So they built a system that detects when large volumes of pseudofed were being sold to one person so that authorities could try to sort of figure out what was going on. That then translated into the control substance resource library. So if somebody's buying opioids or if somebody's buying control substance, we want the doctors to be able to look up the history of control substance utilization. It's a really cool company detecting people. Also, I think during moments of suffering, that they're able to sort of alert and alarm the appropriate people.
Rajiv Parikh:So you guys started working together. What was it like to have the team that you were building and mesh it with another team?
Jaay Desai:It was a transition for sure. I think that our team kind of came into this larger organization and it's amazing, I think, the anytime a transaction happens, the team gets just inundated by recruiters because everybody's like, okay, this is the moment that they're going to be willing to sort of wedge out. I think that for the people who are kind of like director level, senior manager level, vp level where in the smaller company they were at the top of their game, they were about to get promoted and potentially be the number one Now they were kind of a couple layers deeper in the organization, but they were incredibly gifted, incredibly talented at what they were doing those people were immediately poached and they were like, okay, now's my time to go do this at a smaller company.
Rajiv Parikh:Did you plan for that from the get go?
Jaay Desai:This is the first time that I've been through it so honestly I didn't fully know what to expect. But I don't know if they acquire or plan for it fully. I don't know if they really invested early in retaining that employee base. They were a little slow to the punch.
Rajiv Parikh:So it sounds like you lost folks, but in that transaction you were also coming together with them, so did you take over that, or was it?
Jaay Desai:No, I was just sort of like on the sidelines. I was there helping, for sure, with the transition.
Rajiv Parikh:So this was your exit. That was my exit. You built it up. You got your exit, so you were the one who was an advisor because they knew you had invaluable experience and then you got to hopefully enjoy the fruits of it, which was a ton of fun yeah, it was great and then you stayed as an advisor, but then they really loved you so they wanted you back. Because you have this, you have a new way to take them.
Jaay Desai:Yeah, yeah, I think what they saw happening to the business wasn't something that they were excited about and there were some performance issues and I think they asked if I would be willing to take over and I had a very specific idea of what could happen and I said, if we're on board with exploring this and seeing if it's viable, then I'd be excited to try it out. And I'm doing it on an interim basis, so it's been about seven months and I've really enjoyed it and I've sort of pointed the company in this direction of reducing suffering and, yeah, it feels really mission-led now, which I think we lost a little bit our purpose as one that we were very focused on, just like the business and trying to make the business successful, and we kind of lost our reason for existence.
Rajiv Parikh:That happens a lot. Right, when you're in the business. You put things together, you have to make an outcome for the private equity firm or whatever firm that owns the company, and so in that you get so caught up with hitting the business metrics, you forget about the mission and what really drives people there. So it looks like they realized that and they're re-injecting it with having you there, which is really cool. So now you did raise a lot of capital in doing this. Did you always feel like you could raise over $100 million to go build a company? Or was that like oh, you went to Wharton, that's just normal. Everybody does that, definitely not.
Jaay Desai:No, but it's amazing how these things end up being really incremental. It's like, I don't know, maybe it's the way that I'm wired and I did notice it relative to like there's two different ends of the spectrum. One is you feel when you're building a company and raising money. One is the insecure child of immigrant experience, of I have to prove everything and show everything and get the data to demonstrate that we're making progress, traction, and only then should I earn the right to do more. And then, on the other end of the spectrum, I think if you can just sell an incredible vision simply on the confidence of your vision, without a lot of substance or meat underneath it, and get people to believe in that vision, you can raise large sums of money and do it. And I didn't have that. I didn't have that confidence. I didn't have that. I think I gained the confidence as I would see things work. To be an entrepreneur, you can't be fully, otherwise you just sort of exist in your own paranoia and you don't actually take any risk.
Rajiv Parikh:You have to convince people to do it right, and so one of the things you did is you made out of believed it from the get go, but you believed enough of yourself that you could talk to other people about it. So you probably did you surround yourself with just amazing folks, or did you use the network to get to those folks and create your case?
Jaay Desai:You kind of gradually. I talk about the chicken and egg and startups, the constant chicken and egg and startups.
Rajiv Parikh:Oh, it's a huge issue.
Jaay Desai:Yeah, there's always like how am I going to raise my first round of capital until I get traction? And how am I going to get traction until I have some money? How am I going to make my first big hire until I get a real organization that they want to join? Well, how am I going to make a real organization to get my first big hire? There's a constant stream of you have to create that future a little bit to get people to take a leap of faith on you before it's actually built. And for me I would always do that very incrementally. I'd kind of inchworm my way towards the next big milestone. It's exhausting because you're always thinking in your head like once I do this, then we're going to, but then there's always the next.
Rajiv Parikh:There's always something next right. It's like the Rockefeller thing how much money is enough money? $1 more.
Rajiv Parikh:Right and I think it's a good management. In a way, it's a great management technique, right, you always want people to believe, as an entrepreneur or as an executive, that you have something else for them. But after we get to this next point, you're going to move them to the next one, right, and there's a next one, the next one. At the point they feel like you're just sitting statically in one place and you're happy with being very operational, they lose interest. They lose interest. That's a human behavior. We always want to see what's next.
Jaay Desai:We said this thing in our company where we were dealing with some cost issues and we told our team that these products are in maintenance mode. I can't tell you how much that sapped the spirit of these teams. They're like I don't want to work in a product that's in maintenance mode. I want to be built into. Everybody has this.
Rajiv Parikh:Makes you sound like a janitor at that point oh man or a tech dealer Like yeah, I'm on the shitty maintenance product.
Jaay Desai:Yeah, I'm so excited. We want to keep the lights on.
Rajiv Parikh:Hey, honey, I'm home, I'm working on the maintenance product. Yeah, we're going to the maintenance product.
Jaay Desai:I mean, I think maybe it's just a branding thing, I think if you said this product's in cost mode, like ah, I kind of want to cost. Oh god Cost, I like that. Well, you're a surfer surfing the way.
Rajiv Parikh:People want to feel challenged right, they want to live that challenge. So now you've done multiple things right. You've worked in the nonprofit, government-oriented space. You've built and started your own company. You've you know, in all these different Investment banker. You're investing, right. I mean, isn't that sort of the next part of your essay that you wrote when you were going to Wharton I'm going to be a successful entrepreneur and then I'm going to be a great investor? No, just joking, that's what I wrote, but it sounds like you are investing in new things.
Jaay Desai:Yeah, yeah, no, it's. You know it's fun to be part of. You know early stage companies and you know, passing on the lessons that I learned and being part of their journey, it's like a way to live. You know kind of live vicariously through through other companies. It's like I think about people who get into Michigan now and it's like I would have never gotten in. I think about the people who got in. It's like that, you know. It's like you see the new companies that are coming out, the founders that are building them, and I'm just like wow.
Rajiv Parikh:I had this great conversation just yesterday with this, with a super successful businessperson, entrepreneur. Right, he's like you know what? I'm a little older now, he's in his 40s and he's saying you know, but the things that make us successful made me successful. There's some new things that these folks are seeing that we're seeing differently. A lot of these young new founders Is that is that. Are you seeing a difference between these new founders? They have access to these technologies that I could literally build themselves with, like gender AI, with cloud, the thing they can connect to people all over the world and put together teams. Are you seeing something that's different in them that you saw way back?
Jaay Desai:I think there's like a super hero level of invincibility around challenge with like real, thoughtful, logical plans on how they're going to jump over these barriers that otherwise, you know, a decade or two ago would have thought that either they're insurmountable or they're just multi-year journeys. Now they've shrunk to month long journeys and just the. You know the. I don't know if it's all Adderall Field or what, but like that's the difference.
Jaay Desai:Well, yeah, the complete invincibility of like I'm just, you know, we're just going to do it Like, well, how are you going to do it? Well, this is how we're going to do it.
Rajiv Parikh:And you're like, okay, yeah do it and I see them do it.
Jaay Desai:You feel like you buy into that I mean, I've seen it happen now, like I've said no to things, I'm like this guy's smoke, you know, like there's no way, and then I, then I, you know, I miss out on an opportunity because they, you know, they just sort of ram pass. Whatever I think are the reasons that are not going to, you know, not going to make a thing successful Is it because do you think maybe it's more availability of capital or, you know, are there so many more VCs?
Rajiv Parikh:Like you you talked about? There was a story in your life where VCs were chasing you. Right? Are more VCs there to chase these men and women? I had a thought which was like I wonder if you know, because this younger generation, like, like, when I think about Arjun, your oldest, he grew up in a very different world than I grew up in, right, he, he, 9-11, the, the, the crash pandemic, like, like, these are huge markers in his life. Basically, that contains his entire life, right, like, and climate crisis is just this constant barrage of existential problems, whereas I think when I grew up in that, in that generation right before him, it was a little bit more and both of us you know all of us here, really you know it was it was a lot more kind of hope and we were like in this peacetime vibe, of course, berlin Wall falling, america's dying, yeah, like you felt like things were moving.
Rajiv Parikh:Yeah, just all these civil rights movements, you know the gay, lesbian movements.
Jaay Desai:Everything was on its way up, yeah.
Rajiv Parikh:Everything's yeah, you're, you know, hope and change, right, very Obama and sort of like culminate with Obama, whereas the narrative for them is like crisis all around. So I wonder if just being hit with all like it's like do or die. You know, it feels like do or die for them and it's like, okay, fine, if you're gonna, if you're gonna lay all these giant challenges on us, then screw it. We have to do it ourselves and figure it out, you know, and have the confidence to figure it out, otherwise we're doomed right, and I don't know, maybe that's sort of forging their their blade, so to speak.
Jaay Desai:I wonder, yeah, adversity breeds, you know, brings, you know, breeds sort of opportunity or something like that. Diversity breeds sort of the conditions for confidence.
Rajiv Parikh:Well, they have tools now that they didn't, that we didn't have. They have social media to amplify what they say. They can band together with other folks and am and really push those things together. They, they. I'll give you my youngest son. He's coming up, he, with AI. He's seeing what his girlfriend's dealing with. She's a type one diabetic and he, like I, don't want to see her suffer the way she does with these current tools. They don't do a good job managing her insulin. So he's decided to create an algorithm to run on top of the algorithm that runs the insulin man.
Jaay Desai:Insulin pump.
Rajiv Parikh:And he's like and he's actually running me through the, the, the analysis that he's doing. And he's like, yeah, take the Apple watch output and I pump it through this algorithm and he's just building it. I don't know if he'll succeed or not, but he thinks he can. There's such value in that naivety, right? I was just talking to some young upstarts here in LA. You know about that very thing.
Rajiv Parikh:I'm like I don't know how to to impart that wisdom of, like, what you don't know right now about how this world works is such an asset Like yeah because you don't come in with all these you know self-defeating kind of experiences of like if I try that it's going to fail, so I might as well not try that anyway. It's like that is such an asset, like, just go, like, go use it. You know, use your naivety as best you can. It's a huge, valuable thing. Well, I guess I guess on that what's next for you. You know, like what would you do if money was no object? What would you do for a job You've done pretty well for yourself? So maybe you're in that space too, and would you just do lots of vipassana. Is that what you're doing? Yeah, run vipassana. Is that your form of darkness retreat? Is that just joking? It sounds like you have a greater mission.
Jaay Desai:Yeah, I think there's certain interest areas that I wanted just brought in the way that I drive impact and the space of like homelessness, social isolation, substance use disorder is one big interest area, Mine and bamboo is kind of like one platform to drive impact towards that problem area. And there's others and I think that Julia, my wife is I don't know, I'll give you the analog she's, I was going to say she's. She's about three and a half months, four months pregnant.
Rajiv Parikh:Woohoo, congratulations, that's man.
Jaay Desai:First one, first one, yeah. So I mean we're later, you know kind of later the party. But I give this fable of the chicken and the pig when I'm giving career advice to like young people. So have you heard of the fable of chicken?
Rajiv Parikh:I don't know. Yeah, no, remind us. I know the podcast listeners probably haven't, so that's all that matters, yeah.
Jaay Desai:So chicken asked the pig do you want to start a restaurant? And the pig says sure, what do you want to call it? And the chicken says well, how about ham and eggs? And the pig says no thanks, because if we do that I'm committed and you're just involved.
Jaay Desai:So the moral moral of the story is like taking a job, like take the pig job, put your butt in the line, you know own a number, be responsible for results, you know be accountable for a number, meaning like you know if you succeed, then you're, you can see the impact of your work. And if you, if you fail, then you can see the number come down as opposed to the chicken roll which is just laying eggs and opining and you know kind of on the sidelines and then you know sort of hope that other people succeed to do the job. And so I think founder, ceo type roles is kind of the ultimate pig job. And you know, I think I'm in a phase right now where the chicken job is probably a little bit more appealing, where you know I want to, you know just sort of help and advise and you know support other companies.
Jaay Desai:But there's a few things that I feel pretty motivated about that I may get more involved in. So I don't know exactly, but I do know that when I was in Coast mode you know when I was in Coast mode and you know, not not working that much before patient being I definitely got bored. So I don't want to go back to that, but I think the job that I'm in right now is pretty intense, and so I think it's probably something in between and I haven't quite figured it out, and so I need to figure out a way to actually create some balance and harmony.
Rajiv Parikh:That's a lot of sense. So just bring a full circle. So you tended. According to our producer, who wrote this little question here, you attended the greatest university on earth, the University of Michigan. He's also a Wolverine, I think. Please, please, tell any of the Wolverines that might be listening what's your favorite food spot on campus, and I'm not. I will not say go blue in the same and all caps as you wrote it on the script. I won't do it, but I will.
Jaay Desai:And I would say the first restaurant that came to mind was Pancho Villa. I'm not even sure if it's there anymore, but it's like the dirty, you know late night burrito spot that we would go to that, or in and out for a slice In and out for a slight Wait.
Rajiv Parikh:What? There's a pizza place, oh sorry.
Jaay Desai:It was called in and out was a pizza place. Sorry, not in and out. The one here is in and out Like a like a convenience store that had really good pizza by the slice. Crazy, that's confusing, but OK got it OK.
Rajiv Parikh:here's another quick one. You went to two great schools, michigan and Penn Wharton. Which one do you love more?
Jaay Desai:I mean definitely Michigan.
Rajiv Parikh:Whoa, it's a yeah I love that. It's your first love. Like right, like, yeah, it is your first love.
Jaay Desai:Exactly, I guess it's really hard to replace a good experience in college with anything else A grad school, luckily, yeah.
Rajiv Parikh:Yeah, b school, you were going to black tie events.
Jaay Desai:You say that like it's a good thing.
Rajiv Parikh:I haven't all kinds of fun, all right, thanks. Thanks for coming on, man, yeah.
Jaay Desai:Thank you Appreciate that. Oh man what an interview.
Rajiv Parikh:Jay is an amazing person. What I like about it is how open he was about the problems in the industry and how we can go ahead and save it right, or how we can address it, and how he just devoted his life to it. He found it while growing up and he found it while he was working in a regular job and then he carried it forward all the way from business school. It's just incredible. Yeah, I think like my like big takeaway was like it's not just one spark that might happen in your life. You know, it's almost like continuing to investigate and search for your spark leads you to other sort of epiphanies and realizations and helps you reframe how you're fundamentally going about your business or running your business. And you know, having that be, be a practice or be a part of your life, I think is a invaluable exercise like that. That was incredible.
Jaay Desai:You keep looking for your spark, sometimes or keeping an analyzer.
Rajiv Parikh:He kept going as he went, like you said, he just didn't start with this is what I'm going to do the rest of my life. He was encouraged heavily to be a doctor. He is father, was already running his own company as a pharmacist, and then he just kept seeing things and kept wanting to make a difference to people's lives and said, well, I can do that with the excitement with myself as a business person. Combining that with a person in health care, it's just really remarkable how he took it step by step and was humbled the whole way and kept learning the whole way and now has been asked to come back and reengaging it. I'm still kind of floored that when he talks about some of the health care companies, most CEOs would not poke at health care systems when they're here likely his customers, right, and it shows remarkable courage.
Jaay Desai:There's a brand for it, and that for sure I just had a blast.
Rajiv Parikh:I think it was incredible and I just want to wrap it up by saying you know. Thank you all for listening. If you enjoyed this pod, please take a moment to rate us and comment. You can find us on Apple, spotify and everywhere podcast can be found. This show is produced by myself and Anand Shah. We got production assistance by Taryn Talley, edited by Sean Mayer. I'm your host, rajiv Parikh from Position Squared, the leading growth marketing company based in Silicon Valley. Come visit us at position2.com. This has been an F and Funny Production. See you next time and remember folks be ever curious.