Healthcare startup for seniors

This is a story of my 2013 side project to care for our aging parents. It involved several failed attempts to get into accelerators/incubators and ultimately a letter of intent (LOI) from the biggest health insurance provider in the country.

It all started at Tech for Good | Startup Weekend at Hub Ventures (now, Better Ventures) in San Francisco. That’s where I met Evin. Evin is not your typical young techie fresh out of school. He has kids that are in college and parents well past their prime. He’s the marketing brains, and I’m the tech guy–developer and designer.

We started talking about the burden on families when an aging parent has an incident and loses the ability to cary on as usual–in industry parlance, this is called loss of Activities of Daily Living (ADLs). I remember my mom was basically working a second full-time job to take care of my grandmother in the last several years of her life. From groceries to appointments to managing finances, it’s a time consuming endeavor being a caregiver.

Caregiver agencies are in business to relive this role from friends and family. Unfortunately, they leave a lot to be desired. For one, you don’t know who the agency will send out to help. For instance, I know a lady that went through dozens of professional caregivers at these agencies in order to find one that had the competency and personality to get along with her Alzheimer’s mother. She ended up having to quit her job and move in with her mother because she wasn’t able to find a caregiver in time.

It’s not necessarily the caregiver’s fault that there isn’t compatibility. The agency shields the caregivers from those seeking their service. Professional caregivers, who are often highly trained with a B.S. or M.S. in social work, barely get paid minimum wage while the agency bills them out at a much higher rate. It’s all part of their traditional, offline business.

In summary, friends and family are struggling to find competent people to care for their loved ones. Professional caregivers who are there to help get screwed by the middle man. Meanwhile, the agencies keep making money because people are desperate for the caregivers’ services.  Doesn’t this sound like an industry ripe for disruption?!

It didn’t make sense to Evin and I, in the age of TaskRabbit, that we couldn’t quickly and easily get help for our parents. For instance, maybe they need a ride to the grocery store, help with the yard, or just switching out a light bulb. Given our parents don’t often live nearby, it can become a huge time sink to help with such ordinary tasks. TaskRabbit isn’t designed for seniors or families trying to get help for their aging parent. (You don’t want to send some stranger over to your mother’s house, especially if she’s not well.) However TaskRabbit did supply the inspiration: you could see reviews of the TaskRabbits and you could book services online quickly and easily.

So SeniorServe (later renamed to EngageCare) was born. After talking to people over the weekend we decided it was better to design this tech solution to friends and family caregivers instead of the aging senior.  We won second place at Tech for Good/Startup Weekend, $1,000 in FB ad credits, 3 months of co-working space at The Hub, and we were a finalist for Hub Ventures’s incubator program.

We created the following presentation, but didn’t get invited for the incubator program.

Finalist PPT with Wireframes

A month later we had more success at a weekend hackathon known as the Health and Technology Code-a-thon. By tapping into TaskRabbit’s API (and with the following presentation), we won first place, including $5,000 and a booth at the 2013 Health Technology Conference.

Now that we had some momentum we looked for ways to focus on this full time. We applied at RockHealth (early 2013 ) and Tumml (see application), without success. Finally, we caught a break by attending an event through Prebacked.

Prebacked is an interesting kind of incubator/accelerator in that they start with the customer. The customer presents their problem(s) and work with teams (like Evin and I) to create a solution. In our case, they brought in a Blue Cross Blue Shield (BCBS) from the midwest to tap into the young talent of Silicon Valley. Three teams would be selected after one week. In our first of two weekends with them, they moved around from team to team where we listened to their problems and iterated on solutions.

I have to say that listening to these guys, and reading between the lines, was a bewildering experience at first. As business leaders, technology leaders, and even doctors within the organization came by to talk to our team, we had to deal with what was often contradictory advice. By the end of the weekend, we realized they didn’t really care so much for the senior services we were providing–though some could relate on a personal level. They didn’t even care about saving BCBS money. However, they were interested in the more broader problem of taking care of discharged patients so that they adhere to medication and generally take care of themselves so that they aren’t readmitted and have healthier outcomes.

In the following week we crafted our demo and pitched them. Of the roughly fifty teams, three were selected to move forward with a letter-of-intent (LOI). We were one of the three (team 19). With this LOI came a $25k check to work with them over the next 90 days to create a solution that we could pitch to the higher-ups for a longer-term contract.

During the next few months, we had weekly meetings with Prebacked and BCBS, we changed names from SeniorServe to EngageCare (to remove the senior focus and sound more enterprise-y ), and we iterated on our proposal. We learned they had an internal case manager that communicated with patients who could potentially tie into our product at some point–a valuable product addition from our vantage point.

Unfortunately, one of the biggest let downs from this co-designing of our product was that we didn’t get a lot of feedback from BCBS on our weekly phone conferences. In retrospect, I realized this is likely due to a lack of Creative Confidence from representatives of such a conservative industry.

On the last day of September 2013, BCBS paid for one member of each team to present to 8 VPs and the CTO. Evin presented for our team. Sign up for to have a look at the demo. It’s a responsive web site (desktop, tablet, and mobile) built with Ruby on Rails v4 and Bootstrap v2.3 and served from Heroku. I initially started coding it with Node.js and Backbone.js, but Rails lends itself to faster prototyping using the built-in gems.

Interestingly, this was the first time the execs had been in a meeting together like this; the $6 billion company normally operates in walled silos. Each team presented for 25 minutes with Q&A. The response was about 2/3 positive and the other 1/3 saw risk. Risks were HIPAA, brand/name risk, and engaging in the uncontrolled world of social/Facebook-style communication. The positive side saw brand and customer engagement at a time of need at virtually no cost with “free” social care support of friends and family. Most importantly, it created strategic customer value for BCBS.

The CIO missed our presentation but was one of the more enthusiastic supporters of our work, so the tentative plan was to come back later and present to him. Though there has been a lot of talk since this event, we’ve yet to move forward with BCBS.

In the meantime, we went to another hackathon. This time it was an event put on by Novartis for Congested Heart Failure (CHF) to “create a mobile solution that helps caregivers of loved ones affected by Heart Failure regain control over their lives and provide more effective daily care.” We designed an app for a family member (caregiver) managing their dad’s heart failure, as you can see below.

It was a competitive event, and this time we didn’t make it to the finals. I uploaded the code in case you want to open it up on an iPhone 5 simulator to have a look. I used Bootstrap v3 to speed up the prototyping.

We put in another application (below) to RockHealth late in 2013.

After a year of ups and downs, we’re taking a break for now.

Lessons Learned

You have to start with the customer. It’s not the first time I’ve learned this lesson. There were reasonable excuses. Other similar services in the marketplace have failed to take off. Evin thought we needed a distribution partner in order to get our product in the hands of the user. It might of worked, but ultimately I think you need to understand your end user via the lean startup approach, as explained by Yammer, before even going after the big guys.

I felt there was a good balance of strengths for co-founders. Evin was a great networker. Watching him take notes at events was like watching an A+ student in class. He did his homework and thought through issues. In past startup ventures, I’ve felt like I was doing a disproportionate amount of work because I’m the tech guy who has to build (and often design) the entire solution. In this case, I thought Evin was an excellent compliment to my skills by uncovering opportunities by attending events and networking.

I learned more about what it means to design for the customer. Even though I was insistent about an MVP from the beginning, I struggled with what exactly that meant for us. We did ultimately talk to 100 potential users, which resulted in a top 10 list of features. However, I think this may have been biased to what we were already developing given they occurred in parallel in order to meet the deadline by BCBS.

A more sensible approach might have been a wireframe or sketch of how we saw the top 2 or 3 features working and then taken it back to the user for validation. In fact, we would have probably learned more by creating multiple versions of a single feature and iterated on that alone.

Even after a year on this project, I think for this project to still have legs we would need to essentially start from scratch. When one imagines a product for the enterprise/payer (BCBS, for example), providers (hospitals, for example), and patients, i.e. seniors, there are too many disparate parties to please. It’s great to have that as a vision. For a product, however, I think it’s the reverse. Like a sculptor with a slab of marble, I think a product needs to chip away at the vision until they have a product with the absolute bare essentials–an entry point into the marketplace.

If we pick this back up after a break, we’re starting by focusing on desirability.


(copyright IDEO for the venn diagram)


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