James Cohen is the CEO of Nevvon, a healthcare eLearning SaaS for home healthcare caregivers. James founded a home healthcare agency to solve the biggest issues he had in getting proper homecare for his grandfather. After that, he founded an eLearning app for home caregivers to solve the biggest problem he had running an agency: training caregivers. I talked to James his about experience building both companies and being recognized as one of 50 Whole Health Heroes (Empire, Blue Cross, Blue Shield, and Crain's Business Award.) We also touched on home care trends created by the COVID-19 pandemic.
Click here for audio and audio transcript.
1. James' personal experience and paint paints that led to founding a home healthcare agency.
2. James Cohen was honoured as one of the 50 Whole Health Heroes for Nevvon's community contributions during COVID-19. One initiative is free vaccination training, available to everyone, including as a white label solution. Their goal is for 100K people to take the training. Watch the video to see what else they did. When do the folks at Nevvon sleep?
3. An unorthodox way to determine product market fit, and why they went with a pay-per-use rather than pay per seat price model.
4. Nevvon's content creation process is very thorough. The content team includes script writers, nurses, lawyers, and instructional designers. As a documentation aficionado, I am suitably impressed.
5. How do you get feedback that you can't get from a survey? They talk to their users every day. Also, James shares the questions they asked their users to design the app's user experience.
Welcome to How Founders Build. My name is Sharon Landis and I’m your host.
Sharon Landis I'm very excited today to be talking to James Cohen, who is the CEO of Nevvon. James, could you provide a quick intro about yourself and also a bit about your company?
James Cohen Sharon, thank you for having me this morning. A pleasure to be on. My name is James Cohen. I'm the CEO and Co-founder of Nevvon. We provide online app-based training to healthcare workers, to keep them in compliance with regulatory requirements, to keep their certification.
1. Why I love home healthcare
[00:39:98] Sharon Landis I took a little browse of your LinkedIn profile. One of the things that I found nice… just nice, is that you love home health care. Can you talk about that?
James Cohen Like many founders, the ideas come from personal issues or experiences. I had a grandparent who was going through the aging process. We required home-care for my grandfather. At that time, it was very hard. Inefficient. Expensive. Hard to find proper caregivers. Hard to find quality caregivers. Hard to deal with the government to get any type of subsidized care.
Once I realized how hard it was, I realized there was a major pain point that could be solved. I'd been in health care for nearly 20 years, specifically in home healthcare for the last 10 years. Most of the elderly people that I've spoken to preferred to age at home. Economically it’s more feasible to stay at home and get care than go into a facility. And, there are not enough beds to take in the aging population. There are 10,000 people a day in the United States alone, turning 65 every day. People are living longer. People are living with co-morbidities. I felt there was a huge market opportunity around home health care. We did a really good job for my grandparents. It means a lot to me. It's very personal to me.
Sharon Landis Do you feel that the improvement you were able to provide for your grandparents is what you're able to provide for other people's grandparents? Is that why you love it, too?
James Cohen Absolutely. I love it because... Startups who decided to solve personal pain points, we have that unique experience of sitting in the seat of our customer. We know what they felt.
I remember having to find a caregiver. Having to pay for it. Having to replace them. Having to find caregivers who speak different languages. Having to find men or women. Or someone who can interact with my grandparents in a better way. And of course, communicate with the families in a good way. I went through all that. So I know very well what it feels like. We've done really well in solving those issues that we had on a personal level, as a family.
2. 50 Whole Health Heroes Honouree for COVID-19 Initiatives
[03:17:38] Sharon Landis You were honoured as one of the 50 Whole Health Heroes. What was the work that you did behind receiving the honour?
James Cohen When the pandemic hit I did a few things. I created a website overnight. I'm not a coder, I used Wix. There were a few things I was trying to solve.
There were a lot of companies laying off people, so there was a lot of good talent out there unexpectedly without a job. Then there were a lot of companies, because of the pandemic, were hiring. I was trying to match make the two.
The other thing I did was… There was a surge in prices for personal protective equipment. For 100 gloves, you might have been paying $2 a box. All of a sudden they're up to $20 a box and difficult to source. We donated about $100,000 worth of personal protective equipment. And there was a time that, unfortunately, healthcare workers were reusing gloves and masks. Not safe. Not right. And it wasn't because the home care agencies didn't want to spend the money. There wasn't any supply. I was fortunate to have supply from other resources. Whatever I could donate, I donated. When it got a little too much for us as a company to donate, we connected agencies with suppliers that had fair pricing. We only let suppliers with fair pricing on our website.
And then of course we did a lot of what others did. We delivered about 4,000 meals to health care workers. We went to retirement homes and long term care facilities and sending Uber Eats cards and packaged meals, just to give them something. They were working sometimes 20 days straight without even going home. Just to give them something back, because they were truly front-line in the thick of everything, while everybody was at home, and they were working. So we did a lot of that. Fortunately, I was recognized for doing that.
Sharon Landis The website that you are matching up employers with potential caregivers. Is that still up?
James Cohen Yeah, it's on our website, NevvonCares.com. As we do things for our community, we add more to it. Part of our mission is to give back to the community.
Sharon Landis You also give free COVID-19 training. That must have been part of what you were recognized for.
James Cohen Absolutely. We gave free COVID-19 training back in March. I was shocked at how many people who are health care workers, did not know how to don and doff their PPEs.
A lot of people don't know that there's more risk of spreading the virus, not by how you don the PPE, but actually how you take it off. How you take off your gloves. How you take off your mask. As a community, many of us came together to give education on how to do that.
Furthermore, there are a lot of people that I call anti-vaxxers. They're scared to get the vaccination. We had set up vaccinations for healthcare workers. A high percentage were telling us that they don't want to get vaccinated. It came … from Google is hiding all the results of the vaccinations specifically from health care workers because they want us to be the guinea pigs. To something more reasonable. I spoke to one gentleman who is a health care worker and he said- I'd like to see more people in the world get vaccinated before I do it myself. I recall asking him, how many people in the world do you think have been vaccinated? Probably about 10, 20, 30,000 people. Actually, it's tens of millions of people. And he said- really? He now wants to get vaccinated because he feels that if so many people have done it, it's probably safe.
We built out vaccination training. We're giving that for free. We have a goal to get 100,000 eyeballs on it. There's no catch. It's just for the better good. I feel the more people that get vaccinated, we can end this with pandemic, and Sharon we can travel again. Go for a vacation and do all the fun stuff that we want to. Go back to the normal world. That's a big thing that we're doing right now. 40,000 people have watched the training.
Sharon Landis I think that there is generally a lot of misinformation about COVID-19. I'm surprised that agencies are doing more to inform their caregivers. What I see in the news is that vaccines are being held up. I'm very surprised to hear that millions have been vaccinated.
James Cohen Tens of millions of been vaccinated all over the world already.
3. Homecare Agency to eLearning Platform
[08:24:28] Sharon Landis You first had a home care agency yourself. Then, you built an eLearning system. What made you go between the agency and eLearning?
James Cohen I was the original founder of the home care agency. We scaled it. We did very well. We serviced in Canada, Ontario and Alberta. In the United States- New York, Chicago and Boston. Then, I felt that it was time for my next challenge. I knew it would be something with technology and something around home health. It was actually a really simple exercise. I asked myself: What are the pain points that I had building out a home care agency? Recruitment, retention, and training of home care workers were the hardest things that we had to figure out as we are scaling the company. As we talked to health care agencies, it's was always one of their top three issues.
Sharon Landis Why is it so difficult?
James Cohen The pay is extremely low and the work is extremely hard. There's a huge turnover in the industry. In the United States, for example, home care workers can be paid anywhere from $18,000 up to $25,000 a year. They don't have set schedules. Their schedules are sometimes in the evening, sometimes they’re 3 hours at a time. They're often on the weekends. It's a very emotionally difficult job because you’re caring for people at end of life. Physically it’s a hard job. They're doing a lot of housekeeping, meal preparation, transferring the elderly person from bed to wheelchair, to maybe give them a bath, or shower, or toileting them. There are a lot of behavioral issues with elderly people. Specifically, people who have advanced dementia.
It's a very, very difficult job. The pay is so low that sometimes the home care worker asks, why am I doing this? I could be working at Tim Hortons or Dunkin Donuts as a cashier, maybe making more money and a lot less stress and have fixed hours, coming in 9 to 5, as opposed to having hours all over the place.
Sharon Landis Why is it difficult for the agencies to educate their staff?
James Cohen There's such a high turnover in the industry. A 2020 survey reported 60% turnover in home health care agencies. If you had 100 caregivers working for you on January 1, at the end of the year, 60 of them will be replaced and only 40 would stay with you. To continually provide training, with such high turnover, is very hard to do in a scalable, standardized way.
In the past, training was in a classroom setting. Very inefficient. Inexpensive. Agencies hated it. Caregivers hated it. When eLearning became available regulatory-wise to train the caregivers, it opened up an industry, where all of a sudden you can have high level of training, and very accessible. We build our training in bite-sized micro lessons, so they're not hours at one time. Literally 3 to 5 minutes at a time. If you want to refresh your knowledge on how to deal with dementia behavioral issues, you can go to the app, or go to the website, search for dementia, and then you'll have bitesize micro lessons. You don't have to come into the office. You don't have to schedule a time. It's available for you 24/7, at your fingertips whenever you want it available. It's cheaper for the agency. It's more accessible. More efficient. And definitely more standardized and a higher level of training.
Sharon Landis When you first started having this idea and getting excited about it, did anyone try to talk you out of it?
James Cohen No. I'm pretty well versed in the home health care industry. It was clearly a big pain for home healthcare companies. What was challenging was that each agency is different, and different agency sizes. If I use a new CRM in my company, or a new tech tool to better communicate within my company, it takes time to get buy-in to a new technology. That change management, to compel the home care agencies to change the way they’ve worked for the last 10, 15, 20 years, and now work in a different way, that was definitely the biggest challenge that I was going through and thinking through.
There were a lot of surveys done. And bringing together agencies to ask them questions. Building MVPs. Getting feedback. Iterating on those MVPs. And continually improve and listen, based on what the market needs and wants.
Sharon Landis How long did you go through iterating on MVPs, before you had something that you felt would work?
James Cohen Easily…Well, I could say we're still doing it right now, in one sense, or continuing to improve. But, I would say 9 to 12 months, until we felt that we fully got it, and we had complete product market fit.
Sharon Landis Do you remember the first feedback that you got that made you feel- OK we got it here.
James Cohen I have an unorthodox way of thinking about when we have product market fit. The day that we stop having to discount and stop having to customize. When they just take it as it is. As we priced it. Then I knew we had a product market fit. That was lightbulb moment. Now we have something.
Sharon Landis Do you find that at the beginning your pricing is more complicated? As you get feedback you realize looking back, oh why didn’t I see this in the beginning? Your pricing on your website looks really simple.
James Cohen Many of our competitors charge by a per-user per-month model. The problem with that is there's such a high turnover in the industry. 60% of your caregivers will leave your agency. So if you bought 100 licenses for 100 caregivers and 60 of them left, you just wasted 60 licenses. You have to buy another 60 to replace them.
Instead of selling seats, I sell hours. In most States each caregiver needs 12 hours a year of continuing education to stay in compliance. So if you've got 100 caregivers, very simple, you buy 100 times 12 hours, you buy 1200 hours. If a caregiver started with you and only did two out of the 12 hours that you allocated for them, you have 10 hours that you can allocate to a new caregiver. You only pay for what you use. A lot of the industry comes to use because of our pricing. Agencies only spend money on true training hours, which has been a huge advantage for us.
4. Caregiver eLearning Content
[15:47:09] Sharon Landis It seems that you have a very interesting process to put content together. It's very, very thorough. Could you talk about how you put it together and what people like about it?
James Cohen We drive our content our content library based on two items: Is it a regulated course? Is it something that the province or the state is requiring each caregiver to have? Then we look at what our clients’ are asking for. For example, we had a client who asked- can you build out training for us on bed bugs? That is something that is super interesting that could be helpful.
And the third way… when things come up like COVID, or vaccination training, or anything around infection control, is really important now to keep people safe. We're doing a lot of that as well.
When we build out the content, it takes us about three weeks from start to end.
We have script writers. We have clinical nurses. We have lawyers overlooking to make sure that the regulation is correct. Then we have instructional designers. They look at what are we teaching, and who is the learner. We build it in plain language. We build it in micro lessons. We often have multiple languages. Our whole library is in Spanish, Russian, Mandarin, and Haitian Creole. We build training in up to 14 languages.
We're looking at the learner and then we're looking at, what are we actually teaching? How can we ensure that the learner, who's a caregiver in our case, is retaining that knowledge? Sometimes we use our studio. Sometimes we use video. Sometimes we use animation. Sometimes we use gamification to learn. We have different modalities. Our instructional designers are skilled on deciding which modality we're going to use based on the education that we're teaching.
5. Customer Success
[17:47:60] Sharon Landis How is your company organized for customer success? What kind of roles do you have in your company to make sure that agencies are taken care of and care givers are taken care of?
James Cohen We have two sides to our customer success. We help the caregivers if they're having issues with the app or with the website. They might have forgotten their password. They might have some questions about the content. We're there to help them with that.
The other side of our customer success team is to deal with the agencies. They need to make sure that all their caregivers are learning throughout the year, taking the correct topics and on time. They need all the certificates passed on to them. They need reporting for auditing from the Department of Health. We work with them to make sure they're set up when they get audited, that they have all their papers. Well I shouldn’t say papers because everything is electronic, but that they have everything ready to present to the Department of Health when the surveyors come in.
We help, from a compliance standpoint, for the agency office. For the caregivers, our customer success team helps them use the app in the best way possible.
6. How We Get Feedback and Building MVPs
[19:09:70] Sharon Landis How do you get feedback from either parties that you’d never be able to get on surveys?
James Cohen We are constantly calling and asking. From the caregivers we're asking for feedback. Often as we're talking to them. We probably talk to 50 to 75 caregivers a day: How are you doing? How is the education working for you? Can you give us any feedback?
I'll give you a quick story of how deep we get into this.
When we were building the design, the user experience and the user interface, we were trying to think, how are we going to do it, so that they will use it in the best way? We actually did focus groups with them. One of the questions we ask them is, what are your favourite apps on your phone? What are the apps that you use all the time? By far and wide, the two biggest ones were WhatsApp, likely because that's a communication tool where you can video chat. A lot of caregivers have family in a different country. You can video chat for free. And the other one was Instagram. I don't know why, but Instagram was a big one.
When we were building the user experience and the user interface, we actually mimicked WhatsApp and Instagram. The way you register. The way you log in. Where the buttons are. Even a little bit of the colouring. How you move from page to page, we tried to mimic it. So when they go in, all of a sudden, some of it, or hopefully a lot of it will feel familiar to them. They don't realize why it feels familiar to them. It’s because we did a lot of research to understanding who are user is. We wanted to make it very user-centric. Our success is completely based on how well they're using that app. If they're not using it, our clients are not going to pay us. If they are using it, we're going to do very well.
That's how we get feedback. We do that consistently, both from the agency side and from the caregiver side.
Sharon Landis That's something a lot of founders have trouble grasping. Even though they have this technology that does everything, they still have to talk to their users. One-to-one conversations.
James Cohen Absolutely. Reminds me of the days when website designers would come out, and you pay them to build a website. They would build everything from scratch to a fully blown website. When they deliver, you look at it and it’s like nothing like I expected. If they would have showed it to you during the milestones, you would have been able to give feedback and had a deliverable that you're actually happy with. Same thing over here. We built our MVP. Get feedback. Iterate. Feedback. Iterate and keep growing like that. We've done quite well building our technology in that way.
7. Nevvon.com APIs
[21:55:70] Sharon Landis Are there other companies that you work with, that you can share about, that help you provide a better service that you wouldn't be able to do on your own.
James Cohen We have API integration with other software. Home care agencies, unfortunately have to use different software. They have their CRM, their agency management system. Their HR system, payroll, and training. So we built API integrations. For example, certificates. Agencies have to keep all the certificates of all their caregivers. The certificates are housed on the Nevvon platform. There’s an API integration, so that anytime a certificate is generated it automatically goes into their HR system. It saves time. It's efficient. Obviously, it saves money. That’s a big initiative we have now. To keep improving on the efficiencies between all the software. Remove human error and save money for the customer, for the agency.
8. Home Care Trends Due to COVID-19
[23:06:78] Sharon Landis Let's talk about trends that you see in homecare. Do you think because of COVID agencies will have requests for other types of services? A lot of people who aren't necessarily sick or wouldn't be so lonely because of COVID are at home. Do you think that's going to expand the home care industry?
James Cohen Definitely. We're seeing telehealth companies thrive during this time, where they can offer socialization, or reduce hospital visits or emergency visits by just talking to a nurse or a physician over a Zoom or video conference.
I feel telehealth, anything around mental well-being, mental health to reduce the feeling of isolation, is happening right now. After the pandemic, I feel it will get reduced a little bit, but I don't think it's going away. Tele-health has been around for a long time, but has had hockey stick growth since the pandemic. I don't think they'll show the same growth as they have when the pandemic is over, but I don't think they'll go away. I think they'll stay very viable in the industry.
Sharon Landis Do you think there will be other types of services actually going into the home, other than Zoom telehealth?
James Cohen There's a whole movement around hospital-at-home, because as we know- end hallway medicine. We've all been to hospitals and we've seen patients sitting in a wheelchair in the hallway, which is a terrible thing to see, especially when it's your own family. We're seeing more innovation come into the home and trying to bring the hospital into the home. Hospitals can’t take the capacity that they're taking in. It's much cheaper to care for people at home, whatever type of care it is than it is in a hospital setting. Definitely we're seeing a lot of innovative startups starting to look at what can we provide at home rather than in hospitals.
Sharon Landis Do you see it beyond hospital care? For example, companion care. Not necessarily somebody who would go to the hospital, but something that would be brought into the home that wasn't brought into the home pre-COVID.
James Cohen I've been in touch with several companies who've done the companion care. Unfortunately, now, because of the pandemic, a lot of the elderly people do not want anybody coming into their home. So that companion cares is not happening right now. But I imagine when the pandemic is over, that definitely will come back again. There are a few startups out of San Francisco that I know of that are doing it right now. I don't believe that anybody that has built at scale yet, but someone will eventually figure it out. The future of care is definitely at home.
Sharon Landis And possibly to service a younger population, not necessarily on critical care issues. Do you see that happening?
James Cohen Yeah. I'm not sure if you know that if you saw I sit on the National Brain Injury Association.
Something extremely important to me personally, that I've been involved with for several years, as well as from a professionally. Also, we [our agency] cared for a lot of people with brain injuries and traumatic brain injuries. Those individuals tend to be younger. They tend to be in their 30s and 40s, usually from workplace accidents or severe car accidents. There's a lot of care that is deployed to them. There's a lot of child care as well. So, I don't see it only for elder care.
And we do that as well. When we train, we're not training just for elderly care. We're training for any type of care that is happening in the home.
9. What's next?
[27:13:83] Sharon Landis I'm glad that you're looking out for everyone. What's next for your company? What kind of things are you looking to get into? Kind of people that you're looking for? Anything at all.
James Cohen We're a growth company. We're hiring mode right now, we continue to hire in every department that we have. I've done really well in life by swimming in my lane. I like to be good at one thing rather than trying to be everything to everybody and being average at it.
For now, we're doing training. We're looking at other verticals where we've done mostly home health. We're looking at assisted living facilities who need training, some of the skilled nursing facilities and hospital systems. We're looking at workforce investment organizations that need up-skilling. All in our industry and related to health care. We very much have intention to stay in our lane and continue to better what we do really well right.
[28:21:80] Sharon Landis There's a lot that you talked about that I didn't know. I misinformed just like many people. So, that was good to know about. Thanks so much for being so open about your company and sharing so much information.
James Cohen Thank you so much, Sharon, for having me.