Niharika Shah - Investing & Building in AgeTech

Welcome to another VC Wisdom pod. We have Niharika Shah with us today. She's investing in building in age tech, not ag tech, but age tech. She's founder and partner at Koi Age Tech, K-O-I, it's spelled, Ventures in New York City. She's a Najunk professor at Rutgers Business School. She's been at EY for some time, Prudential, Toys R Us even, which was my favorite toy store when I was younger. So, Niharika, welcome to the podcast. Tell us a bit more about yourself and what you've been up to.

Yeah, thank you for having me. I'm excited for this conversation. My background, and I think you sort of summarized it well, I've used throughout my career technology as a catalyst, as a multiplier to achieve what I would call outsized impact, whether it's business or people or social. Just by way of background, I'm an engineer turned marketer who then found her way after I left corporate into venture capital and entrepreneurship. I was with Tiffin for 4 years and then left there to start Co-Age Tech Ventures. We are focused primarily on building and investing in ideas that bring more vitality, more joy, more financial security to the later years in life. So it's this beautiful intersection of longevity and vitality. We don't call it aging, we call it longevity. And I think, you know, given the silver tsunami, the precipice of the silver tsunami that we that we stand upon where many of the major world economies, if not all, are facing an aging population without the proper infrastructure or tools or capabilities to manage those. We are one of the very few companies that are squarely focused on the individual and the family and the caregiver. There's a lot of innovation happening both on the wealth and financial side and— on, in health tech and age tech as a broader category around the clinical workflows or the financial workflows. We think there is a white space on, you know, really at the end of the day serving the families. That is what we're deploying technology and capital to enable.

And why age tech specifically for you? You have a story that opened your eyes to it?

Oh, absolutely. And in fact, we have 14 partners in— partners, you know, subject matter experts, part of COI. And each one of us is either a Gen Xer or maybe slightly older. And we've lived through this experience of confronting sort of our own, you know, aging process. But in watching our parents or our loved ones deal with advanced years of aging. And my personal story is I actually left my corporate and venture capital career because I was the primary caregiver for my mother, and I still am. And it— the, you know, there are about 60 million unpaid caregivers today just in the United States, and the number is only growing. So yes, Kauai Age Tech came about from a very profound personal experience for myself, and I would say for almost all of the members of the collective.

And why not hire someone to take care of your mother if you have the means?

Yeah, I mean, look, you can always hire people, um, in the United States, uh, without the proper insurance, and it is incredibly difficult to navigate the healthcare system, the Medicare system. Is very, very expensive. And even if at the end of the day, the caregiver becomes the mission control for the family, right? The quarterback. And you can hire all the help, but at the end of the day, it is your family. And you are responsible. And all this while you're managing your own career, your own child, your own personal health. So it takes a lot of— however much you decide to outsource, at the end of the day, it does come back to the primary caregiver.

Right, I think the model on my end would be take full accountability over the strategy, but then manage employees, right? Just like I'm doing with various things already, the nanny, the house cleaner, the car guy, you know, like whatever. Like, I think I, I would not outsource the thinking and I would take full accountability on the decisions, but must be pretty expensive as well in the US, right? I'm in Mexico, so it's way cheaper. Everything is cheaper here. I've had probably 3 very good founders in that space of like taking care of the elderly. They're creating marketplaces, right? Where you can hire such people. Is that the kind of ventures you start at the moment or you finance? Yeah.

Yes, so we— our first venture that launched last year was— is called Care For One, and that again was born from my own personal experience of— now my mom lives back home in India, and as you can imagine, like Mexico, labor is cheap and accessibility to doctors is relatively easier. We— so what we did was launched a platform to manage long-distance caregiving. So that is, you know, that is if you take caregiving, even if you're physically co-located or separated by small distances, here you're talking about cross-border separation, cross-currency separation. So we actually solved for that. That was our first problem that we took on. But let me give you another example, right? You're saying you can hire and outsource.

Mm-hmm.

One of the problems that we are currently taking on, and the product, the platform is in development, is to address the polypharmacy issue among seniors. It's a $30 billion adverse cost impact problem. And what that essentially means is the healthcare system in the US, we've sort of evolved to, there's no better way to say it, but toll booth medicine, right? You find somebody in their late 70s, early 80s, or beyond, who has multiple comorbidities, seeing multiple physicians, clinicians, and no bad actors. It's just the way that, you know, if you see a cardiologist, they're giving you meds. You see a neurologist, they're giving you meds. You're seeing an ortho, they're giving you—

It's just crazy when you think about it, but go on.

And nobody, nobody's reconciling all of that. Nobody's looking at it longitudinally. What was good for you at age 65 is not good for you when you're 80, right? So, the titration needs to be changed or alternative therapies need to be developed or deprescribed. But proactively, nobody's taking that approach. And eventually it all falls on the caregiver to manage those contraindications. And sometimes the caregiver's so overwhelmed in the day-to-day, they don't even have the right questions and the answers to bring to the clinicians. So that is what we, the product is called Medly. We have partnered and have brought on board physicians, pharmacists, and of course we have AI engineers working alongside them to bring some of that medication intelligence to the caregiver and then eventually evolve to more of your overall health intelligence. You know, the problem with polypharmacy, the toll booth medicine is one part, but also look at the fragmentation that comes along with it, both from a data— Mm-hmm. And service provider perspective. Each hospital system owns their own health data. If you're talking to two different doctors, they're not sharing data, right? So I think there's a lot of real problems that we need to solve. And I think what we're doing with, with Medli is one step forward in that direction. We also have other ventures that we actually, we are one of the few companies looking at bringing together the financial ecosystem and the health system. We know as humans, as people, that wealth and health are inextricably linked, but your financial advisor has no access to your clinician, which is fine. They shouldn't be talking because there's patient privacy and all of that. But imagine a situation where your clinician is aware that, you know, 15 years later you might require hospitalization, or there are triggers or signals that can give you that genetic history, et cetera. Mm-hmm. Your financial advisor should know that so that they can plan your retirement plan and allocate funds as such, right? So those are some of the other problems that we're looking at solving.

That's so interesting. Um, here's another wild one, right? When doctors prescribe medicines, they don't actually test the compatibility of the client's, uh, system with the actual drug. So they don't factor in like blood tests or biochemicals in their blood, uh, history of genetics maybe, but they don't have a blood test done when they actually prescribe a medicine, which is crazy. Have you thought about that one?

Um, I don't know. I think some of them do. I mean, I think they're, they're very, very responsible clinicians out there that will do all the due diligence and make sure— like, you know, I'll give you an example from my mother She has an orthopedic spinal issue, but she also has gastrointestinal issues. So the doctor is aware that they cannot prescribe some pain meds that would, you know, inflame her stomach, her intestinal lining. So there is some of that. However, I think what is more important is those things that, you know, when pharma companies produce drugs, there are a list of side effects and experiences.

Mm-hmm.

However, when a patient actually consumes those medications, and because of their overall context, their overall health, their other comorbidities they might have, they might have different experiences. So it's kind of a Venn diagram, and nobody is capturing and acting and determining if it is even important on what are the side effects and symptoms between those clinician visits, right? Those micro moments, there's tremendous amount of intelligence that can be gathered through that because mom might have just tripped and fallen a little bit, right? Next time you go to the clinician 2 months later, you might not remember that, but Medli will track it. And after a couple of other indications, changes in gait or Medli will create a signal for you to bring to your doctor, right? So it is preemptive in that case. I think our health system and, you know, you know, this overall, we're, we're meant to catch and treat disease, not maintain wellness, right? So all, even your blood indications and your blood test reports or any of those ranges are to detect disease. They're not to detect wellness. And that is what needs to change.

Right. Hmm. Not, I guess, GPT, the same question, and there's no test to measure biochem, but compatibility. For example, if I take a cancer drug, and I had a guy on my podcast discuss that last week, but it's just crazy, right? Because if they would test, for example, they got microbiome, a cancer drug could be as much as 50% more effective, right? So, I just wish there would be something like that because a biohacker like me, I test my blood quite frequently, right? I know about potential markers that need my attention. Yeah. And I think, yes, doctors rely on their judgments mostly for that and analyzing stuff. I'm not saying they're incompetent, but I'm probably saying that doctors are like in a constant execution machine. Like you've been there probably as a founder as well on your side, and they don't have much brains left for improvement. They have so many clients, they're like stuck in a machine to constantly serve their existing clients. Arguably, I'm into that with all these podcasts myself, and I have very few time to think about how to improve my current practice. Do you also feel that on your side?

Absolutely. I think the standard of care is dictated again to manage disease, not to maintain wellness. There is, and that's why we see a whole boom around concierge medicine, right? It is very, very expensive, but that is what people need. And I think, you know, in some, so let me give you another example of, an idea that we are working on. I think it's very preliminary, um, but it, it is related to specifically perimenopause, menopause, all the way through longevity, with a pure focus on South Asian women and women of color, um, that are— You know, I just started this experience myself just to learn how it was, and it is mind-blowing. My, my current suite of doctors— I have a primary care, I have an OB-GYN and everything And one of the discoveries we made was I've been taking vitamin D supplements, just— and by the way, supplements to drug interaction, huge issue. Do not buy supplements over Amazon. I'll say this very proudly and very deeply, do not. But people are loading up on supplements without realizing that they are pretty potent compounds. And so one of the things that we found was when the doctor actually looked into my blood work at a very detailed level, in fact, went down to the mitochondrial level, realized that I needed a methylated form of vitamin D. Otherwise, the vitamin D that I've been, you know, having for the consuming for the last 15 years was just passing through my system. So it's those kinds of things that need to be spotted. I think deploying purely and putting all the burden on a clinician in the context that they operate in and how they're compensated automated is not possible. And I think this is where technology can come in and become a force multiplier for the industry. Not saying that we take away clinicians, and we're not saying that tools like Medly will replace a clinician, but it will definitely empower the entire care team, including the caregiver, to do better, um, towards patient outcomes.

Age tech seems bold and complicated from an investment perspective, right? Because the patient themselves are sometimes confused right? Then you bring another player in, which is their children, right, to manage that. That brings complexity, it blurs the data, it blurs the decision sometimes. Plus, when you try to market to those people, it also seems like a challenge, right? Like, as a marketer, it's harder to find out that you're the daughter of this lady, right? Mm-hmm. Isn't that like a bold challenge on your end to launch these initiatives? Isn't it more challenging economically for your ventures to be successful than, let's say, if I launch a longevity product like Bryan Johnson would and target younger people?

Sure, but that's not what the pain is, and that's not where the problem is. So I think that is a solution looking to chase a problem. You know, I did a lot of work at Prudential around people I think the awareness around longevity has definitely become a lot more higher as we've all seen our sort of parents. I mean, as a, you know, the singular most critical accomplishment of the human race over the last 100 years is what? You could say the microchip, you could say airplanes, you could say penicillin, you could say pasteurization of milk, you could say a lot of things. But we as a human race—

Internet.

Have doubled lifespans in the last 100 years, right? Even in the United States, in 1926, the average lifespan was 55 years old.

And now it's stagnant, right?

Well, it actually went down for a little bit. It's gone back up. If you look at it across the globe, right, longevity is a man-created phenomenon. And we should be very proud of it, but we just haven't built the infrastructure to to deal with that. So to answer your question, I think that is more— one of the experiments that we did at Prudential when we were getting people— it's the same issue, right? In your 20s is the best time to save for retirement because of the compounding value of money. Oh, you'd rather go out and buy a Red Bull and vodka at that time rather than putting money away to— for your retirement. We actually ran an experiment in which we asked people to visualize their retirement. We actually had to put them through hypnosis for them to do that. And this is— remember, this is the age of— what was their show called? Um, the dealing with zombies. I'm forgetting the name, but people found it easier to conceptualize and visualize a zombie apocalypse than their own retirement.

Uh, yeah, I could picture that for sure.

That's what we're dealing with. But I think when you get closer to, you know, the age groups, and when you, when you become a caregiver and all It's very front and center. You have to deal with it. And I think I want to fly into where there is a problem. I want to fly into where there is impact at scale, right? And provide real meaningful impact. And when we talk about this polypharmacy issue in seniors, the $30 billion problem, it's not just confined to United States. It's everywhere. Everywhere. You know, I've spoken with physicians, clinicians, people in the UK, in India, in Mexico, in the UAE. This issue is prevalent. Now, in terms of finding them, I think our approach to many of these are B2C2B, which is our pilots go direct to caregiver to prove out the models need to be trained. We need to show enterprise, you know, readiness. HIPAA, SOC 2, all of that. But at the end goal, we want this to be, we want our solutions to be embedded across the distribution ecosystem. So whatever we build, we build as a standalone usable interface directly or as agents that can be embedded anywhere.

What about the software that captures like all my IoT device data of my mom's house and sends me a report like, oh, this caregiver is good, oh, they're— they could improve on that, or they're abusive. Wouldn't that be a good idea?

Yeah, we're not into care management. I think that that's a red ocean. There's many, many players out there, um, and I think that gets us into a service model. Um, so what we would rather do is where care is being coordinated, to plug this in to make that care better and more effective.

Right. Medli is one, you named a couple, I've tried to reach Medli, which one's the most active and financially successful so far?

I think that, so we haven't launched Medli, Medli is an MVP. The only one that we've launched is CareForOne.net, which is between here and India. And there we are seeing some good success. And one of the other approaches that we took, unlike many other platforms, is we don't look we don't look at just health. We look at estate planning, we look at financial planning, we look at yoga, nutrition, social engagement. You know, you can now pay— I can pay for my mom's groceries sitting here, right? I can— I have an expense account where if she needs to go visit the doctor, I can pay for that. So it's, it's those small little things that used to take up hours and hours of my time now can be done instantaneously, which is pretty fascinating.

Interesting. And this one, is it— how much money is it generating on the short term, and how do you determine which of your ventures to, uh, put the attention in or more resources?

Oh, good, really good question. I think CareForOne is definitely— we're putting in Investment, not so much on the marketing side because that we believe there's enough word of mouth through the community, through local events and we have advocates everywhere. So we are taking much more guerrilla sort of word of mouth marketing approach. Where we are spending is to expand our footprint because as opposed to financial, advice and estate planning and tax filing, which can be done virtually. We can have two, you know, service providers for that. For health, it's a city-by-city activation because you want your doctor to be local. The caregivers, the attendants, they have to be local. So we— the investment that is flowing in there now is much more around expanding our footprint rather than feeding it marketing dollars. But to answer your question, at the portfolio level, We don't want, we don't build businesses that we believe will fail. Everybody says that, right? But there's always value to be extracted one way or the other. And I think for any of our ventures, we haven't gotten to that point yet of making that, you know, should we shut down and move ahead? We are very, very specific around what we invest and who we invest in and how much we invest in. And that, by the way, it's not just dollars, it's also time and attention of the people. But we operate very lean. We are all fractional operators. Most of our partners are in either a revenue share model or a cost saving, cost model, cost plus model. So that also helps keep our operating costs low. We've got partners on the marketing side, we've got partners on engineering and operations. We also have a whole fractional CFO office. So we operate very, very lean. To give you an example, we actually did a, this was not one of our Venture Studio projects, it was more of a consulting project. We did for a fintech, we reduced their operating costs by 67% and delivered, you know, I would say 2 months earlier than what they had anticipated. And we can do that because we operate very lean and we operate in this fractional partnership model.

And Care41.net, is that the only one that has seen the market so far in 2 years? Like, what's your full thesis How much businesses do you want to launch on a yearly basis? What MRR do you want these businesses to reach? Like, what's, what's your full thesis?

Yeah, it depends on each business, but the reason, so we launched Koi about 2 years ago. Our first year was building out the model. So we only took on consulting projects. We worked with founders and helped them build launch scale, right? That was our first year. In the second year, having proven out the model, established the processes, is when we launched the studio. So we actually launched the studio in April of 2025. And there are 3 ventures that we started working on. Now, one was Care For One. One is a fintech that unfortunately I can't share more about because it is under deep strategic— we have a strategic whom we are partnering on building that out, and we're under very strict confidentiality agreements with them. And the third was, is, is Medli, which like I've mentioned, we're about to launch now as part of Care For One. We're looking at expanding, like I mentioned, the longevity clinic for South Asian women. That is one idea that we are working on expanding Care For One.

And the source of financing, how do you finance all of that?

Yeah, so we bootstrap until MVP. And then the goal is to raise capital to scale or to find a strategic. So for Care For One, we're still bootstrapping it. We haven't taken outside capital. I think the incoming revenue is enough to sort of sustain it until the next boost infusion is required. For Medli, we're actually actively raising capital now that we've funded through the MVP. The MVP usually is bootstrapped within the found— within Koi, or we'll take some friends and family money. Mm-hmm. In a safe structure. And, um, we don't actually officially raise a round until after MVP with demonstrated success.

And with Care41, you mentioned the red ocean when I mentioned this idea. Um, how is home attendance training and estate planning not red oceans?

Oh, they are, and they are here in the US, right? But, uh, for people living like myself— non-resident Indians is what we call them, and they live everywhere across the world— um, there are 32 million parents living in India right now with no children living with them because their children are abroad, right? That is the blue ocean that we went after.

But estate planning, is it that helping them with their will?

It's will, but it's also, remember now, just to give you an example, I'm a US citizen, my mother is not, my mother is an Indian citizen. Gifting inheritance tax laws are different if you are separated by, and we don't have dual citizenship between India and the United States, right? So that's one issue. The second is when property needs to be transferred, how do you avoid double taxation? So it's all of those cross-border, cross-tax things that if you're confined within the US, completely agree estate planning, you know, You can get it anywhere, but to find skilled professionals who truly understand both markets, both regulations, that is super interesting.

So you're targeting Indian elderly with that part of the service?

It's the children, so it's people like—

Okay, the children's. Okay, got it. Huh, interesting. Yeah, no, targeting Indian Americans could be a cool niche. Um, Hmm, do you do that via Facebook or Instagram, or do you fully rely on word of mouth and events?

Primarily word of mouth and events. We do LinkedIn. LinkedIn works very well because what we are looking to do, and it's expensive, but what we are looking to get to are people of Indian origin and with professionals, right? Because the service is not cheap. And honestly, your point earlier, whether we're targeting the parents or targeting the children, the parents will not want their children to pay and they will not want their children to pay because when you convert dollars to rupees, it sounds outrageously expensive, right? So we don't— our decision maker, our client is the child who lives in the United States, who is right now putting in between 6 to 8 hours of their time on a on a weekly basis managing long-distance care. If we can reduce that, and forget the emotional turmoil and the stress and this, the time zones, right? I used to stay up sometimes mostly all night because of the time zones. It was the only time that the doctors were available. So if you can reduce that burden, that time, even by, you know, 50, 60%, that's huge. That's huge because, you know, this is their For most of us, this is our productive years. We are stepping on the gas as it relates to our careers. Our children are growing up, they're going off to college. We need to manage all of that. I mean, it's the proverbial sandwich generation, which by the way, I don't think it's sandwich anymore. I think it's panini. We're just getting pressed with cheese oozing out at this point. There's a lot of stress on the system. Yeah.

I love the analogy. How How are you surviving the corporate to founder transition? Like, you've been in that world for so long, talking about Panini, right? How can you make that transition? Isn't that like the hardest thing to do?

I'll say this, and I don't mean this in a derogatory way, but do you know Lily Tomlin? She's a comedian.

No.

She had a famous line which said, you know, even if you're in the rat race, even if you win, you're still a rat.

And— I like that.

And I just found that, you know, having worked in corporate, whether it was in consulting side, or, you know, you mentioned toys, I was one of the first few to launch Babies R Us on Amazon when Amazon was just books. I mean, it goes back way back then. I have a lot of respect for large organizations. I have a lot of respect for people who can learn to navigate those systems. But I find very hard for these organizations to get out of their own way to truly do something meaningful and disruptive. I think that is hard. It's just that time is not on their side. Speed is not on their side. Lawyers rule in some financial systems and health and compliance people, right? So that's intentionally why I left my corporate career and joined a VC firm. And I will tell you, the transition was extremely hard for the first 6 months. When you walk out of an organization where you're leading a team of, you know, 1,000 people, have a half a billion dollar marketing budget, you have chief of staffs and admins and all of that, and then you end up and partner at a firm where you're the first revenue person there and you have to stand up everything from the ground up. It was really, really hard for the first 6 months. And I asked myself many times, what am I doing? Like, you know, I used to— people used to wait 6 months to take meetings with me. Now I'm chasing them to get meetings, right? But I will tell you that experience taught me so much. It has rewired me completely. And I know how to hustle now. And I love that. I love the scrappiness of the startup world. I love the hustle. I've always— let's go Knicks. I've always voted for the underdogs. And what an amazing lesson in leadership, by the way, Jalen and everybody, but I'm a huge Knicks fan. But— Yeah, I think I'm at this point, and in fact, I just did an interview for a lady who was writing an article about this transition, right? Going from corporate out. And I said, you have to have in your mind, be very clear about your purposeful priorities. And I don't mean purpose in that altruistic, you know, ikigai kind of way. I mean, just having your priorities clear with purpose. And once you do that, the rest of the stuff just follows. I think if you get mired in the contrast and the comparison between that world and this world, you're just going to be swallowed up in the eddy current. So there's a lot of fun, there's a lot of grit required in the entrepreneurship world, but what you're able to do, the speed that you're able to move with it, is extremely gratifying and satisfying. But you do not live on a— you cannot live on an hour-to-hour, day-to-day basis, otherwise you'll kill yourself. You have to look at it from a long-term perspective. And just as— who said this? I think it was Tom Hanks, or it's like you got to embrace the cactus. You just got to fall in love with taking on thorny problems and bleeding for it, but just keep going. And I think Once you're wired that way, this becomes a lot more fun.

I think it was Matthew McConaughey, his latest book that was on emphasis on cactus, and I just love this guy and his books, "Poems and Prayers," but "Greenlights" is obviously a classic. Well, thanks for coming on. I'm behind you, like, let's go, you know, like, you left the cage, now you're furious, you know, like, just go after it, because I think, yeah, corporate tends to cage people, cage talent, picked up and exploited. And I'm always happy when people get out of the, the rat race, you know, and start the real race, which is a very personal and painful one. But there's so much growth on the other side. You grow as a human being exponentially. So good job for that. Uh, where can people find out more about you?

Yeah, the best way to connect is on LinkedIn. Um, you find me, I usually connect. I love chatting and connecting. I always learn. My academia experience actually pairs along with my entrepreneurial experience. In fact, I bring a lot of that. A lot of my students work with me on my projects. They're very practical. And in fact, I'm now going to be teaching at NYU this fall. I'm super excited about that as well. And in fact, NYU is taking a very avant-garde approach to changing higher education. They're launching a new program and master's program, which is actually an apprenticeship, 12 months, and you bring your startup idea or you bring your family business and let's pivot together and the entire curriculum is structured around building that idea. So I'm super excited about that and yeah, or just, you know, go to our website koahtech.com and you'll find us there too.

That was Niharika and