Josh Komenda & Veyo Are Connecting Those in Need With On-Demand Medical Transportation

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And welcome back to the Tacos and Tech Podcast. I'm your host Neil Bloom. We are continuing our Coronavirus style doing this virtual and I'm lucky to have with us CEO and Co Founder of VEO Josh Kamanda. Josh, thanks for being on.

Thanks so much for having me. Neil, it's great to be here.

Yeah, we're really excited to have you here. I wish we were hanging out in person, but you know how it is right now.

Definitely. It's a new life.

Yeah, really is, Josh. We've crossed paths so many times in the startup ecosystem, but I don't think we've ever really gotten a chance to sit down. So I'm very excited to get to know a little bit of your backstory. Where did you actually grow up?

I grew up in Winnipeg, Canada, which is probably in terms of climate, completely the polar opposite of San Diego, quite literally. So I guess I spent the first 18 years of my life there and then after college moved to San Diego. So I think I put my time in and I was ready for some good weather.

Was that specific the reason? The San Diego is just like change of pace, change of weather.

You know, I think like, I always, you know, growing up, I was always California dreaming and, you know, just always was enamored with it. And when I was in college, I attended University of Waterloo for college just outside of Toronto, which is a pretty big tech school. And I had the chance to. I covered my internship at Qualcomm while I was still in college and I moved here and completely fell in love with the city. So I needed to make it happen.

So you were an intern in San Diego or was there like Qualcomm Canada?

No, it was intern at Qualcomm in San Diego. Oh, okay.

What a tease. While you're still.

Had to finish up my final, my final semester in January after. After kind of being here for eight months. So that was a bit rough. But I knew I was working toward a full time job after I graduated, so, you know, it was something to look forward to.

Okay, so what were you working on at Qualcomm?

I worked in engineering. I led a global engineering team. We did, you know, worked in the bread and butter division. Their QCT chipset division organized a bit differently now, but let up a device driver team for SIM cards.

Okay, so give us a timeframe. Like when was this that you were working there?

So I was there from. I graduated in 2004. So after my internship, I was there from about 2004 until about 2010.

Oh, okay. So you saw the rise of smartphones, which was a big change for their business.

Definitely and always was like mobile devices, technologies and all the services surrounding them were always, always like a huge interest of mine. And it was a good place to kind of get my feet wet and learn about the industry and figure out how I wanted to plot my entrepreneurial career.

So you already knew you wanted to start something at some point?

I think always, I think, you know, since I was a kid, I was always like trying to think about business ideas and ways to go into the marketplace and think about doing things differently. And so, you know, I wasn't really ever much of a fortune, you know, Fortune 500 or 400 Fortune 100 employee. Qualcomm was a fantastic place to work. I think I also like the long term plan was always to get my feet wet and learn an experience and then figure out how I wanted to go the entrepreneurial route.

So at Qualcomm at the time, was it kind of typical or in the culture that people would spin out and start their own thing? Was that like something you could tell a lot of people did?

You know, there's a lot of stories from. Qualcomm's a big company. You have a whole array of people. I mean, it's overall like, it's a, it's a fantastic place to work. You know, it's been some years since I've been there, but I always had a great experience there and got a chance to really, as I said, I worked in Asia a lot, got a chance to travel the world and experience business in a lot of different countries and see a lot of different, get a lot of different cultural experiences, which was awesome. And I learned a tremendous amount about how software gets built and commercialized and things that I would do as a company and emulate things I would do differently as an entrepreneur. So yeah, I mean, there's definitely lots of stories. I mean, you hear lots of stories of people breaking off, but then I've also got really close friends that have made like really awesome career paths within the company. And that's like, you know, there used a lot of both.

Okay, so was your first idea the one that you jumped at or how did that come about?

I always like, you know, used it as a, kind of as a hobby before I was serious about it. Like, I always kind of like talk about business ideas with friends and how we would kind of test the viability of ideas. And so my first idea I came up with a friend, you know, Kenneth, I came up with toward the end of my time at Qualcomm with a friend of mine from Qualcomm, actually we both kind of, you know, put together to pursue, to pursue this company. And it was an idea that, you know, basically back in 2009, 2010, you know, kind of Sort of really pre smartphone. Well there's blackberries but you know, wasn't like the smartphone app revolution really hadn't happened yet. And it was also pre Uber and Lyft. I mean they were kind of just barely ideas that, you know, were pretty much San Francisco only and very niche products. But we came up with this idea of like how to make ordering a cab easier. And so we kind of launched the first SMS based and then later mobile app based service to order cabs. Now at the time, you know, as a first time entrepreneur I probably thought, you know, I thought we were being disruptive. Little did we know that there was sort of like these shadows lurking that was going to completely upset the entire industry in a much more cataclysmic way than we could have. But you know, that, you know, we had still had some pretty moderate success. I think we were, you know, had a window there where you know, we were caught, you know, developing a lot of technology enhancer in the experience and kind of the first group of companies to bring technology to a hundred year old, you know, sleepy industry. And I think more than anything was just learning, kind of getting a front row seat on the Uber and Lyft story and really what it looks like to watch a highly regulated, highly controlled, sleepy industry get completely, radically changed within five years. Wow.

So that was go FastCab, right?

FastCab, yeah, my first company.

Okay, so when did you start that? 2010.

Yeah.

Okay.

Yeah. Wow.

And so what was that like starting jumping off and quitting Qualcomm to make it happen?

I mean it was pretty nerve wracking. I mean like I, you know, I think, you know, I come from like my parents have always been, my parents work in healthcare, my dad's a family doctor and like they always had very like stable, conservative career paths I guess. Not like, not, you know, so I think, I think like my parents reaction first was like, why would you, you're gonna quit this awesome job, awesome reliable, stable job at Qualcomm and like how are you gonna make money? How much money is your company making right now? So I mean it was definitely little bit of a leap of faith, but I got good advice early on from mentors and stuff and said look, if you have the passion and desire, you'll find a way to land on your feet eventually. And doors will shut, but windows will open and you'll figure out. And that's kind of exactly our story. We definitely scrapped and got challenged as a company early on and had some moderate success but eventually kind of realized that Uber and Lyft were, you know, really completely changed the industry. And there probably wasn't a place for our service specifically, but we ended up selling to our largest customer in 2013, a company called Total Transit of Arizona. And they ended up acquiring my first company basically as part of an aqua hire situation. What they really wanted was me and my team so that we could start a new company together. And so I think in many ways Uber and Lyft were probably the reasons that my first company wasn't successful. But also they opened up this new idea of tech enabled transportation and tech enabled logistics and these new business models. And ultimately Total Transit wanted to explore new opportunities in this new tech enabled transportation world. And they felt that me and my team had this expertise and it worked out really well. And that's kind of how we ended up with vaio.

Oh, that's cool. Okay, so you, by the way, were you doing any of the tech in the beginning or you were always like the business side and your co founder was the tech?

You know, I have a tech background obviously. Like I, you know, studied computer engineering in college and worked for Qualcomm and I was running in an engineering group, you know, but like starting my entrepreneurial career, I was really, really running more of the business. And you know, we would definitely do product specs and stuff like that, but we worked with, we worked with a separate dev team over that. So it certainly helped being in the domain. But I haven't really coded since I left Qualcomm.

Okay, so was the acquisition of GoFastCab like timed right the same time as starting the new company or was there like a waiting period where you just kind of figured out what the next company was going to be for a bit?

Yes. Actually the story, I think back in 2013 we, you know, we saw this massive change happening in ground transportation. And the traditional ground transportation company was obviously really starting to fight for their survival at that point. And you know, while we watched a lot of our customers and prospects in the industry really kind of struggle and not necessarily have a good path forward. Total Transit was, you know, ground transportation company. They also had a really big background in healthcare, transportation as well as some other transportation segments and extremely progressive traditional industry and traditional ownership that have been in the industry for 30 years. But also very progressive mindset in terms of, hey, we realize there's a disruptive technology here, we can't fight it. So let's figure out how to adapt our company in ways that make sense. So we started talking more and More about what was really happening. It wasn't just the mobile technology. It was or mobile ordering app. It was really like mobile and cloud and GPS technologies that were becoming ubiquitous and converging to allow these new business models that could support a virtual fleet of drivers and vehicles that could be really dynamic, expand and contract and have much better unit economics and higher service quality. We wrote a white paper back in 2013. Total transit was a customer of ours, but they got really on board and said, we started having dialogue about, you know, Uber and Lyft are pioneering this in the passenger transportation space. But there's so many other logistics and transportation segments that are still yet to be disrupted and a lot of them have those requirements and specializations and things like that. So we start talking in the future, you know, food delivery or courier services or yes, medical transportation, all these other things we think are going to start adapting these new more efficient business models. And we decided to join forces to explore and be kind of a first mover. Total Trans at the time was about $100 million transportation company. They had 30 years experience but didn't have the tech background. And they knew that they weren't the people to run the company, this new company. So they acquired my first company and we started talking about different opportunities. And I think what we settled on was really as we sort of studied the industry and space, we realized that like medical transportation, also known as non emergency medical transportation, was this like very traditional segment, but pretty significant, you know, about a $10 to $12 billion industry in the United States. A vital service that a lot of consumers don't really know about unless you have to interact with it. But the more we studied it, we're like, wow, this is a vital and massive industry that is suffering from a lot of the same problems that consumer transportation suffered for, like unreliable service, difficulty with supply, expensive, not transparent. And you know, we started talking to, you know, traveling the country back in 2014, 2015, right after the acquisition and talking to the, you know, directors of health plans and hospital systems and Medicaid directors. And the number one problem over and over again was transportation is so unreliable, it's so hard to get, especially for folks that are lower income, don't have a vehicle in the family, are living with disabilities. There always has been transportation available to Medicaid folks, but it's just not been reliable and it's been expensive and not transparent. And so we really realized that using adapting some of the technologies and business models that Uber and Lyft had created for consumer transportation, adapting to Work well for healthcare and then kind of delivering that service in partnership with health plans that we could offer something extremely powerful that really like, you know, not only would save money, but also really improve lives, improve the healthcare system and really have so many compelling value propositions.

Wow, that's awesome. So that's the original business model that you pretty much came up with and started?

Yes. So acquisition happened in 13. We kind of studied this problem, you know, with Total Transit for a couple years and then Total Transit had an existing division doing healthcare transportation that had had about 15 years. So had kind of good requisite history and background and how to deliver and meet the compliance and regulatory requirements and some of the necessary traditional operations. But then essentially in 2016 we spun that division out and then reinvented it in our tech enabled model, moved it from Arizona to San Diego. And so we're kind of part startup, part spin out. Veo started in 2016, but we're really sort of standing on the shoulders of a company that kind of figured out the basics for 10 years and then introduced these new tech enabled models.

So everything's headquartered in San Diego. Very cool. And what does that look like from a company? I mean it's heavily engineering or what else does it entail?

You know, our biggest employee population is still, is still call center. So although that might seem like a very traditional type of business, I mean under the hood our delivery model and fulfillment model is, looks a lot like, you know, big components of it. Look a lot like Uber and Lyft. Right. We have, you know, a similar driver population, although all our drivers are trained, embedded in, credentialed for healthcare. But you know, it's all app based. We have, you know, kind of run on the same tech platform, but the constituents which we serve. A lot of these folks aren't big technology adopters so we might interact with them the old way. So we still offer, we have technology tools for booking, but our service is designed for healthcare and designed for Medicaid populations. So folks can still call us from the call center. We also support a booking portal for healthcare providers as well as mobile apps, SMS services, et cetera. So population wise, we have a large call center based in. Our call centers are in Arizona and Connecticut and then we have field offices in Virginia, Connecticut, Arizona and Orange county and then our corporate headquarters in San Diego.

Oh wow, that's really cool. And so take us through. Do you want to take us through a little bit of like how your kind of average user interfaces with the technology? I mean, is it just like Uber, if that's the, if it's through the app and like that.

Yeah, I mean so like we're not like a consumer facing company. So really our customers are what we consider health payers. So either Medicaid plans or state agencies that are delivering a benefit to Medicaid recipients or Medicare Advantage. Medicaid is our, is our country's health insurance plan for low income folks are those living with disabilities. Medicare Advantage would be for generally for seniors 65 and over. But the transportation benefit is generally afforded to folks who have transportation problems. Right. You don't have a car in the family or you're living with an illness that makes it difficult to drive and getting to life sustaining treatment like dialysis or chemotherapy or behavioral health therapy is a challenge. So your insurance figures out transportation assistance for you. So the way people interact with us is generally either trips are booked and managed by healthcare providers. So we have a product called Rideview which is, you know, in dialysis centers and behavioral health centers or hospitals or doctor's offices and they book and manage rides for their patients and their insurance, the insurance gets billed or members can call us or SMS or use a mobile app with us directly to book trips. It's a bit different than Uber experience. They're accessing an insurance benefit. So our system automatically verifies eligibility, what their benefits cover. We ensure that the trip is for a valid medical reason or meets their insurance criteria and the trip is direct billed to their insurance company. So we manage all the claims, benefits management, fraud, waste and abuse, etc. So we're not, you know, just doing the transportation, we're also managing the benefit for the payer.

Yeah, significantly more that goes into a ride than calling an Uber for sure.

Yeah.

That's incredible. What so as growth been kind of a geographic growth or is it kind of the kind of transportation needed? What's that been like?

It's generally geographic based. So our customers are as I said before, they're large insurance companies. So a typical, what we call a managed care organization that does, you know, Medicaid, for example, they may say I operate in this state, say state of Arizona and I cover, you know, 200,000 lives in my plan. And my plan generally my members need about, you know, 3,000 trips a day, 2,000 trips a day and it could be statewide, although most trips will be in urban areas. Right. And you know, generally we have to, we have to manage all mobility needs. So you know, folks who can get into a sedan, that's about 80% of people don't need a special vehicle. And then, you know, 15 to 20% of people might need a wheelchair accessible vehicle or higher level of service. But even within the 80% that use a regular vehicle, you know, a lot of those folks still need help. A lot of folks are using a walker or have a medical frailty or they're living with a mental illness that, you know, the driver has to be aware of or intellectual disability. So you know, our drivers generally like a lot of the trips where we can go regular sedan, we use an Uber or Lyft type model, but our drivers get cpr, first aid, ADA training, cultural sensitivity, how to work with folks who don't speak English or don't have a smartphone or how to folks that might be living with an intellectual disability or behavioral health challenge or going through drug rehab. So it's kind of like Uber Lyft in that regard, but far more sensitive to the needs of the broad needs of the population.

Oh, wow, that's incredible. What a service. Thanks for doing that. Is there a sense that Uber, Lyft, any of them want to get into this space or are they staying B2C while you kind of. Or this B2B engine?

Uber and Lyft, I mean they have been involved in our space to varying degrees since really we've been in it. But you know, as I kind of have pointed out, serving the complex name. And there's a few things that we do and really specialize in they don't do. Right. The first is managing the benefit. So you know, we, when we contract with these large payers, we have a huge infrastructure, technology, operations, capability to really manage the benefit. And although as I said earlier, building these, we don't just contract with individual drivers also we contract with wheelchair accessible fleets, structure services, and we really figure out how to manage and design the benefit. And that's in itself a pretty complex task, which only a few companies in the country really do today. And Uber and Lyft don't really have that capability. They can do some trips. In fact, we do contract with Uber, for example, and we send a small number of trips their way in areas where we don't have our own drivers available or they can be helpful, but we also recognize that they have limited capabilities. Uber and Lyft do what's called curb to curb, which means they pick people up at the curb and they drop them off at the curb. Our services really including our driver's capabilities, are really what we call door to door and hand to hand. So a lot of our trips are not curb to curb they require the driver goes up to the front door and helps somebody from the front door, you know, help them fold up their wheelchair or their walker. Understand that folks who are elderly or frail may not be able to wait, you know, in the Connecticut cold, in minus 10 degrees or in the Arizona sun for 110 and may not have a smartphone. So the driver has to be sort of very cognizant of all the needs that they're encountering. So it's, you know, Uber and Lyft have, do participate to some degree and sort of maybe what we call the low hanging fruit, the, the much more simple trips that don't require extra assistance. But in our world there is a lot of sort of specialization, training, not just making sure your drivers are trained, but the technology can transmit needs that you can case manage and understand and troubleshoot complex needs that you have adequate supply in rural areas and can move people long distances and that kind of thing.

Okay, so these are some pretty essential life saving services for people. Like I gotta imagine Covid's thrown a little bit of a wrench for some of that. Like take us through what coronavirus has done to the business the last few months.

Yeah, it's been, it's been, we had some, some pretty significant adaptations for sure. I think the first thing that we suddenly like, you know, and it sort of felt like a tsunami all at once. I think that the very real, the very real risk of infection and spread and how we really adapt all of our businesses and personal interactions to prevent spread, you know, that that was a very real concern for us and really, really realizing that NEMT is potentially a high risk touch point for spread. Right. Vehicles could get contaminated. Drivers are not paramedics, there's no, these are regular vehicles, they're not ambulances. So there's no separation between driver and passenger compartment that can kind of protect against infection. So there's a couple things. I mean first our volume during the social distancing phase, our volume is significantly reduced. You know, again that, you know, doctors offices have closed temporarily and delayed sort of any appointments. They're all essential appointments, but some can be delayed a little bit longer. So we're starting to see that pick up back up again. But we saw our volume dropped pretty dramatically. The trips that remained in place were the trips that absolutely cannot be delayed. Stuff like dialysis, chemotherapy, you know, other life sustaining treatments that folks absolutely need. And so we needed to make, you know, make our services as safe as possible for those folks. So that included making sure the drivers had PPE and masks, which was difficult to procure in the first, the first couple weeks, as well as making sure our call center agents and other, you know, other touch points were screening members for symptoms or risk factors, making sure they touch base with their doctor by phone first to make sure that their doctor felt it was safe to come with any emt. And then we also adapted in some other ways too. We had some excess supply of drivers available. Obviously our demand was down. So we started contracting and helping out with Meals on Wheels who had a tremendous spike in demand for meals for needy folks at home. And so we thought our drivers. We've delivered thousands of meals so far with Meals on Wheels in our east coast markets. We also partnered and did PPE delivery for Medicaid members who might be at risk and really have pre existing conditions. The last major thing we did was develop what we call our COVID 19 positive specialized fleet. So there's a group of folks, unfortunately, who have been infected with COVID 19 and either our person under investigation or confirmed carrying the disease, they still need to go to dialysis and still need to go to treatment. The only safe way to do it would have been by ambulance, which is an amazing, a huge taxing service on ambulances. And there was sort of a desperate need to solve that problem. So we leased a bunch of vehicles, outfitted them with plexiglass and plastic and hired a hazmat cleaning company and you know, kitted out our drivers and trained them on how to do this work and developed, you know, what we call like a sort of sterile environment to transport positive members, get the vehicle disinfected and then go do the next one. So a lot of adaptations we've had to make in the short term. Also thinking about, you know, as the industry changes, what's like, what kind of changes might be permanent to our system that we have to think about.

Yeah.

Wow.

Pretty incredible to have to be able to pivot like that and grow with the need, which as you said now could be like some new long term channels. Is that kind of, kind of what you're thinking now? You've got kind of these other new little areas of operating that you guys can do.

Yeah, I think like what we're thinking about is that, you know, to some degree and everyone's talking about, no, nothing won't necessarily go back to normal that we knew before, but there will be some new normal. You know, I would expect doctor's offices are going to mostly reopen at some point when it's safe and a lot of traffic will regularly resume to doctors offices. But we're also, I also sort of think that like over the last 20, 30 years, telemedicine has been this thing in the background that has been experimented with a little bit here and there, but that at least in our country, we've never taken super seriously. And I think that out of necessity right now, I think our healthcare teach, our healthcare system might be teaching itself that telemedicine could be a more central part of our healthcare delivery models. But I'm also thinking how can we support that transition? And I think even folks that are seeing a doctor by video conference will still need lab work done. They still need their vital signs taken. They may need medication delivered, in some cases controlled substances, like for folks undergoing drug rehab or methadone treatment or also like even delivery models like home hemodialysis and dialysis. Patients can dialyze at home, but they need help with lab work, medications, fluid delivery. So we're thinking about how we can be potentially a better logistics service to help deliver supplies, to take vital signs, to even take lab work, et cetera. And while, you know, especially for folks who have risk factors or medical conditions or elderly and have medical frailties, we could support this sort of virtual delivery model more effectively with our logistics fleet.

That's incredible. Was that a thought more recently because of coronavirus or has that been something you guys been working on for a while, those ideas into telemedicine and logistics?

You know, it's always been, we've always sort of said like nemt is how we enter the space and build our delivery network and our relationships in the healthcare industry. I think that we've always sort of had these ideas in the back of our head, but it never really seemed like the right time or we have plenty of blue ocean in our core space. But I think now it seems like this might be the right time to take these things much more seriously. So we're taking a closer look and researching and figuring out where it might make sense actually for us to enter these spaces more seriously.

Got it. Okay. So taking you back to your early startup days, when you're starting a company, especially a startup, and maybe getting some outside investment, like there's a thought that there's an exit at some point, right? You're part of a much larger company already. Is there kind of some big milestone that's out there that you're taking the company to or it is just build new revenue streams of some sort?

I think it's not, we don't really think about it, like maybe a. Because we don't have a traditional VC backstory, we kind of were really part created as part of a spin out. And I think we don't necessarily think about it in terms of an exit. I think that there's always potential, I think there's always potential for new investors to come into the picture in varying structures or what have you. I think it's what's going to benefit our company's growth and make sense for our customers and our members and delivering service. And so the way I think about it is more of a continuum that when it's necessary or when it's not just investments of capital, but also for growth, but it's also access to more resources for expertise. And so yeah, I don't think about it as exit, but rather the company's gonna go through different phases and different investors will come in the picture.

Yeah. Okay, got it. Well, it sounds like a lot of interesting. Still a lot more to go, you know, from that blue ocean that you say there's so many other areas that you guys can be helpful, which is really exciting. You guys used were a longtime downtown company, right?

Yeah.

And then moved to UTC area. Is that where you guys are?

We are in utc, yeah.

Okay. Though I mean, theoretically, as I'm guessing, a lot of virtual remote working right now.

Definitely almost. Almost all virtual. You know, out of all of our offices across the country, I think we've got a very small. Our headcount is somewhere around 490 employees nationwide. And I think we've got probably about 485 of them working from home. We have probably at least about one sole lone soul in each office keeping things. Keeping things operating. But yeah, I mean, we're pretty much completely virtual right now.

Okay, well, we hope that we can come back to work with our people soon because, you know, that's. We missed that for sure. What's something that you missed from the food front that you haven't been able to get to in a while? Anything like a favorite taco? Anything like that?

You know what, I gotta be honest with you. I think we've been, we've been doing a lot of postmates in Grubhub over the past two months. And I don't think I can like, say I've been totally deprived of food. You know, we've had access to all of our best tacos. So I'm not sure you know what I miss. Like, I think I miss the dining experience with friends. So I'm excited to kind of go out to restaurants and hang out with friends and have drinks when it's the right time.

What's gonna be the first place you go to?

I don't know. Probably one of my favorite spots was to hang out with friends and drink margaritas and eat tacos. Is Puesto and headquarters.

Oh, yeah, definitely.

Yeah. Good one.

Do you have a favorite? Are you a craft brew fan at all?

Being in San Diego, I am a craft brew fan. That's been one of my. One of my vices that I've been trying to cut back on is just as I've especially being in Covid and limited physical activity. I got to watch the carb intake carefully.

I hear you. I'm drinking one for you. I'm having a belching beaver miso honey blonde for you.

There you go.

Josh, really appreciate the time. I hope that we get together sometime soon and I think you've been a speaker at Startup Week for a while. So we hope we get a chance to have you this fall at the new Virtual San Diego Startup Month, which is going to happen. So looking forward to being able to help share more of your story and let people know about Veo in town because it's an awesome company.

Sounds great. Appreciate it, Neil. And one real quick plug. I mean, I think we will be hiring some positions in the San Diego office. So if what I said was interesting to folks and you want to join our mission, watch our website or get in touch.

Yeah, we'll put a link to your careers page in the show notes. Absolutely.

Really appreciate having me, Neil. Thanks so much.

Yeah, thanks Josh.

Thanks for joining us on the Tacos and Tech podcast with Neil Blum. Thanks again to Cox Business for helping make this possible by expanding the reach of the San Diego tech ecosystem. Big shout out to School of Rap for our rad intro music. And thanks as well to Nest Podcast Network where we are recording live inside their studio at Nest Co Working in Bankers Hill. You can find Neil Bloom on Twitter neilbloom as well as Fresh brewed Tech and Tacos and Tech Pod on Twitter too.

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