Aging in Place: Cameron Carter on Leading Rosarium Health and Navigating Healthcare Policy Changes

What if healthcare started at home?

In this episode of First Builders, hosts Amber Illig and Rachel Tsui sit down with Cameron Carter, Founder and CEO of Rosarium Health, a company helping older adults and people with disabilities age safely in place through smart home modifications.
A seasoned healthcare operator turned founder, Cameron previously held leadership roles at Truven (acquired by IBM Watson), Evolent Health (IPO), Bright Health (IPO; later acquired by Cigna), and DaVita before taking a personal mission and turning it into a company.

In this episode, Cameron shares:
– How building a ramp for his aunt on Medicaid sparked the idea for Rosarium Health
– The scale of the “silver tsunami” and why aging in place is a necessity, not a luxury
– What the new “Big Beautiful Bill” means for Medicaid, providers, and founders building in regulated markets
– Why policy knowledge is a strategic advantage for healthcare startups
– And why “move fast and break things” doesn’t work when lives are on the line

It’s a deep-dive into mission-driven healthcare innovation — and a masterclass on how to turn policy into opportunity.

FOLLOW CAMERON CARTER

LinkedIn: https://www.linkedin.com/in/cameron-carter
Rosarium Health: https://rosariumhealth.com
Rosarium Careers: https://rosariumhealth.com/careers

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Transcript

0:04

Welcome to First Builders, the podcast for those who shape companies from the ground up. I'm Amber Illig, founder and general partner of the Council Capital, where we invest in early teams solving critical problems in essential industries. And I'm Rachel Choi, partner of the Council. This show is about the people behind the playbooks, the ones who take a leap early and help define what their companies would become before anyone else could see it. Today's guest is Cameron Carter, a seasoned healthcare operator turned founder. Before launching Rosarium Health, Cameron held leadership roles at companies that have made some big moves. Truven was acquired by IBM Watson, Evolent Health went public, Bright Health went public, then was acquired by Cigna, and he's also worked at Davida, a long-term public company. Rosarium, he's tackling one of the most urgent needs in healthcare, helping older adults and people with disabilities age safely at home. Rosarium provides home modifications that reduce fall risk, prevent hospitalizations, and keep people out of long-term care facilities. Cameron has also spent a lot of time thinking about the implications of the newly passed Big Beautiful Bill and its effects on the Medicaid and aging populations. Given his experience working closely with Medicaid beneficiaries and providers, he brings a unique lens to how policy shifts like this one rippled through the system. And the council is actually an early investor into Rosarium Health. And one of the reasons we were able to build conviction in Rosarium was Cameron's first builder background and experience in the healthcare and the Medicaid populations. Cameron, welcome to First Builders. Thank you so much for having me. I'm excited to be on and uh Santon Both the podcast. Yes, I'm super excited to have you here. Um, let's dive in. You know, we we mentioned this earlier in the intro, but obviously you've worked across some of the really big names in healthcare like Truven, Evelyn, Bright Health, Davida. Can you walk us through that journey and what made you decide it was time to leave those worlds and build something of your own? Well, yeah. So I kind of fell into healthcare and particularly value-based care. I started my career in academia, primarily in healthcare disparities research. I'm really focused on the pediatric population, which is how I became comfortable and worked with a lot of Medicaid populations. My time at Truven Health Analytics came from a former colleague of mine who, when I was working with my PhD, had talked about this idea around population health and the idea of using data and using services to be able to improve not only health outcomes, but also sustain those health outcomes for diverse populations. And in that time in Truven, learned a lot, worked with time of large employer groups as well, worked with a lot of researchers who kind of really put me on to the idea around value-based care. And from there I was really hooked. For me, that led to my career path, you know, from Truvan to then Evelyn Health, building product for hospital systems, primarily ACOs. We're really thinking about Obamacare as a new way and a new venture to support populations. And then from there, working at Bright Health, my population aspect around health insurance, as well as Davida before I started Rosarium Health. That's awesome. And um, is there anything like, you know, what was kind of like the main kind of like moment for you where you're like, oh yeah, like this is the problem. I need to leave now. I need to start my own company. For me, it was a personal uh mission. During my time at Bright Health, I was overseeing supplemental benefits during the pandemic. So that included things like telemedicine, food is medicine, transportation, dental vision hearing, and really saw the opportunity around how these services elevate individuals' whole health, um and particularly those who are underserved. And during that time, my aunt, who at the time was on Medicaid, was looking for home modifications to be able to age in place my hometown of Crompton, California. However, the health plan that she had not only did not have a network to support the benefit, really had no idea how I actually facilitate it for her. And so my cousin and I did with any level and would do and actually built our ramp. I mean from there, really started to understand the impact of that home modification or that uh that solution, a built environment as it improved her independence. Then I started working with other individuals in that community, friends of mine, veterans, you know, through my uncle and aunts who are also veterans as well. And then really saw the opportunity because um, for me, it was like, you know, when I get older, if I'm blessed to be able to get older, um, I realized I want to be independent as well. You know, think about the home as being a site of care and a place that people want to age in, but most homes are not accessible. So for me, it was that uh initial genesis of working with my aunt, really working in the community like company in California, and then evolving that to say, okay, what does this look like across different states, different populations, different housing stocks and different housing units? And that really kind of gave me the bug to say, you know, let's just uh take a leap of faith and let's leave into Vita to start Rose I am. That's awesome. And it's such a huge problem. I mean, we've invested in a couple of aging tech deals at the council. So we've started to see the market level insights about aging and and what's actually happening. But could you talk about that a little bit for our audience? Just how large of a scale this problem is uh with our aging population growing and just even if you didn't care about aging at home, like do we have enough facilities to even serve everybody out there that's going to need help? I can talk about the aging opportunity, you know, some blue in the face. So the phrase you may hear is the silver synonym. Um so for context, what that ends up looking like is you have the silent generation, the baby boomers, as well as the Gen X population, not only aging, but aging quicker and also living much longer. So in America right now, we have around 65 million individuals over the age of 60. By the end of this decade, that number would be around 74 million individuals or one in five individuals in America. That is a large population to serve, but their needs are much different than they were 20 or 30 years ago when we thought about an individual being the age of 65, getting ready to retire. Whereas now someone in their 60s, 70s are probably starting their third, fourth act of their life. So when we think about the population as an age is, those needs will change. But what's critical is that individuals still want to age in their home. They do not have an appetite to really move into a nursing home. And then for a lot of individuals, nursing homes and institutionalized care are actually unaffordable. So if you think about the advert around age in place, it's not necessarily a nice to have anymore, but it's determinate a necessity and a must-have for individuals as they think about where they want to live in that third act of their life. Um, when we think about the population right now, the fastest growth, the fastest growing age group in America is 85 years and older. And sometimes people really think about that and say, there's there's no way. I don't see people who are over the age of 85. You got to get out of major cities to find these. Yeah, we're in bubbles. We're in bubbles. And, you know, one of the stats that came out more recently with Fortune was that there were more homeowners, or excuse me, home buyers over the age of 70 than under 35 in 2024. So you're starting to already see the impact of the service and I'm in the housing infrastructure and real estate market. And we're already going to start to see that in the healthcare space. So with the Rosarium Health, we sit at the intersection of both housing and healthcare. We full prime to be able to support these new needs, this new population demographic shift, but also to really support the housing environment to become a part of healthcare delivery. Yeah. And clearly we need more uh more opportunities to age in place as a necessity, like you said. But what made you choose to focus on the home modifications and what do people not really necessarily realize about what's possible there? So when I was working on my PhD, we're really focused on healthcare disparities and social determinants of health. One of the five pillars of social determinants of health is the neighborhood and the built environment. It affects around 50% of your healthcare outcome is based on the neighborhood you live in and the housing infrastructure that you actually live in as well. It's a blind spot healthcare. Now it's really tough for someone who is a neurologist to think about what are the interventions that their dementia patients need. Or if I'm a nephrologist, like when I was at Davida, and you want to actually do in-a-homesis, there's really challenges in that most nephrologists did not know where their patients lived, did not know the housing unit they lived in, and didn't know if they can actually fit a dialycizer through the door for the individual if they want an in-home peritoneal dialysis. So I always had that in the back of the mind, my mind, that it was a blind spot, but didn't really understand how to actually service that particular uh vertical of social determinants of health. The home modification benefit was one that I was very much aware of once the 2019 CMS call letter came out that redefined clinical benefits that allow things like food as medicine and transportation and some of these other social drivers of health to be addressed by services. Home mods are just one of the many benefits you can cover. However, there was not a brand out there that I, as a health clan, could actually partner with to support end-to-end from taking on referrals to provide income assessments to modifying the home beyond just small grab bars, but think of things like bathroom innovations and installing ramps, installing elevators. So it seemed much more like a pipe drink. And I think for me, I just kind of loved the idea if somebody can actually service this particular need when I was at a health insurance company. And then once I moved out to Tavita and I saw home modifications being utilized in different parts of the world to support in home dialysis, I was really kind of another trigger to say, um, if not now, then when? And then for me, it was one where I kind of just said, hey, I've done a lot in healthcare. I've enjoyed healthcare. Let's take a, you know, really big risk and see if we can find a way to build a solution to support both housing and healthcare simultaneously in the United States. Yeah, that's awesome. You know, we'd love to talk also about the the big beautiful bill that just passed. For listeners that may not have been really following closely, what are some of the major changes that it introduces from a healthcare perspective? So the headline that individuals will normally see is that uh the big beautiful bill will cut a trillion dollars out of Medicaid. Um and what that ends up looking like is that they're gonna actually usher in new work requirements that will make it really difficult for individuals who are able-bodied or folks who can actually work while they're on Medicaid to be able to actually stay in on Medicaid and all. And that's what's gonna cause a lot of individuals to primarily lose coverage over time. So when you think about those cuts, it's not that tomorrow 12 million people are gonna lose coverage, but it's gonna be a challenge over time for people to stay active on their actual coverage of the next 10 years. Additionally, the bill goes into effect from Medicaid in 2027. So with a lot of individuals like Rosarium Health, or shouldn't companies like Rosarium Health, we're preparing over the next 18 months to support this new paradigm of Medicaid that is coming away. And then the last thing that we hear a lot about is some of the cuts to provider payments, which will have, in my opinion, deleterious impact on both nursing homes, institutionalized care, and rural hospitals, as those facilities that primarily support managed Medicaid members, excuse me, Medicaid members, they're not going to have that federal subsidy or the federal payments to support uh their business, which is why now you're starting to see uh layoffs in medical hospitals and academic hospitals, as well as proposed cuts to nursing health and institutionalized care, given that the federal government will be cutting uh spending for those types of cared uh care models. Yeah, and it seems like there's like really this kind of like cycle too, because if you have less people who are covered by Medicaid, then of course you're gonna have less people who are able to get the reimbursements from Medicaid as well that then fund, right? Like these, again, like you were saying, like those hospitals that primarily rely on Medicaid patients in their population. So it just seems like this kind of vicious cycle and from that perspective. So yeah, it's it's I think it's a very large impact, you know, on the on healthcare for sure. Agreed. I think it's a it's a large impact. A I see it as an opportunity for innovation, you know, in my opinion. That, you know, when I was at Evelyn Health, I was there from Obama's last turn to when Trump was elected. And in a time when they actually put in things like the 21st Century Care Act and some of the other components around value-based care, you saw innovation come out of the Trump administration. And one of the things that we I tell my team at Rosarium is that even though there is new policy coming, we still have to be on the forefront of innovation. We can't look at this policy and kind of take a step back. You can't look at this new paradigm of Medicaid instead of say we're not going to serve Medicaid anymore. For us, we're doubling down in Medicaid. And I think it's important for us to really stay true to our mission to support anyone who wants to age in place. And that starts with the most underserved. So as we think about the opportunity in Medicaid more than anything, we look at the home and community-based service vertical of Medicaid, which is where home modifications are covered, as not only not cut, but really actually better funded. So for us, it's really important for us to lean into these policies to support Rosarian, but also our mission to support individuals that want to age in place, moreover. Yep. Um, and then we've we've already heard, if we could talk a little bit about like urban versus rural, um, we've heard projections of rural hospitals kind of losing billions in funding and nursing homes struggling to keep their doors open. What does that mean for access to care and anything you want to share there? I think all those are true. Um, when I think about rural uh populations, we are Rosarian primarily serve rural populations with all modifications, whether it's in the Imperial Valley, down on the border of Mexico and California, parts of western New York, as well as different rural parts of Texas and Louisiana. So we're really in tune to what the rural needs are of these populations. And they will let us know there's one hospital, there's one clinic in this area. Um so if it does close, it's gonna create what we'll call it healthcare, does it? What that's gonna end up looking like is that there's gonna be more of an onus on the home to be not only a site of care, but a site of care for the next not five or 10 years, but decades. So the advent of the ability to actually ensure that home is able to have not only access to the internet, access to utilities, but is also accessible for the individuals they age over time is gonna be much more critical for individuals who live in rural populations that don't have additional housing, that don't have additional access to healthcare opportunities. And then your earlier point about urban settings, one thing to note is that a lot of academic hospitals, a lot of large brand hospitals primarily serve Medicaid members. And what that's gonna look like is as those hospitals lose federal funding to support those Medicaid populations, you're gonna see downward cost pressure on those hospitals as well. And what that may look like is that it's not the hospitals closing, but you're gonna start seeing layups. And these are things that you're starting to see more recently with the university, excuse me, with I believe it's the Vanderbilt Medical Center that just had a large layup, you know, um, large layup news, you know, a lot of hospital systems that we work with in both Texas and California have really alluded to us that there will be cuts over time. And these are things that a lot of these facilities are preparing for because as this bill comes into effect in about 18 months, these hospitals will have to be able to still support a very tight margin business. And these rural and urban population have still need care and these hospitals trying to figure out how to do that as best they can. And one thing I just want to draw attention to is I I really love your background having worked through multiple administrations too. You know, having seen Obamacare and then like Biden coming into office, Trump being in office twice. I think you've you're able to kind of see these larger trends and the pendulum swinging back and forth and stay focused with your team. So that's really cool to hear, you know, how you guys are just like, hey, we can't give up or slow down now. We have to, we have to go all in. And in some ways, this provides more opportunity for Rosarium as well. So to make a bigger impact. We agree. Yeah, definitely. And you know, you talked a little bit about this also, right? You know, like this paradox around like institutions like hospitals, nursing homes are gonna face these cuts, they're gonna have all that pricing pressure. Um, and then, you know, with that though, there's gonna be a big demand for that home-based care, right? Because there people will still need care. Like, where, where are they going to go? How do you kind of see that playing out, right? Like, how do you, how do you envision almost like this future state? You know, take us like five years out. When I think about home-based care, especially in the United States, I really see a a ramping up of high acuity care in the home starting first, whether that's palliative care, hospice at home, and even things like dialysis and home. And I think of those first populations receiving care in the home to really test its efficacy. Is this individual receiving care at the same quality as someone in-center? Are their health outcomes being met at this standard? And with value-based care becoming much more of a norm. And more importantly, in five years, CMS wants all Medicare recipients and value-based care family models, you're gonna see the home becoming a really strong fixture to enable not just home-based care, but also home-based care that is really affordable for health insurance companies. Once you unique about, you know, I use the example earlier about dialysis, you can do things like nocturnal dialysis in your sleep if you do it at home. You don't get that access incentive. So when you think about home-based care coming to the forefront, I think it's gonna be these high acuity populations first. And then you're gonna start to see this next wave of primary care at home, hospital at home. And we even have a relationship with a company called Fedari Care where we're supporting in-home chemotherapy. And it's really important that people start to think about this home, not just as like, I go to sleep there, but a place where you should really spend two-thirds of your waking hours. I think what's really important is that as individuals start to age and like a population becomes much bigger who's older, um, they're gonna want to be in their home much longer. They really care about being in their home much longer. Um, so they're gonna start to desire these things. And I think you're already starting to see that now. ARP has a study that came out a couple of years ago that said 80% of individuals 50 years and older want to stay in their home for the long term. I don't see that stat getting smaller. As individuals start to live in their 60s, 70s, 80s. You know, even at Rosario, we've you know helped individuals or served individuals that are 102, 103 years old. They don't want to go to a nursing. And I think that's gonna be the norm, such that it doesn't matter what my condition is, what my ailment is, I want to be able to recover in my home. And that's gonna be the we start to see the next five, 10, probably the next, you know, few decades, to be honest with you. Yeah. Almost everyone I know with an aging parent is hearing the same thing from the aging parent that they would rather not be in a facility. They want to be at home. And my my grandparents are in their 90s and lucky enough to be at home. But honestly, I think a big part of it is because they're both still alive. I think it would be hard if one of them was not. And so I often think about wow, like this is really lucky that it has worked out to this point, but that's not the same situation on the other side of my grandparents and not the same situation for everybody. So yeah. And then uh one other thing I wanted to ask about obviously this big, beautiful bill, it is literally huge and there's a lot of nuance. And so it doesn't apply, my understanding is it doesn't apply work requirements to seniors, people with disabilities, or those considered medically frail. So, how does that kind of shape Rosarium's tar target population and strategy? You know, it's it's interesting because a lot of individuals have not read that nuance of the bill. So with Rosarium, the population we primarily serve is not affected by the work requirement uh that's coming across the Big Beautiful Bill. If they've looked at we primarily serve, we'll still have access to both Medicaid or manage Medicaid in the particular states that they're in. We look at the Big Beautiful bill as being a tell when to our business, not only because we're starting to see these individuals who are really asking for home modifications from the age in the home, but we're seeing health plans say, hey, Cameron, we really need to speed up our age and in place strategy, but to find a way to not only support older adults, but also young adults with disabilities, even children. The youngest patient that we've actually served with Rosam is actually three and a half years old. So for us, we're trying to see a much broader population, a much broader age ban who's looking to age in place because health plans are thinking about the home as a part of caregivers. And with the big beautiful bill, reducing um federal funding for institutionalized care, reducing funding for things like SQHCs, a lot of these health plans are starting to think through the holistic need of an individual and saying if we have the home and the home is a consistent place and individuals have an accessible home, more importantly, we can actually support that individual their home more continuously. And what we're now looking at that is when you start to see a more diverse population where multi-generational housing is becoming the expectation for particular communities of color, health plans are starting to really understand the value of that. Now, what that ends up looking like for Rosarium is that we have a reality where there could be a grandmother and particularly a grandchild who both are at risk for long-term care, both have means on Medicaid. And health plans are asking us, can we combine their home modification benefit? Which we've done, which has allowed us to do things like home modifications that are over $10,000, $12,000, $13,000 for a household who has a household income of $20,000. So it's really unlocked us or unlocked our ability to be able to support this benefit and do things that weren't really available to us even six, seven months ago before this bill came into play. So with this big big, beautiful bill going into law in about 18 months in 2027, health brands are looking at us saying, how do you accelerate our aging and place goals? How do you accelerate our social determinants of health goals? How do you support our built environment and strategy to be able to serve not just an older population, but also a population that may be underserved, maybe much younger, and may just even be disabled. And that's been, you know, a great thing to see because it really broadens our mission beyond just individuals in their 70s or 80s who want maybe a ramp or grab bars like we thought about a couple of years ago when we started the company. Yeah. And then one other question I'd love to ask about sort of how Rosarium works is because I think it's super interesting. Um, you know, on the contractor side, this this must be even more foreign to them than it is for folks that are dealing really in the throes of uh aging or folks that work in healthcare or for payers. So how do you work with the the contractors and in construction companies to be a part of this? Because I imagine there's paperwork required and a lot of uh process there that they're not familiar with to make it possible. For us, we try to do everything we can to make it as easy as possible for these home and modeling companies to be home and modeling companies, whether that's reducing the administrative burden on finding what an MPI is, to understand how to get paid, to understand how to get referrals. A lot of our platform does the administrative work for these modeling companies to really not only grow their business in Medicaid, but also participate in Medicaid and participate in things like Medicare, which guy programs and things of that nature. So as we go out and recruit homeland modeling companies, we recruit them much as if they're a physician. We're educating them on Rosarium, we're educating them on managing Medicaid, we're educating them on what a hick picks toad is and building trust in communities. You know, one thing about our remodeling company is that few remodeling companies in America do everything in the home. They may work in the kitchen or maybe not the bathroom. They may work in the bathroom, maybe they don't do stare at installations, but they do know those who do. So for us to be able to actually support these remodeling companies, allow us to grow in their communities on the rebuilding side or the home remodeling side to be able to grow our network to be able to serve in about 30 states today. And what that's allowed us to do on that is the platform that we're using is repeatable in individual state. So those in California, those in let's say Massachusetts, those in New York that we work with, they have a very similar experience. And for them, they enjoy it because they also have flexibility when they do serve individuals in Medicaid. Um, and I was gonna say this for context the average time it takes to get a home modification in Medicaid today is around four and a half. Months. So when we talk to a health company, we talk to a modeling company, we say, hey, the expectation is that this person's going to get this job done in four and a half months. They take pride in doing it quicker, which is why, like now, we average around five weeks to renovate a home or renovate any type of home in America through Rosarian. So for them, they see this pride of being a part of healthcare, being sort of in their minds and kind of a forgotten solution, you know, when you think about what people need in the home. But for them, it's really meaningful work, you know, to be able to serve individuals who has dementia, to serve a child who has special needs, to serve a family who has even a rental property where they're saying, hey, I don't own this home, but I still want temporary modifications. We have incredible builders on our platform who do that work, do it at the highest quality possible. And they still kind of don't know why that they're actually getting paid by Medicaid plan. Because some are still not really sure what Medicaid is, but it's it's fine. They're they're doing their work. Yeah, that's amazing. I mean, it really allows you to like connect like that mission, reduce that administrative burden for them. And it really opens up even like a new revenue stream for them that they probably wouldn't have been able to get before. So yeah, it makes sense. Um, and then let's talk a little bit about like on the health plan side too. I know you're partnered already with HealthNet and the Central California Alliance for Health. What have you learned from these partnerships about scaling a Medicaid-focused business? How have you taken some of your learnings from you know prior roles before as well to this? So we enter a lot of the conversations with health plans with a ton of compassion. And what I mean by that is a lot of health plans are unaware they can actually cover all modifications. Um, it's still a foreign benefit to a lot of individuals. And as someone who sat in those same seats as a you know, the head of something low benefits, I don't know every benefit that I could cover as a health. So we when we walk into that conversation, we want them to know that, hey, whatever it looks like with you, we want to build with them. And that could be just building the rails to receive referrals, building the rails to submit invoices and prior authorizations correctly to a health plan. So we work with these health insurance companies, it's really about being a great partner with them and being a lot of treatment partner with them. So we may start the relationship in just one county for a small population subset, may grow into a second county or a third county with a statewide expansion really on our focus. But what's also critical is that a lot of these health plans not only know the members who need modifications, but they may not know how to actually get it done. These care managers don't know contractors, they don't know electricians, they don't know plumbers, they don't know building codes. And to be able to bring that insight and understanding to these particular health plans in California, much like we support Medicare Part B providers who guide in the Northeast, it's still with that compassion of saying, hey, what is the right solution for your membership? What is the right solution for the counties that you serve? And then setting expectation for them to understand why a home modification is able to reduce inpatient spending, able to reduce ED visits, able to reduce long-term care cost savings and really helping them understand where in their PL they're going to actually see these savings with these modifications. It's utilizing my background at a health insurance company, using my background in places like Tobita and others to be able to have that conversation and sit at the table with them. But then as an operator, being able to help walk things through, how do you start this relationship? How do you measure success in this relationship? How do you hold us accountable in this relationship as well? And then being a great partner with them for this new benefit as we continue to scale it across these different Medicaid markets. It's awesome. And then one thing you mentioned earlier is you're also participating in CMS and the CMS guide model. What is that for our listeners that don't know? And then how does it fit into your broader strategy? So the most, the simplest uh experience is that it is a new model of care through CMS for primarily Medicare members. These are individuals 62 years and older who can easily get access to care. It's covered anybody who has um medic or who's over 62 in America. If they're an individual who is diagnosed with dementia, they can qualify for this thing program called GUID. GUID, it's an acronym besides the point, but it's just called GUI. And one critical part about GUID is that you are assigned a neurologist and a PCP. You do get additional funding to support your caregivers who are around that particular patient. And from there, you're able to get at lifestyle management, additional care support, additional services to manage your dementia over time. Where rosarium sits in that is what's critical about dementia care in America is that 80% of all dementia care is done in the home. It's not done in assisted living, it's not done in memory care, it's done in the individual sales. So what CMS requires of those who are in guide is that they get a in-home assessment to not only evaluate the safety, the accessibility, but also to understand what insecurities are specifically food insecurity, housing security, this individual may already experience that would adversely affect their dementia care over time. So where Rosarium supports from that particular guide model is that we partner with Medicare Part B providers. These are primarily physician organizations who already have assigned patients. We receive a referral from that particular physician. We geotag that to our local clinician network. That clinician goes into the home, discusses guide with that particular patient and their caregiver, evaluates the home for safety, evaluates the home for food and security and other social determinants of health, and provides that new information back to the provider group. Because again, we mentioned before, most providers don't know where the patient lives. They don't know what the patient lives in. They don't know any of the challenges the patient actually experiences in the home. So to be able to have that new set of data in a timely fashion better prepares that assigned provider group to be able to support that individual patient. And the last thing I'll say on the dementia side is, excuse me, on the guide side, is that with our model, we're able to complete these in-home assessments very quickly, which really supports that patient continuum or patient journey, in that we get about 60 days to assess the home through CMS. With Rosare, we average around eight days. So to be able to actually receive not just that robust, rich data, but to really receive it very quickly expedites the care experience of that particular patient or caregiver, which is really meaningful as you're starting to see this aging population, which is creating a larger population of folks with dementia and additional caregiver burden over time. Yeah, that that makes such a big difference, right? Like just being able to have any of that care or treatment way earlier in the process and not having to wait over two months, right, for for that to start. So yeah, that's amazing. And obviously, I mean, just even listening to you talk, and I'm sure our listeners would agree and you know, and know healthcare is super complicated. I'm sure building something like Rosarium is super complicated as well. What's been harder for you is in navigating the policy, convincing the payers, building trust, you know, directly with the patients. Like, yeah, what is that like for you? I I would say the toughest part is building trust with the patients, and I would say the demand side of our business amid such an intimate intervention. Part D drugs or food is medicine, you know, even going to a PCP is a very common, very understood part of healthcare. But for someone to have a clinician go into their home and go into their bedroom and go into their bathroom and go into their basement and let someone know this isn't accessible. You need to raise your toilet, these are the recommendations I'm making. And then to also then have a contractor or contractors, because at some point you actually need multiple bids in Medicaid. So to have multiple contractors come in and measure your toilet and measure your shower and do a lot of these things that um are really tough. You know, it's amazing. And what's also critical on building trust is really around health equity. For us, about 30% of all the patients we serve are non-English speakers, and primarily are Spanish or Tagal or even Mandarin. So when you think about supporting someone in their first language, it's also a matter of trust that's hard for that was very difficult for us to really overcome. So we think about building that network of clinicians and contractors, that has to be done in a very localized way. We need clinicians who not only know Spanish, she speaks Spanish, because Spanish is the first language to be able to communicate with a contractor, to be able to communicate with a caregiver, to be able to communicate with a loved one who may be in a different state. So all those different components of building trust have been things that we've learned at Roseam that we're excited to continue to deliver on. But as we think about this market continuing to grow, as we mentioned before, that trust will only become a much bigger hurdle for us to solve because more people have different needs in their home. And as we start to grow in different parts of this country, trust is still going to be an issue, whether we're in Nebraska or Florida or Maine or California. And that's one thing we're gonna continue to earn over time as well as that trust of those patients. That's awesome. And what would you say is your big vision for Rosarium over the next decade? That's a that's a needy question. To us, we want to be the we want to be the age-in-place platform that anybody can use, regardless if they're on Medicaid, Medicare, private pay, or even TriCare as a veteran. And though we're starting with home renovations and home modifications and Medicaid, we know that most people are not even on Medicaid or can still need a clinician visit, are still gonna need a trusted network of remodelers to come in and complete this work for maybe their self, their loved one, or even a loved one who lives in a different state. So for Rosarium, it's really starting to be centered for population and managing Medicaid, growing to serve older adults as well as Medicare, and then over time creating a private pay experience where anybody can use a rosarium, not only for those clinician visits, those income assessments, as well as those modifications, but to be able to buy product directly from us. So to be able to buy particular goods and services that support other age-in-place needs, you know, and that it's not just about home renovations, but things like pediatric asthma mediation services or pest control or dehorting homes or weatherizing an individual's home to be able to live in. These are other built-environment needs that come up that affect individuals' health outcomes that we want to still be able to participate in with our aging in place platform. And these are benefits that are covered in Medicaid. So we get to work on them with an initial population. And over time, as we mentioned, the next five or 10 years, open that up to a population that would be 70, 80 million people who are going to need different types of modifications in their home services to age in place in the way that they want to and to be able to age with dignity as as they deserve. Yeah, absolutely. And you know, going back to kind of like the building side of this and the complexity, what do you think most founders would underestimate about building in healthcare, especially in regulated markets, right? Like in Medicaid, Medicare and such. You you need to read the law. You have to read it. And I and I've I don't say because people will use Chat GPT. I'm like, you should read it. You should read it because what'll happen is going back to the big beautiful bill, we read it and assumed on July 4th of all days that Medicaid was over, Rose Am is going to be able to support this patient population. But once you dug over the weekend, we said, wow, our population is actually not really that effective. And so there's still folks who are that we're gonna be able to support. But if you're in a heavily regulated industry, you know, policy of you know, knowledge is a strategic advantage. Knowing which states to go into versus which states not to go into is a competitive advantage. Which states really need your services versus those who may want it is also a competitive advantage. So for founders who are building in healthcare or even building any highly regulated industry, know the law, read the law, understand the policies, and be able to innovate on top of government. And that's how you start to win as a first mover. When you look at Rosarium, we moved into Medicaid a year ago. We're now the second largest home op provider instead of California. We expect to be the largest home op provider instead of California in a year. We'll be able to take those learnings to be large home op providers in other states that have incredible home modification benefits as we read the law and start to realize there's other opportunities there. So you got to know the policy, you got to know what's there, and you gotta innovate on top of that. And that's something that I've seen success going back to even the first Trump administration. We start to see a lot of, I just say, value-based care kidney care companies come out of the 21st Century CARES Act and really get big very quickly by understanding the law, innovating the law to be able to serve patient populations, food and paradigm of healthcare at that time. Yeah. I love that that simple take. You have to, you have to read the law. I think it because I think a lot of people do just plug things into Chat GPT and and hope they get the gist. And then you also see all these media headlines that are super bipolar based on where you're reading. So it's either all is lost or everything's fine. And so it's uh it's hard to kind of read through that. But I'm curious, how do you stay on top of it with you know, these, you know, sometimes these things are dropped and it's like a 900-page document today, and then something passes or doesn't pass next. So I guess what is your information diet and how do you and your team kind of manage all the constant changes going on? I've been blessed to have a really strong network of friends who are willing to pick up a phone lab questions, you know, whether it's group chats, whether it's live conferences, and really just having open dialogue around what they're seeing on their side of the fence, whether it's from Medicaid and how behavioral health is being affected on this, how you think about pharma and how that's been affected by different policies and just looking to other people and learning from them. That's one of the key parts of my knowledge side is learning from others, particularly my peers. Um, I do read newsletters, um, but sometimes that could be that can be stressful as well. You know, headlines that are just kind of hard to digest. I'm a big podcast. The listener of First Builders is on the favorite list as well. Nice. And really kind of listening to these podcasts and looking things up afterwards, taking notes and really treating it as if I'm a student of the game. And even though I've been in healthcare all over a decade, I still feel like I have so much more to learn and so much more to grow. So I would say for my knowledge guide, also saying humble and saying very curious in this space as well. And that's allowed me to learn more about, you know, not just Medicaid, but also think about Medicare, think about things like dual special needs populations, understanding the challenges with uninsured populations. So it's also being curious about areas of healthcare and areas of just other industries I'm not involved in, which helps balance out um the work that I am focused on with information that also just really fills my knowledge sink as well. It's awesome. Yeah, no, I I love that. I think it's yeah, there's so much information out there. And I think like being able to actually fact check it like you're doing, you know, researching it after you hear something, like that's that's critically important. Yeah. Um, well, we're gonna switch over to our rapid fire um questions over here. So uh we'll just ask you something and then just say whatever is like top of mind. Um, you know, no wrong answer on here. Amber, do you want to start? Yeah. What do you think is the most underrated skill for a founder in healthcare? The ability to ask for help. Yeah, it's a good one. Okay, what about a book or a concept that's really stayed with you? Well, a concept that's stayed with you. Um, I forgot his name, but um, the book's called uh The Diary of CEO. And in that book, it talks about date night which apartment. I'm single, but it's like the the importance of carbon out time for your loved ones um and how important that is to refill your tank as a founder. And I know when I first started Roseam, I was not adherent to that policy. And I was just working with work. And as I've kind of stepped back and really spent time with family and friends, that's something that's been really critical of making sure you plan that time out, be very vocal about it. Hey, I I'm available Tuesday afternoons, wherever it is, to be able to break, you know, to break apart from your work because you can lose yourself in the sleep quickly as a founder, especially as a first-time founder like myself. And one what's one piece of startup advice that you think is total BS? Move fast and break things. Um, I've I've heard that since my time at TrueVent. And, you know, it it made sense for some companies. I think in healthcare really does risk individuals' lives. And I think more importantly now with data privacy and just the advent of AI agents and some of this other technology, moving fast does have meaningful, disastrous impacts on individuals' lives. And I think it's important for those in startup land to be patient. Still, you know, still move, but still be patient. The phrase I like to hear is be quick but don't hurry, which is something John Wooden, who's a basketball coach in UCLA, who was like, you need to move with intention and smooth is fast. But if you move carelessly, you can kind of lose yourself. Move fast and break things. I've always rolled my eyes at that idea because it was like that worked in 2007. Like let's not let's move off on that. Yeah, totally. And then last question, um, this is kind of like a two-part question. Because if you had a magic wand, what's one thing you would fix fix for founders building in Medicaid? And then what's one thing you would wish investors understood better about healthcare founders? I'll answer the second one first. It's gonna take longer to see outside return. Unless someone who's been through three exits in healthcare at True Room and Locar by IBM at uh Evaluant when we IPO'd in four years, and even Bright, who IPO'd in four years, those were those are edge cases. I think more recently looked at places, you know, companies like Hench Health and Omada Health who, you know, it's gone from zero to an IPO in 10 to you know 10 to 14 years. That is the timeline it's going to take. It's gonna take a couple of administrations to get it right. So for investors who are putting downward pressure on a founder to have a hundred million dollar top line in three or four years, that's not what this industry is in. So you want to be patient on that front. Um, and then going back to founders as far as having a magic blind and build in Medicaid. You know, I wish there was more Medicaid conferences. Um, most are very regional. Some of them are like niche within a niche. And I think because you're seeing 90 million people on Medicaid right now, it's it's a massive market. It's a massive health plan market, but it's really ever the focal point of healthcare conferences. And as much as the employer gets a lot of a focus, and even Medicare Advantage has got a lot of focus in the last five to 10 years, I think Medicaid deserved its spotlight, especially as we just you know celebrated, I think it was the 50th or 60th, 60th, actually, 60th anniversary of this line of business. But when someone says what's the best Medicaid conference to go to for founders, we're still not sure yet. So if there was a really strong healthcare conference that was sponsored by, you know, different Medicaid state directors, supported by FQHC, supported by academic medical centers, we have a much, you know, clearer idea of what is happening in Medicaid, how policies are affecting people's state to state, and then more importantly, it would start to put, you know, real strong persona of who lives on Medicaid. It's not just mothers and children, it's not just individuals of color, it is everyone that can be on Medicaid. And I think it's now in our best interest over these next 10 years to think about how Medicaid is growing, to really have a time for folks to learn, founders, VCs, and even community on how the sign of business works, where innovation is showing up and who's doing an incredible job at supporting our Medicaid population. Yeah. And there's so many different companies, right? Like that are building for this. And I feel like I talk to and see a lot of those um come through. Yeah, there's clearly uh a need for this. Yeah. I feel like you're soft pitching us on your new upcoming annual conference from Rosarium. Well, we did a home modification symposium. And so we tried the conference at one point, but it's a it's a lot. Um, but maybe we'll see. We'll talk we'll talk after the podcast and see if we can find some space and put some cool people on some panels and see what we can do. Yeah, definitely. And and Cameron, what's the best way for people to connect with Rosarium and keep up with you and what you're building? And is there anything you'd like to shamelessly plug? Shamelessly plug. Uh you can always follow us at rosariumhealth.com. We do a lot of social media posts on LinkedIn, Instagram at Rosarium underscore. I am active on LinkedIn. So if you ever DM me, I'll probably respond. So I'm not it's not a bot. It's really just me. I like everything on LinkedIn. So if you have questions after this, please reach out. Shamelessly plug. If you are on Medicaid in California, please let us know. We we are excited about what we're doing in that state. It's the largest Medicaid market. Um, but we're able to serve across all the counties in the state now. So awesome. Also, if you're a managed Medicaid plant looking to get into the whole modification space, please reach out, reach out to me directly. Um, and we want to be able to support Medicaid More Market. So if you're in Medicaid another state, happy to talk with you, happy to learn more about how we can support. But um, yeah, Medicaid Home mods, think of Rose AML. We're gonna be there um until the end. Well, we're super proud to be on board. It's been awesome to watch your journey and really appreciate you coming on the podcast today. Thanks so much for having me. I appreciate both you know, both your times, Amber and Rachel. And I'm looking forward to everything. Yeah, thanks so much. Great to have you on. Chat soon. Thank you. That's such a great conversation. I feel Cameron had just a wealth of knowledge on policy, on building in healthcare. Um, Amber, what stood out uh for you in this conversation? Yeah, well, first off, just echoing everything you just said. I mean, he's definitely managing a complex industry and you can see his first builder's experience. Like, I don't think a first-time healthcare founder that has barely worked in healthcare before would be able to just kind of jump in and handle all these moving parts with the addition of, you know, being working with construction companies, et cetera. But then the couple things that stuff out to me the most, number one was you could see permeated through his entire conversation that impact is a really big deal to Cameron, both in terms of the early roles that he took at different healthcare companies, but also in terms of what he's doing today. And we hear about this common misconception amongst LPs and VCs that you can either be impact focused or revenue focused, and that the two things can't go hand in hand. And I think I've actually heard uh Vinod Kosla talk about this too, of you know, one of the more established VCs I have a lot of respect for, uh, is that, you know, you have to be building something big and it has to make a huge impact for it to have the sort of groundbreaking outcome that a lot of people are excited about getting in VC. And so I think Cameron and Rosarium Health definitely embody that because it's as you see that silver tsunami, I've actually seen the graphic of the growing numbers and it does look like a silver tsunami. But as that, as that comes to be, that's a massive market, even though it's also just a great market to be serving for the good of humanity. It's something we need and it's almost like we're running toward a brick wall if we don't do anything about it. Absolutely. So I thought that was interesting. And then the other thing was he talked about how, you know, it's kind of BS startup advice, especially within healthcare, to move fast and break things. And I remember seeing that difference between when I worked at Eli Lilly to then working in consumer electronics at Apple and Snap, and then featured software at Cruise and Atmos. Um, you know, I think when you're I remember at Lily, we would constantly talk about like patient lives are at stake. If we take a manufacturing line down, that means people aren't getting their medicine or they're not getting their medical devices. Or if we make a change and it impacts their medication, it's huge. And that's why there's so much red tape and it's just not worth it if it's gonna risk anybody's life. And then as I moved over to consumer electronics, it was like, yes, we're still looking at all the data before we make a change, but it's a lot faster in terms of the turnaround. And so lower risk, right? Yeah, exactly. And then as I moved into software, it was even lower risk because you can just make a change in two weeks if something doesn't work out, nobody dies. So I think it's it's really interesting for us at the council because we invest in software built for essential industries and almost all of them have some sort of physical real world impact, even if we're investing on the software that surrounds that. And so I think it's gonna be really critical in this new wave of vertical AI applied toward these industries. It's gonna be critical that founders get that right and they don't subscribe to the same move fast and break things. Oh, if it doesn't work, we'll just change it tomorrow. No big deal. It can be huge. So yeah. Yeah, I think we've heard like a number of different founders have the same theme, especially on the healthcare side around like the slowdown to speed up, essentially. I think Eliana from Joyful Health has mentioned the same, but other ones as well. I think it's like you said, it's so critical in this type of industry and in any regulated industry that you have to like really deeply understand it in order to actually create the innovation and have the innovation in there. And then related to that, I know Cameron also really mentioned, like highlighted that you just really need to read the law and look at the nuances around um what's actually in the policy and in the law and not just the headlines. Because, you know, at first glance, if you were just an outsider looking in, you would be like, oh, Medicaid is being cut. So all of these healthcare companies that are servicing on the Medicaid population, like they're gonna go out of business. And, you know, it really depends on the nuance and all of those requirements in there. And, you know, when he he even said that when they read it over the weekend and looked at it more deeply, um, it could actually be a boon for Rosarium's business versus being a being a yep, exactly. Uh and yeah, I think like if you're a general outsider just trying to understand a market like healthcare, you know, it's totally fair to just plug the bill into Chat GPT and ask what changed. But I think, you know, there's a different level of responsibility if you're a founder building in an industry like this. So it's great to hear he's he's doing his homework and staying on top of everything as it's changing, which is not easy. So yes, yeah. Anyway, yeah. Well, for those of you listening, we'll link everything that Cameron mentioned in the show notes. And if you want more First Builder stories like this, tune in next week for our next guest. Yep. And make sure to subscribe to First Builders Everywhere, wherever you get your podcasts, and sign up for our newsletter for more behind the scenes insights and early drop from our guests. Thanks for tuning in, and we'll see you next time on First Builders.