(00:03 - 00:21) Jared Walker: Our big goals are to advocate for patients, to eliminate medical debt, as much medical debt as we can possibly get to disappear, and then use that patient data and through patient advocacy drive policy change at the hospital and state level.
(00:23 - 01:17) Mike Spear: Welcome to Cause & Purpose, the show about the leaders, innovators, and change agents working on the front lines to solve some of the world's greatest social challenges. Our guest today is the founder and CEO of Dollar Four, Jared Walker. Dollar Four began as Dollar for Portland, helping to crowdfund money to support people with unexpected medical expenses. Inspired by personal experience and evolved through real-world learnings, Dollar Four helps to tackle the staggering medical debt problem in the United States, by helping eligible patients take advantage of charity care, a little-known provision of the Affordable Care Act that requires nonprofit hospitals to waive fees for low-income patients. With nearly half of all bankruptcies in the U.S. stemming from unexpected medical debts, Dollar Four is making a difference on a massive scale, and they're just getting started. Enjoy the episode. Jared, thanks so much for joining the program today. Excited to talk to you and learn about Dollar Four.
(01:17 - 01:18) Jared Walker: Thanks for having me. Appreciate it.
(01:19 - 01:35) Mike Spear: With every show that I do, I find it's helpful to really start from the beginning. I know you're a little bit of an accidental social entrepreneur, kind of coming to it from a slightly different angle than most of us, but tell me a bit about how you grew up. Was impact present in your life from an early age or is it something you came to later on?
(01:35 - 02:11) Jared Walker: Now I'm curious, what's normal? What's the normal way to get into this? You know, one of five, one of five children grew up in Portland, Oregon, been in the Pacific Northwest my whole life, bigger family. You know, I definitely had no, no plans whatsoever of doing the work that I'm doing today. Never, never was on the radar, not even close. Uh, so I think, you know, it's, I don't know if that's normal or not, but something that definitely stumbled, stumbled into on accident. And especially in the last two years, it's definitely been on accident.
(02:11 - 02:24) Mike Spear: Yeah, well, sometimes that's how the best stories happen. But coming up, you know, if I remember right, you were in hospitality, mostly bartending, beer sales. There was something about a trampoline park. Tell us about that experience.
(02:24 - 03:08) Jared Walker: Yeah, there's my least favorite question is like, what's your background? Because I think people expect either a healthcare background or a nonprofit background. I have neither of those. Yeah, I was going through school, was working, yeah, bars, breweries, I did. I managed to trampoline park. I always make the joke that I started a nonprofit to help people with medical bills because I felt guilt how many people went to the hospital from the trampoline park. That's just a joke. But, you know, I didn't really have a plan, you know, after college or whatever. I mean, so much so that I didn't finish college. So it was just one of those things that didn't have a big plan for dollar four, that's for sure. And it was just kind of getting through school.
(03:09 - 03:17) Mike Spear: Were those jobs, the hospitality stuff, was that more just a way to pay the bills at the time? Or did you have a passion for that sort of work?
(03:17 - 04:24) Jared Walker: It's funny. I mean, one, definitely to pay the bills. I had a friend that worked in a restaurant and was like, you can make a decent chunk of change and tips are good and whatnot. So especially flexible hours, all the reasons people get into Serving bartending and stuff. Yeah, I think it was just a job job. I think I was managing I kind of got thrown into the trampoline park stuff and I was like Assistant manager kind of thing like and then all of a sudden the owner had some heart issues and we had like just Started a second location. So then like overnight I was managing I was like managing 60, you know high schoolers and college students, uh that I didn't really have any business doing. So I was doing all the hiring and firing and trying to run this business. So I kind of got thrown into that, which I think was, I learned a lot through that, but definitely wasn't trying to you know, run trampoline parks and long term. Yeah, definitely. It was more more of just like a job job.
(04:24 - 04:35) Mike Spear: So this is all I think, kind of starting right after college kind of as you're going through that and leaving when did you make the transition or first get the inspiration to do dollar for?
(04:35 - 07:28) Jared Walker: Yes. So in 2012, my wife and I were sitting at home. She got a phone call her and passed away from cancer. And then A few minutes later, I got a phone call. My cousin had gone into labor seven weeks premature. The baby needed a heart surgery to live and kind of same day, same hour. Families were hit with these, you know, medical emergencies. I remember one of the big conversations was, how are we going to pay for it? Like, how much is this going to cost? And that was my first running really with the healthcare system in the U.S. of realizing like, oh, you're gonna lose everything because you get sick. You can, you know, for no fault of your own, be put in a pretty bad situation. So that frustrated me that that was the conversation. Felt like it should be more around like, how are we going to get well? And that wasn't. So I realized my family wasn't the only one going through that that day. And I think it was just like ignorance of the problem. I was young and I saw that happen. And then I started getting online and looking up medical bills, number one cause of bankruptcy in America. You know, I think at the time the stats were like 65% of bankruptcies in America are because of medical debt. 78% of those people have insurance. And then the one that really stuck out to me was 85% of the people that declare bankruptcy because of medical bills, it's on bills that are less than $10,000. And that one kind of like stuck out to me because I'm thinking, oh, if you're declaring bankruptcy, you know, it's got to be $100,000 bill or something like that. And really, it's like, no, you know, it's it's a lot of people that get hit with a $5,000 medical. If you don't have it, you don't have it. And it may as well be $100,000. So I with that, I kind of thought, OK, well, what if I started you know, kind of like a crowdfunding platform. What if we got a whole bunch of people to give small dollar amounts and every month we would pool the money together and pay medical bills. So dollar four started out as dollar for Portland. Cause I grew up in Portland and it was a crowdfunding grassroots, like, you know, hustling and bars and breweries and coffee shops and music venues to, to get people to sign up for these small donations. And, and that's how that idea in 2012, started chasing after it. I think like that December we did a benefit concert and we like launched the organization. It was actually like several hundred people showed up and you know, new stations were like interested and there was like a decent amount of people are into it. Then I started getting asked questions about like, who's on your board and are you a 501 C three? And I had no idea what that was. So I was like, maybe I should take a step back, which is when I actually started working at the trampoline park. And then in 2015, I like quit my job and went in all in on dollar for dollar for Portland.
(07:28 - 07:32) Mike Spear: Yeah. Is it, you're what, like 2Four, 25 at this point, somewhere in there.
(07:32 - 07:33) Jared Walker: Yeah. Yeah.
(07:33 - 08:00) Mike Spear: 20 to 2Four when you got those two phone calls. I mean, it's, it's admirable to like just jump right into research mode, but I'm curious how that feels to you guys. I mean, of course you're concerned about your family members, but in terms of, you know, looking at how you might help in these situations. It seems like it weighed, it hits you guys relatively hard. And I'm kind of wondering what that experience is like, you know, as you turn sort of hearing the news into inspiration for action.
(08:00 - 08:54) Jared Walker: Yeah, I think that there was probably a good couple hours of just kind of sitting with it. You know, being with family and processing all of that definitely wasn't like, let me grab my laptop and start looking up stats on medical debt. So there was like, and it's kind of funny. I usually don't like tell this part, but I actually like sat down and I like kind of dozed off for a little bit. Like I, you know, it was just kind of like a heavy day. I think it was like, man, honestly, I think the same day, like my, we were all in like a car accident too. Like it was like, like nothing crazy, but there was just like a car accident thrown in there as well. And so, you know, we're all kind of processing and I sat down, kind of dozed off. It was almost like I woke up with like, Oh, it like boom, kind of jumped into action from, from there. There was some time to process, but I, it was pretty quick to, you know, this sucks. Like how do we make this better?
(08:54 - 09:09) Mike Spear: Yeah. So, you know, when you talk about crowdfunding, I think that can be in a lot of different things. Was this like a GoFundMe campaign where you just sort of getting out there trying to get people to give back through, I don't know, PayPal or whatever at that case. Like how did you go about that? That process?
(09:09 - 11:22) Jared Walker: Yeah, man. that like stresses me out when you even bring that up because because I like I it makes me I'm grateful now but man it makes me forget all the BS I was trying to do so like yes I was trying to figure out how do we get a platform that doesn't take a bunch of fees so I was I was testing out all of these platforms PayPal and uh Stripe and like all these ones because I was like if people are only going to sign up for like a dollar a month or two dollars a month or whatever I don't want all the you know, all of it to go because I was trying to promise that 100% of every dollar would go to these families to pay medical bills. So I was testing a whole bunch out. And it was just like a website where I made a you know, super simple website. And people could could sign up for a donation on on the website. It wasn't it was separate from GoFundMe. I wasn't like creating GoFundMe campaigns. And yeah, it was like trying to find I was even I called probably a hundred different like merchant processing companies and just asked them like, would you donate the merchant processing fees so we can, you know, do this a hundred percent? Wasn't having a whole lot of luck with that. But anyways, eventually I actually did. I found one that would donate the fees and then we were able to promise a hundred percent of the bill. So that's kind of, it was just like, yeah, made my own little website and started collecting the dollars. In 2015, when we officially launched, I like put together a big event in Portland at Pioneer Courthouse Square in Portland, like right in downtown. It was the same day as like the Red Bull Flutog. Have you ever seen that? Yeah. Where they like have these little people on bikes and create like these little things that jump, like go into the river to see like, like little hang gliders and whatever. So there's a ton of people in downtown Portland, like more than had ever been in downtown Portland. This was like a huge event. I got all the breweries. and all the places in town to donate all this stuff. And I just said, if you sign up for a dollar a month, you get free beer, free wine, free food card items. So I got all these food cards and beer and wine, and we got tons of people to sign up that day. So that was like the official launch of Dollar for Portland.
(11:22 - 11:27) Mike Spear: That's a pretty good deal. Donate a buck a month and get some free beer. I think that works out in your favor there pretty strongly.
(11:27 - 12:01) Jared Walker: Oh, it was that was like the game, like every single we would do these little takeovers at coffee shops and breweries. And it was always like, if someone signs up, will you give them a free beer or free coffee? Or we even did one at like a dispensary when like when marijuana was first legalized in Oregon, we were like, I mean, we were just getting out there. We would do dollar for shows where if you signed up for a dollar a month, it was your ticket in. It was like, the ticket to see the band or whatever. So yeah, just hustling around with an iPad, getting people to sign up.
(12:01 - 12:14) Mike Spear: Yeah. So at this point, how much are you raising? And how is that money deployed? Was it primarily meant for your family members or was it for the general population within Portland to take advantage of?
(12:14 - 13:20) Jared Walker: Yeah. So every month we would partner with a local organization that would identify family. Northwest Kidney Kids, you know, people like, they would, you know, find a family say, Hey, they got some medical bills. And then we would make a short video, and it would like tell their story. And then we would release it on the first of the month and say, Hey, meet the, you know, December family, and then all the money would go towards that family. So every single month, we were raising anywhere from like 5000 bucks to every once in a while, we'd get like a, you know, local news station to pick it up or whatever, I think the most we ever raised was like 25,000 for a family. We were doing that every month. So yeah, it wasn't, wasn't directed at my family. It was all, you know, we were finding different, different families in Portland partnering with these local organizations and we would, we would pay the medical bills on their behalf. So they would come to us and, and tell us about, you know, what, what big expenses. And it could have like, at the time it was medical bills mostly, but every once in a while, you know, like wheelchair accessible van goes down and like, we would pay for the repairs. Like as long as it was. medical related, we would pay it. Got it.
(13:20 - 13:25) Mike Spear: And you guys were not a 501c3 at this point, right? You're just partnering with others.
(13:25 - 13:41) Jared Walker: In 2015, we were. So 2012, I kind of like launched this thing. And then I said, what the hell am I doing? Took a big step back for a couple years. And during that time, I got the 501c3 status and put together a little like business plan and went from there.
(13:41 - 13:48) Mike Spear: Got it. What was that process like for you? Did you look at going fiscal sponsorship at all? Or you just dove straight into the 501?
(13:48 - 14:45) Jared Walker: I didn't even know what that was at the time. So I just dove right in. My sister-in-law is an attorney. I said, hey, how can I do this? So she sent me to this law firm. And they asked for $8,000 or something to do this paperwork. And I was like, well, never mind. I'm not going to start this nonprofit. No freaking way. So I just thought that that was the end. You know, I told her about that and she was like, well, let me, let me call this other place. And it's like, it's a nonprofit law firm. And one of the big things that they do is help nonprofits become nonprofits. So, uh, I got hooked up with them and they filled out all the paperwork for me, you know, for hardly anything. And, uh, I just had to pay like some of the fees and then we got, we got approved. So yeah, there was a whole bunch of things that they kept happening. That was like, you should have stopped it then in there for whatever reason. I just kept going at it. I was on a mission, I guess.
(14:45 - 14:48) Mike Spear: Hey, what was that launch like? How did the community respond to it?
(14:48 - 14:51) Jared Walker: Oh, it was great. I mean, Portland. Have you been to Portland?
(14:51 - 14:54) Mike Spear: Yeah, a couple of times. It's a great city.
(14:54 - 16:07) Jared Walker: Portland's a cool little town. Such a beer, coffee, foodie type scene. People were super into it. And it was really easy to get. We would do all these little pop-up events. And when people, at the launch, we had a bunch of stuff going on. I mean, we had, we were just calling a whole bunch of like, you know, stunt teams to gain, you know, people's attention. Uh, plus, you know, obviously the dollar beer, dollar, dollar food card stuff brought people in. So like the response was great, but you know, you, you realize like, I thought, Oh man, I'm going to launch this. And like, it's just going to go crazy. Like we're going to get, you know, a million people to sign up for, for, for a dollar. And obviously. It was much harder than that, but I'd say like Portland loved it. Like we had a little grassroots stuff. We had a bunch of restaurants and stuff that, you know, every single month they would do some type of event, you know, AM Northwest, our like local news station in the morning, every single month they would have us on. We would talk about the family we were helping. So it was like, it was a cool little grassroots thing. Definitely not a scalable organization, but just, just something that was like cool to Portland at the time.
(16:07 - 16:29) Mike Spear: Yeah. Well, I mean, I think all of us start out with something that's not that scalable and grow into it. So during this time, you know, before you sort of transitioned into a larger vision while you're still dollar over Portland, what are some stats you can throw out there? Like how much money were you able to raise during that period? Do you have a sense of like how many families you guys ended up helping? What it meant to the community? That sort of thing.
(16:30 - 17:31) Jared Walker: I mean, because it was a family month, we were helping 12 families a year. After a couple of years, I think that we started doing two families, a little more than 12 each year. And then we were raising anywhere from like $5,000 to $10,000 a month. Nothing too crazy. The families that we helped, they're still following us and cheering us on. And at the time, And maybe even still now, there's not a whole lot of organizations. There are a lot of organizations that will provide support. Here's cancer resources. But as far as here's some money, let me pay some bills, there are not very many organizations that do that. So being able to buy the repair for the wheelchair accessible van, or buy the medical equipment that they can't afford, or pay the hospital bill that's gone to collections, a pretty freaking big deal for people. It wasn't a whole lot of people, but the ones that we were able to help were pretty pumped.
(17:31 - 17:42) Mike Spear: Do you have a sense of what it meant for them longer term? Having received the funding to pay for some of those bills, what that really meant for that family's future?
(17:42 - 18:32) Jared Walker: Yeah. I think when people have… Every single one of these families we were helping, they're in the midst of it. They've got a kid with cancer, they've got, you know, someone with a surgery or whatever. So I think, and even just what our organization has turned into now, like, the biggest thing that we hear is feedback is like, I'm so grateful to have had an advocate, someone in my corner, and this has been a tremendous burden lifted off. So you know, I think like, there were a handful of families that we needed to pay rent for him, like it, you know, our support meant that they got to stay in their apartment, or even get to the get to the doctor's offices. Like, you know, the car repairs were a big one. A lot of these families super low income and your car goes out and then you can't you can't get the medical care you need. So I say it's pretty meaningful.
(18:32 - 18:44) Mike Spear: Yeah. Looking back on the dollar for Portland days, what happened, you know, to make you guys decide, hey, maybe we expand beyond Portland, maybe we do something more scalable and tackle this in a larger way.
(18:45 - 19:43) Jared Walker: definitely the most rewarding thing. You get to show up. It's like showing up at these families homes with, you know, small film crew and filming this story and sharing it out so that people can can give and support was really rewarding. We got to tell cool stories and talk about how, you know, incredible these families are. And it definitely rewarding, like, you know, and even now, I mean, every I think that anybody that works a dollar for would talk about like, that's kind of it. You know, it's definitely a feel good type of work. The thing that really made a shift was really just discovering what charity care was. You know, I just had no idea that it existed. And like most people, it wasn't really like, Oh, this isn't, this isn't working. Like I was just kind of focused on helping people locally and I probably should have been thinking more future. Like what, what, what am I going to be doing long-term? What drove the change was just like new information pivoting from there. Yeah.
(19:44 - 19:49) Mike Spear: Tell us what Charity Care is. And I thought the story about how you guys found out about it in the first place was pretty incredible.
(19:49 - 22:43) Jared Walker: I went to some networking event in Vancouver, Washington. Somebody invited me to their like BNI group or something as like a guest. So I went to that event and met this guy named Eli. And Eli was an attorney. And he was really interested in what we were doing. And he asked me if I'd ever heard of charity care. And he might have said, have you ever read section 501R? Because Eli's a nerd. And I was like, no, I have no idea what you're talking about. So he starts talking to me about this, like, oh, hospital. Most hospitals in America are nonprofits. And they have to have these charity care programs that waive medical bills for people within a certain income range. So I'm kind of thinking, one, how do I not know about this? How does everybody not know about this? I think at the time it was kind of like, okay, yeah, whatever, man. Just like some time went by and then we had a mutual friend say, oh, like you guys got to meet. And we didn't remember each other's names or whatever. This is like a year later. We agreed to meet. We meet up at this coffee shop and we're like, yo, you're that guy that I met. So we like kind of had this moment of like, oh, we've already met. We've already talked about this. And he kind of sat me down and was like, no dude, like, this is a big freaking deal. This could change the organization. We started meeting up and yeah, he was right. I felt like an idiot. I had been paying all of these medical bills for these low income families that would have been eligible for free or reduced care if I would have known about these programs. So we started meeting up and digging into these policies and reading Charity Care you know, hospital charity care policies and started applying for people. Cause it was like, we, we knew all these people with medical debt cause they were applying for a dollar, dollar for Portland. So, and it worked. We like, I remember, you know, being in my car, getting a phone call from this guy that we had, it was like a $6,000 medical bill. He was super young guy, got in a bad car accident. He did, he called me and was like, dude, I just got a letter and it says that I have a zero balance. And it was like, just this moment of like, Holy, like, I can't believe it worked. Like, I can't believe that it worked. So that, yeah, that's how we, I discovered Charity Care. I probably did a poor job of explaining it. Charity Care is a federal law that went into effect with the Affordable Care Act. It requires nonprofit hospitals, which is most in America, to have these policies that will reduce or eliminate medical bills for people if they meet the income guidelines. So they don't do a great job of telling people about it, shockingly, so. we got a lot of people that are on payment plans or declaring bankruptcy for bills that they actually don't have to pay. And that got me real motivated to help, you know, help more people.
(22:43 - 23:03) Mike Spear: I can only imagine going through that and declaring bankruptcy or, or just struggling every month to meet your, your payment plan for something that, you know, you didn't control in most cases that happens to you. And then to realize you never had to pay it in the first place. That's a hell of a journey. It's a hell of a realization to have.
(23:03 - 24:36) Jared Walker: Yeah. I think everyone that reaches out to us and is filling out our screener to see if they're eligible, it's the first time that they've ever heard of charity care. Like the hospital is, you know, didn't tell them. So I think that, yeah, it's just, it's like best kept secret and people, it's this huge injustice because it's like we have like these, these hospitals get to, get all the benefits of being a nonprofit, all these tax breaks, sometimes billions of dollars in tax breaks. And the only reason they have that is so that they can provide community benefit, which is charity care, free or reduced care to people within a certain income range. And, and they don't do that. So it's like, well, they're like double dipping, you know, they're, they're getting all the benefits, yet they're not doing the thing that they're supposed to do. And I think that, yeah, people feel obviously frustration with the healthcare system like that's nothing new but this is just like another layer because it's like there's been a solution for the last 10 years for a lot of people like there's been a solution a lot of people have declared bankruptcy on bills they actually never had to pay and I think you know I think that that kind of realization is kind of what made us blow up even like, you know, on social media and stuff. It's just kind of that like, wait, what? Like, how do we not know about this? And that was like the big thing that I was trying to figure out is once I had learned that it actually worked, like I really, you know, we got medical bills to disappear for people. I was just like, how is no one talking about this? Like, what is going on?
(24:37 - 24:52) Mike Spear: So you guys discover this program, you realize it's a nationwide thing, and there's a better, more efficient way to help folks that perhaps is scalable. Was that the decision point to turn the organization into something bigger and go for scale? Or did that come sometime later?
(24:52 - 25:52) Jared Walker: Yeah, we were pretty quick on to like, let's start applying for charity care and, and digging into these policies. We did that pretty quickly. We were still running the other program. But we discovered in probably like seven months that we in seven months, we relieved more medical debt than we had in the previous existence of dollar four, and we helped more people. So it was like, it was so much more impactful, we were able to help so many more people. And in that seven months, we eliminated over a million dollars in medical debt for people by just applying and knowing how to work this this program and system. It was like end of 2019, I think is when we were just like, okay, no more crowdfunding, like we are going to be patient advocates, and we're going to start enforcing these charity care policies. But even even then, it was still just Oregon and Washington, we did a little bit in in like Northern California, but it was really just like Pacific Northwest.
(25:53 - 26:07) Mike Spear: How's that moment for you guys? And the reason I ask is because it can be scary to sort of throw out the playbook that had gotten you to the point where you were and helped make you successful to really pivot in a completely different direction.
(26:07 - 26:48) Jared Walker: Yeah, I think that there was a little bit of like, oh, shoot, like people know us as Dollar for Portland and and we've like At least locally, we had kind of developed a little bit of credibility and people were following us because we knew, you know, Hey, you give money and every month it goes to a different family and you get to watch the video and, and all that. So it was like. The change was a little bit scary, but we just knew that it's like, well, if we really care about eliminating medical debt, we're going to be able to do it at a much larger scale doing it this way. So it was like the, the impact. just drove the conversation and end of the decision because it was just so real that, you know, wasn't really any denying it.
(26:48 - 26:58) Mike Spear: Yeah. Was it, was it scary for you? Like how did you, you know, did it seem like an obvious next move or was it daunting to kind of look at shifting the organization to have a more scalable impact?
(26:58 - 27:30) Jared Walker: It was definitely scary. Like I think that making the switch was definitely scary. We didn't know what we were doing and we were also like, We'd, you know, been successful with this at a handful of hospitals and in a handful of cases, but we didn't like, you know, what if hospitals change their policies? What if this, like, we didn't know any of this information. So it was definitely scary to switch. But I think that we were also like, very confident, and that the impact was there, and that we needed to make the change.
(27:31 - 28:00) Mike Spear: So it sounds like pretty quickly you guys had some pretty good success and certainly had a much larger impact with the pivot than you'd had before. You've also sort of a viral moment at one point, and you, you managed to, I think, basically double your organization's revenue year over year for the past few years during a time when, you know, a lot of organizations have been shrinking or had a bigger challenge fundraising than they have in years past. Let's talk about the year over year growth, and then let's talk about your TikTok sort of launch.
(28:01 - 29:14) Jared Walker: Yeah, I since 2019, when we like made the official switch, I was telling everybody, I mean, I was shouting from the rooftops trying to trying to get the information out there. Like, there are all these people that don't have to pay their medical bills. And I think there's this like, too good to be true kind of thought in there. And it just wasn't I was not getting traction. I was talking to all these journalists and, and news stations and just trying to get it out there wasn't having a lot of success. That is when I was talking to my little sister. She said, hey, you should get on TikTok. And I was like, eh, I'm not going to do that. So that was at Thanksgiving when she was in town. Then she's in town for Christmas. She says, hey, you've got to get on TikTok. People would love what you're doing. I kind of ignored it again, but I downloaded the app. I downloaded TikTok. And it's like right at the beginning of the year, I saw that video. What's a piece of information that feels illegal to know? And that was the like prompt that I was like, Oh, this is charity care. Like I know the answer. This is a piece of information that, that nobody else. So posted my first TikTok video and it went, it happened to go viral.
(29:14 - 29:27) Mike Spear: So what's, what's on the horizon for you guys. I know you're, you're going through fast forward, which I'm also curious about as well, but how does that increase revenue and efficiency translate into the next stage of your growth as an organization?
(29:27 - 30:44) Jared Walker: I mean, the last few years have been. insane. It's gone from a one-man show to 1Four people, either, you know, full-time, part-time, or contracting, and going from the Pacific Northwest to national. Like, we've eliminated medical debt in every state. It has been very fast. I think that, you know, the TikTok video brought us to a lot of people's attention, and then, yeah, we started getting invited to these accelerators. Foundations started paying attention to us, and we've gotten a tremendous amount of press. Right now, there's no lack of need. An estimated 100 million Americans with medical debt, $195 billion of outstanding medical debt in America, and a lot of those people are eligible for charity care. They don't have to pay those bills. So how do we get them to know about us? Our big goals are to advocate for patients, to eliminate medical debt, as much medical debt as we can possibly get to disappear, and then use that patient data and through patient advocacy, drive policy change at the hospital and state level. So that's kind of like our big goal. Our big mission is make charity care known, easy and fair. And right now, it's none of those things.
(30:44 - 31:05) Mike Spear: Talk more about that. a sort of second part, you know, creating policy change at the hospital level. You're sort of working with hospitals to be more proactive in how they make patients aware of this. I think there's also sort of like an enforcement angle to this as well, where for hospitals that are not being transparent and clear about this, sort of forcing their hand in some ways in the legal system, right?
(31:06 - 32:29) Jared Walker: Yeah, we have a database of every hospital in the country, all the charity care policy data, a patient can go to our website and find out if they're eligible for charity care immediately. So we know what the policies say. But then we also know what they look like in action, because we're doing the advocacy. And sometimes those things just don't line up. And hospitals do illegal things, they have illegal practices, they have policies that, you know, they say they do things that they don't. we are able to collect all that. And we have all these patient stories and patient experiences. So we have been able to kind of find the bad actors and go after them and say, Hey, you know, we've got all these patients at your hospital that have had this experience. Like we need to talk. So sometimes it's just calling out the hospital on the individual level. Other times it's going to the AG's office. Other times it's talking to the, you know, hospital, uh, you know, department of health or hospital associations in that state. and just kind of getting after it as far as like making, at least making the problem known and trying to convince the hospital to change. So I think now we've, we're at like Four5 hospitals that we've actually been able to get them to, to change their policy, to be more favorable to patients, which is great, but it's the patient advocacy that drives that work, like without eliminating medical bills for individuals right here right now, we wouldn't be able to do that work. So it's kind of a two programs that really complement each other.
(32:29 - 32:44) Mike Spear: Take me through the patient experience. If somebody incurs medical expenses and qualifies for charity care, you know, in general, and I'm sure there are different quirks at different hospitals, but but what's that process like to start pursuing forgiveness of those fees?
(32:44 - 34:00) Jared Walker: Yeah, people go to our website. There's an eligibility screener. So they put in their household size, their income, what hospital holds the debt, and it will tell them immediately if they're eligible. Once they find out that they're eligible, they are given two options. One, self-advocacy. We can give them all the instructional, you know, educational videos, tips, tricks, tools to do it themselves. And they can answer or, you know, ask questions along the way. About 10 to 15% of people choose self-advocacy. A lot of times it's like a privacy issue. They don't want to give us their information or whatever, that's fine. And then the rest of people do full service, which is we have patient advocates that help patients complete the paperwork, submit it to the hospital, advocate on their behalf until the bills are gone. So if you're found eligible with our screener, you're going to have a patient advocate reach out say, hey, let's fill out this paperwork that the hospital needs, get the proof of income, do all that. And we're going to submit it and we're going to check in on the hospital and bother them until they do the right thing. And normally it takes anywhere from like four to six weeks. There are some hospitals that do this better than others. So sometimes you hear back in 2Four hours. Other times you wait six months and you fight and fight and fight. But yeah, nothing is standardized about it, unfortunately. So it's hospitals are kind of making their own rules.
(34:01 - 34:11) Mike Spear: Yeah, so you guys not only have the information to navigate these systems, but you have case managers basically to actually walk people through the cases.
(34:11 - 34:32) Jared Walker: Yeah, so you can when you're when you're found eligible, a patient advocate will you'll be texting or emailing with a patient advocate throughout the whole process. And just making sure that you know, all the paperwork submitted, and then we'll be checking in with the hospital sometimes together, you know, we'll hop on three-way calls at the hospital and try to figure out what the heck's going on with the application, check the status, all that.
(34:32 - 34:48) Mike Spear: Yeah. I mean, I imagine that's a pretty profound aspect of your work too, given that, you know, a lot of these folks are really just trying to get back on their feet figuratively or literally, but to have that kind of support, you know, among everything else that they have to worry about at that stage, I imagine is a big part of the program.
(34:48 - 35:21) Jared Walker: Yeah, definitely. The only reason you have a medical bill is because you had some type of medical emergency. So a lot of times it's people that are recovering from surgery or just had a child or going through chemo. And the thought of reading that 30 page hospital policy to figure out how to apply for charity care is just a little overwhelming. Same as before with Dollar for Portland, biggest feedback we get is like someone was in my corner. I had an advocate and it's a huge weight lifted off my shoulders.
(35:21 - 35:41) Mike Spear: You mentioned childbirth, which I was going to ask you anyway. You know, one of the quirks of this quirks of this situation is that in some cases, or all, childbirth is considered ineligible as an elective procedure. How did you guys learn about that? And I think there's a pretty funny story about how you guys dealt with it.
(35:41 - 37:32) Jared Walker: Yeah, we find these things with hospitals. So some hospitals will just have, they just have terrible policies, like things that you're like, how did this get passed through? But again, no, there's no oversight. There's no, there's no charity care police. Nobody's checking to see what these hospitals are doing for the most part. Yeah, we found a hospital that denied a patient of ours that was claiming that childbirth was not eligible for charity care because it was considered elective. And we kind of were like, this has got to have just been the wrong email. They sent the wrong email. They sent the wrong letter, right? Because that's absurd. But then we had another patient get that same one from the same hospital. And then we had another one. And it was kind of like, OK, what is happening here? So we wrote them a handful. strongly worded letters from our attorney and said, Hey, like what, you know, what's going on. So immediately hospitals say like, Oh, we don't do that. That's a one-off, that's a one-off case. And then you have to show them like, okay, guess what? It's not, they ended up changing the policy, retraining their staff, you know, doing an internal audit to see how many people were, were impacted. And I think that's, that's a part of our work that really is evolving. Like how do we step in and correct a hospital on this? But then like, make sure that they actually implement the changes. Because I think, you know, on paper, it's like, Hey, we won, we got this hospital to, you know, we've got the receipts, they're going to fix this. But in two years, like, is it still fixed? Like, so then you, it gets into, well, how do we change the laws? How do we, how do we make it so that they can't do this? If they are doing it, what, what are the, what are the consequences? You know? So I think it's a part of our work that's, that's, that we're trying to figure out. But yeah, I mean, that's like, that's one example of a lot of examples where hospitals are doing shady stuff, unfortunately.
(37:32 - 37:42) Mike Spear: It's amazing for organizations that are in the business of healing people, that they would be pulling tricks like that, especially the nonprofit ones, theoretically are mission driven.
(37:42 - 38:27) Jared Walker: Yeah, no, it's I think a lot of people would be surprised with some of the stuff that we we uncover with this. You know, sometimes it's a letter from our attorney. Other times it's. You know, tagging them on an Instagram video and getting people's attention. Hospitals do not like bad press. And I don't like playing the shame game, but we're good at playing the shame game if we need to. And we have a social media audience and we have, you know, other influencers that will get on board. So like every time that we've ever called out a hospital on our social media, like it's fixed pretty quickly. So, you know, part of me wants to just do that all the freaking time, but it's, Something that we got to be careful with as we're growing.
(38:27 - 38:36) Mike Spear: Yeah. What's your success rate like with these applications? Do you have cases that are still denied and is there anything to be done in those cases?
(38:36 - 39:59) Jared Walker: Yeah. So I would say 70% of people that, that see if they're eligible for charity care on our website are found eligible. So that's great. But then we got to lead them through like the hard part, like the real applications and the proof of income and all that. And there is a drop off. And we're working on trying to make it better user experience and get that conversion rate up. But for the people that we apply for and they follow through, we're not applying for people that aren't eligible. If they're not eligible, we're not trying to get them to apply. So it's like a lot of people that we work with get approved. There's another part of our system that we're trying to fix actively as well is When we fill out all the paperwork, we're doing it on behalf of the patient. So who gets word that their medical bills are waived? It's the patient. And you would be shocked at how many patients forget to give us the detail that their medical bill was waived. So we have $27 million of medical debt that has been wiped out that we know of. Wow. there's probably another 20 million in there that we don't know about. And like even yesterday I hopped on TikTok and I got a comment that was like, oh my gosh, this organization helped me get $10,000 in medical debt waived. And it's like, this is the first I'm hearing of it. And that was a while back.
(39:59 - 40:02) Mike Spear: You guys still had the open case for that person?
(40:02 - 40:54) Jared Walker: Yeah. It's like, oh, they got the letter and they just whatever, hopefully they celebrate it at home. But like, that's the thing is, you know, the numbers are higher than we know it, but the numbers that we have are still pretty, pretty darn good. Because trying to figure out like, hospitals don't want to talk to us. They don't, you know, when we call, and like, even though we have every single patient sign a release of information, and we're a lot like, it's a pain in the ass. And I understand like, there's HIPAA laws and hospitals are terrified to break any of these things, but they should be able to tell us information about the case. I can get you real numbers of success if I pull up our dashboard, but I think it's something that we're working on to figure out how do we actually know about a lot of these cases.
(40:56 - 41:14) Mike Spear: It sounds like your basic sort of impact measurement stuff is like medical debt relieved, medical debt avoided. What else, what other metrics are you looking at that are really either things that you can sort of brag about and sort of claim, Hey, we accomplished this or, or things that you really study in terms of ways to improve your own programming.
(41:14 - 42:35) Jared Walker: The key metrics for dollar four are definitely medical debt relieved and, and the patient served. Um, the medical debt avoided is still trying, you know, that's like our policy work. And trying to figure out impact numbers on that is really hard. Like, you know, you get a hospital to change their policy. Like we just got one, it's a 30 hospital system and they changed their policy. It's going to impact people in six different states. What's the dollar amount on that? Like what's the impact? We know. So trying to figure that out. I think that the other ones like that they're really, really paying close attention to are certain demographics. Like we know, that Spanish speaking communities are hit harder with this. We know that black and brown communities are hit harder with this. We know that disabled communities are hit harder than this. So like how do we impact those people, the people that are most vulnerable, that the system is hurting more than others? How do we uh, make sure that we're accessible to them. So I think we, you know, we've translated everything into Spanish. We have been trying to do deep work in like Texas and Florida, Georgia, places where it's like non Medicaid expansion States. And like, those are the hotspots, Texas, Florida, Georgia, like medical debt's a big problem over there more so than in Oregon and Washington. So those are some other metrics that we, that we really pay attention to.
(42:36 - 42:44) Mike Spear: As you guys are sort of evolving and looking for scale, tell me about the journey that it took you to fast forward and how that experience has been for you.
(42:44 - 44:09) Jared Walker: Fast forward has been incredible. And the journey there was I had another foundation that had helped us out and the lead person over there introduced me and gave me like a good recommendation to fast forward. That was the start of like, they reached out and said, Hey, we're this tech nonprofit accelerator. And I'm thinking like, dollar four is not a tech nonprofit. Like, I just did not. It's like, I don't know. We use tech. Like we use yes, we use tech, but we're not like, we, I just wouldn't consider ourselves that hop on the first call. And you know, they're asking me the questions and I'm, I'm kind of telling them like, Hey, I don't think that this is a good fit. Like I'm honored that you would, you know, consider me. So they're like, well, tell us about like what you do. And I, you know, start telling them about TeleFour and she's like, well, it sounds like you're a tech nonprofit. So I'm like, okay. Like I, so I applied. Cause that was like, they were, they were asking me to apply. And so I said, okay, cool. Like, you know what we do. And, um, if you say so kind of thing. So I, I completed the application, submitted it and got word about that. It was, I talked to a handful of alumni, they all had. incredible things to say about Fast Forward team and the program that they run. So I went for it. It was everything that, you know, it exceeded all expectations. Yeah, been been a huge honor to be a part of that.
(44:09 - 44:24) Mike Spear: I'm curious to hear a little bit more about it. Like, what are some of the things that you got out of the program? And I think, you know, most interesting, at least to me would be things that you're doing now or opportunities that have opened up now that would not have been there had you not gone through it.
(44:25 - 45:56) Jared Walker: Fast forward does a lot of programming. Like every week you are meeting, they do something called micro mentoring. So they bring in like really, really smart people from Google and GitHub and like all of these different tech companies. And you get to sit down with them for an hour and talk to them about your problems, tech problems, like fundraising problems. I mean, there's some incredible people that they bring on. So that's one thing that you're doing throughout like the months It's really like, how do we scale the tech? And I was real, like the cohort that I was in, it's 10 nonprofits that are, that are chosen. And some of them are way more tech heavy than we are. So it was like, you got to learn a bunch from them too. Like people that are using like AI chat bots to help, you know, people like it's, it's like, that's not, that's not something that I would have had on our like roadmap. But like it is now like it's something that I'm like, oh, we could do this. Like we could automate this patient experience, leveraging tech, leveraging AI, all of that stuff where I'm like, I wouldn't have had that because their lens is so specific of like tech nonprofits. How do you use tech to scale and tech for good and all that? It's like, I just wasn't thinking that way. And they've kind of opened up a whole world into like, oh, wow, this could scale a lot faster than I thought. So, so that's, those are things that it's like how it's changed the organization is just like being a lot more confident in, in tech moving forward.
(45:56 - 46:17) Mike Spear: For those people that don't know, Fast Forward is a nonprofit based in San Francisco that accelerates other tech nonprofits. Shannon Farley is a co-founder and executive director. She was on the show last season and they've been sending us a bunch of guests you've, you've probably heard from. So they've really, you know, been a big part of this show, but always exciting to hear kind of how people's organizations are impacted as they move through it.
(46:18 - 46:55) Jared Walker: I mean, fast forward has been incredible for us, learned a lot, like I said, with tech, but also just like getting to know other founders in the community that they have. It is great to be able to talk to other founders that have been through this, that are a couple steps ahead, or even encourage the people that are a couple steps behind. It's been amazing. And then obviously, it opens up doors. You get contacts of people and foundations that are passionate about your work. Fundraising is always an issue with nonprofits. And trying to find the people that are passionate about this type of work, they do a really good job of connecting you to those people.
(46:56 - 47:36) Mike Spear: I mean this in the best possible way, but I'm curious about imposter syndrome and how it relates to you as you've started this organization, particularly being in the fast forward cohort where so many folks have advanced degrees from Stanford, Yale, Harvard, all these big schools. And you're a guy who, you know, learns by doing, which I think is actually, in many cases, a huge advantage while creating a new organization. How do you experience this? How have you been confronted by this as you've grown and overcome it? Because you're clearly still at it and thriving. What about that sort of, for lack of a better phrase, school of hard knock sort of approach to entrepreneurship has really served you as a powerful asset?
(47:36 - 50:15) Jared Walker: Oh, gosh. I don't freaking know, man. Honestly, like I've been, so first of all, I didn't know. And you, you know, it's kind of referenced at the beginning, like, oh, like it's kind of taking a different route to this. Like I, it's kind of, I don't know any other way of doing it, but I have now figured out like, oh, most people don't get into this work the way that I did. I feel like with all of the accelerators, whether it be Praxis or fast forward or, or being a part of DRK. It is not my scene like I'm like, Oh, this is a lot of smart people in here. And I don't feel. I think that people look and I've been, I've been told this like in big rooms like oh we love we love Jared and dollar for. you know, because, you know, he grew up closer to the problem. Like, it's like this way of saying that, like, yo, you were kind of poor when you grew up, and you don't have a fancy degree. Like, that is how it's like spoken of, which I mean, I don't, I think that I definitely struggle with that. It's definitely something that I'm like, oh, shit, like, I'm in real, I'm in deep now people think that I know something and I'm trying to figure it out. So it's definitely something like that, that I struggle with. And there have been times where I've like had to sit, you know, go back to my hotel room and just sit down for a second and be like, okay, like everything's going to be fine. Like, even though I feel like a moron in front of these people, the imposter syndrome is something that as dollar four has grown, has been more and more of an issue for me trying to figure out what is my role in this organization? What do I do? Because I feel like I'm doing less now because most of my time is spent fundraising and going on podcasts and speaking and like being a part of accelerators. And I have this whole team that's like doing all the work. And I don't have like the deliverables that I used to have. I used to be the one calling hospitals and waiting on hold and advocating for patients. And it's like, I don't do that anymore. So I'm trying to figure out, what am I doing? I feel like I'm the weak link in this organization in a way, or I'm the annoying lead singer of the band that gets all the credit for stuff, but I'm doing, that's how I feel. And then obviously you tell that to a lot of other people and say, oh my gosh, no, the organization wouldn't survive if you weren't fundraising. And yeah, I get that, but the transition over the last two years has been, extremely difficult for me, for sure.
(50:15 - 50:20) Mike Spear: How do you see yourself adapting to it? You know, what keeps you pushing past those doubts?
(50:20 - 51:30) Jared Walker: I think in the stage that we're at, people really want to talk to the founder, they really want to talk to the person who started it. And it's like, we're not, we haven't like graduated out of that. So I think that it's like, it's my unique role to tell the dollar for story and what we what we've done, how we got here and all that. We're still super like early stage. So I think that You know, when people say like, do what only you can do, it's like, well, a lot of people can fundraise, but like, I'm fundraising specifically for dollar four. And I feel like I can do that. And I can tell the dollar for sure. Cause it's, it's a, it's a part of me. So I think that one, it's just one of those things where it's like, well, it is what it is. Like, I just got to keep, keep going. I'll figure it out. And groups like fast forward, when they put you in front of all these other founders, like there are some that have very similar stories and that's very encouraging because it can be pretty lonely sometimes. So I think that. talking to other founders that have gone through it and just trying to roll with the punches, I guess. I think I'm still trying to figure that out. It's like, okay, in this next stage, what am I doing? And then how do I do that well? How do I get to be really, really good at this role that's completely different of anything that I've ever done?
(51:30 - 51:40) Mike Spear: What about a sort of less traditional background do you think has actually been an asset? What have you guys done as an organization that you might not have otherwise had you not just learned by doing?
(51:41 - 52:56) Jared Walker: I mean, I think that not knowing the rules has helped. Like it kind of gives me like more grace or people give me more grace, I think. So I think that that's helped. Like truly, I mean, I don't know, I don't, I don't know the rules. Like, I don't know. And there are rules like, you know, being a part of these accelerators and talking to really wealthy people and reaching out to foundations and like hosting events. Like, I don't know. I think that people have more grace for me and for dollar four, because yeah, I think that they do see me as some, you know, some guy just running around trying to figure it out. So I think that that could be helpful. I also, this is going to sound terrible, but it's like, I can be one of the token, like, you know, people that didn't graduate from college, you know, people that, you know, that was closer to the problem. So I think that, that like, honestly, people, that's a metric that people use is like, X amount of our founders experienced this problem personally. And that seems to mean something to people. Like we're more credible because I didn't grow up in a family that could just pay their medical bills with no problem kind of thing or whatever.
(52:56 - 53:48) Mike Spear: Entrepreneurs with a certain amount of naivete about the fields they're seeking to enter or disrupt, I think is actually a pretty big advantage. Not knowing what you don't know and questioning status quo in a way that you wouldn't otherwise if you'd sort of grown up in that, number one. And number two, you know, I'm a big believer in sort of human centered design and participatory design with these problems and understanding The real needs of the people that you're trying to serve and coming out of that, you know, being a product of some of those real experiences, you know, even forgetting about socioeconomic statuses, but like inspired to start this as a result of family members, people you care about having these medical expenses unexpectedly. I think it, it does lend some authenticity, you know, optically for sure, but also, you know, I imagine you're engaging with a problem in a slightly different way that is, is more directly serving the population that you're attempting to help.
(53:49 - 54:07) Jared Walker: I think it comes into play the most with fundraising. You know, like if you have a bunch of rich connects, it's a lot easier to get your nonprofit off the ground where otherwise you're going to ice cream shops trying to get people to sign up for a buck. You know, like what, what are we doing?
(54:07 - 54:15) Mike Spear: So, you know, you guys have pivoted a bit. You've come out of fast forward and the goal this year is 1.7 million. Is that, is that still true?
(54:15 - 54:15) Jared Walker: Yes.
(54:16 - 54:23) Mike Spear: How'd you guys arrive at that number and what's on the horizon? How's that going to be deployed and what's that going to unlock for you guys as an organization?
(54:23 - 55:50) Jared Walker: So the 1.7 would be a couple key hires. We do not have a media person. We desperately need a media person. We've been very fortunate. We do get a lot of media. We do a lot on social media. That is something that takes up a lot of my time. Then more patient advocates. Like I said, there's no lack of need. We are overrun. with people that need help with medical bills. And then the tech, like getting the right tech, building out our platform so that we can boost our conversion rates to people that are, you know, eligible for charity care, getting them approved. So it's really like staff and tech are the two big things. We came to that number because one, I felt like it was a big enough jump but not too crazy. I do think that there's a thing of growing too fast and maybe we're already there, but it seemed like a reasonable number. And after pricing, going through all the different things that we thought that we could do in a year, like, okay, how many pieces of tech could we actually deploy and get going and have this be really meaningful for the patients that we serve? And what key positions in tech do we need to buy? crunching the numbers, like, well, it's a lot more than what we did last year. So I didn't want to, obviously, we can keep going and keep going and our budget's probably going to raise next year, but it seemed like an appropriate step.
(55:50 - 56:03) Mike Spear: Outside of dollar four, outside of recouping or preventing medical expenses for people that have unexpected expenses and don't need to pay them based on whatever criteria, what do you think is the most important cause folks would be tackling right now?
(56:04 - 56:22) Jared Walker: I was really inspired by a lot of the mental health organizations that fast forward. I think that as we get further along with technology, I think mental health is going to be a big, big one. I mean, obviously environment, like we would love to continue living. I think that that's such a hard question.
(56:22 - 56:40) Mike Spear: At the end of this journey with dollar four. you know, whenever you're ready to move on or, um, you know, go to the next chapter of life, what's, what's something that you'd like to be able to look back on and say, you know, Hey, we accomplished this one thing. What would you feel really good about having done in your time at dollar four?
(56:40 - 57:17) Jared Walker: I mean, I think it's just that, that people wouldn't fall through the cracks that, that charity care would become, I think it's that like known easy fare. Like people know about charity care. at the end of the day, I'd like a better health care system, right? I'd like to not have to exist altogether. You know, the rest of the developed world has figured this out. And that would be the ultimate goal is like, hey, you don't have to exist anymore. So on to the next thing. Outside of that, I would say like making charity care accessible to everyone so that people aren't paying medical bills that they shouldn't.
(57:18 - 57:34) Mike Spear: As far as $Four is concerned, what's next on the horizon for you guys? How can somebody who may be facing medical expenses, they're having a tough time paying, interact with your services? And how can people who want to support your work get involved as a funder?
(57:34 - 58:12) Jared Walker: If you have medical bills, if you have recently been to the hospital, go to $Four.org help. That goes right to our eligibility screener. You can answer a couple of quick questions, see if you're eligible, and we'll be in touch. I always tell people there's no shame in it. It says everything to do the bad system and not of something you've done. I feel like there's a lot of people with shame out there because of debt. And if you are someone that is passionate about this, then dollarfor.org. Check out our website. You can give there. And yeah, would love the support.
(58:12 - 58:35) Mike Spear: Jared, thanks so much, man. It's been great to catch up and hear about your story. Really excited. for what you guys have accomplished at Dollar Four and what is in store for the future of the organization. I personally love these sort of unsexy sort of niche causes that, you know, make a real impact that people aren't necessarily paying attention to at a large scale. So thanks for all the great work and for sharing your story with us.
(58:35 - 58:37) Jared Walker: Thank you so much for having me. Appreciate it.
(58:41 - 59:30) Mike Spear: That's our show for this week. Thanks again to our guest, Jared Walker, and to the team at Fast Forward for helping to make this one happen. You can learn more about Dollar Four at dollarfour.org and in the show notes at causeandpurpose.org. If you enjoyed, please follow, subscribe, or leave a review wherever you listen to podcasts and share the link with any friends or colleagues you think might find it interesting. Our next guest is mother, technologist and entrepreneur, Heidi Kershaw. Heidi's the CEO of Multiple, a nonprofit VC of sorts, funding innovative technology to help people living with autism live happier, more robust, more vibrant lives. It's a great episode and a phenomenal way to end our season. Hope you'll join us. Until then, cause and purpose is a production of altruist.org. On behalf of myself, Jared, and our entire team, thank you so much for listening and look forward to speaking with you again next time.
