The Dark Side of Building a Healthcare System That Works | Ep. 391 with Harry DiFrancesco Founder & CEO of Carda Health

0:04I have to say today is a very special episode, Harry, because I have it's been on my mind. My family's had numerous health issues. Many of my grand I think all my grandparents have passed away from some sort of cancer and other health issues like my dad has colitis. So throughout my life, I've been looking at things like I need to be more preventative. But it seems like the healthcare system, just healthcare in general, is so reactive. It's not really preventative. But by the time something happens, we're seeing all these celebrities and such that are going bankrupt because they're dealing with these health issues.

0:49And I wondered how much could have been solved before they even got there. Why are you so passionate? And what do you see as the fault right now in people's health in the US and healthcare? Well, I'm passionate because my family too. My dad specifically has had heart disease my entire life. So I've seen him struggle, particularly to access follow on care after he's had major events. Over a decade ago, He had a serious heart event, and I've been his sole caregiver ever since. He couldn't get to the rehabilitation program that was prescribed to him afterwards, which is a series of exercises and kind of nutrition interventions that's supposed to get you back to your health.

1:32So I've seen it firsthand how difficult it is to access the types of preventative care that ultimately get you healthy. It's a personal mission of mine to change that in the healthcare system in the United States. and Carta Health is the platform. My company, Carta Health, is the platform through which I'm doing that and we're doing that. But as far as the second part of your question around the problem, what is the problem with the way our healthcare system approaches it? Well, we reward sick care. So we reward and pay for interventions once people are already sick. If you go to the hospital with a heart attack, if you have an exacerbation due to your heart failure or something like that, or you have a cancer diagnosis, then you get treatment specifically targeted at that disease.

2:26But you don't get treatment or it's very hard to understand what treatment you should access to prevent that disease in the first place. So that's our fundamental problem. So obviously artificial intelligence makes it very exciting around healthcare and possibly things that it could solve from what I'm hearing. We talked to a company that used to take them two years to find drugs. Now it takes them months, if not days, to find possible drugs. Do you think there's some hype in this AI solving all health problems? or do you think that really we can look to AI in the future to doing this? There definitely is hype, but there's also real progress and real value that will be created.

3:15I don't think, so on the drug discovery side and the scientific side, I think that's probably where there's the most promise in AI. But I think a lot of our problems when it comes to healthcare in the United States are not actually on the drug discovery side of the fence. There certainly are problems there, but a lot of them are on the healthcare provisioning side, meaning it's too hard for patients to access care. And it's getting worse, right? There's a stat out there that 10 years ago, it took 20 days to schedule an appointment to go see your physician. Today, it takes 30 days, right? So it's getting worse over the last 10 years, right?

3:51And that's the problem that most Americans are facing. Most Americans today are not worried like, oh, we don't have drugs for this you know particular disease state or whatever again i'm not saying that's not a problem they're they're focused on the problem that it's too damn hard to go see my physician to get advice on what i should be doing um so ai can help solve that absolutely the second problem that i'm talking about and that card is focused on but it's not going to say just remove the physician or the clinician and all of a sudden everyone's going to have like their own robot physician or something driven by an AI platform, an LLM, I don't think that you're going to have a whole one-to-one replacement.

4:33I think they can actually be quite complimentary. They can arm the patient with the tools that they need to go talk to their doctor about the high leverage key, you know, health concerns that they have. And they can enable the doctor to really focus only on the most important conversations versus kind of like doing a lot of the rote work that a lot of clinicians have to do in today's healthcare system. So when you started Carta Health, what were some of the stats, some of the learnings that you come to find out that just had you like, wow, shocked that this is how it is? Yeah. So 90 % of, we treat chronic disease primarily.

5:15So we're treating people who are quite ill and heart and lung disease are the two primary disease types that we're focused on for the moment. Those are three of the four biggest killers in the United States. The main problem that we face directly is that 90 % of heart disease patients and something like 95 % of lung disease patients don't access the follow-on care that they are entitled to and that they should go access after they're diagnosed with heart or lung disease. So literally you have a 90 % market failure. One out of 10 patients is accessing this in the United States.

6:03The whole point of CARTA is to solve that problem. It's a known problem in the healthcare system. But the fundamental issue is that the patient experience, the consumer experience, if you will, of accessing that care is too hard. It's too difficult for patients to access it. So we make it easier. I mean, it's so sad, right? Like that you could work your whole life and all of a sudden something health wise happens and then your whole life is destroyed. Your wealth is destroyed. It's kind of crazy in 2026 that we still even face issues like that. So it obviously is such a big problem that you're trying to solve.

6:42GLP ones have been all the rage for the last few years. And I know you have some findings and thoughts on GLP-1. So is GLP-1 a savior or is GLP-1 something else? Yeah, it's always, is it a utopia or a dystopia, right? Is it going to solve all our problems or is it going to make them all worse? Somewhere in between, for some patients, those drugs are very powerful. But I will say for a lot of patients, they have very negative side effects. somewhere between, you know, two thirds to three quarters of patients who were prescribed those drugs don't stay on them for more than a year. And when you go off them, you regain all the weight.

7:21Not only do you regain all the weight, but you regain it typically as fat instead of muscle, and you lose muscle when you're on the drugs. So if you are not careful, you can end up in a net, net worse health uh work you can end up net net worse from a health from a from your health perspective a year after starting the glp1 then then you were when you started it right um they need to be prescribed carefully i would say the biggest thing that we need to focus on in uh american health care is providing proven behavior change lifestyle intervention programs that people can do in a really accessible way that you can pair with something like a GLP-1 in the case that it's necessary, and that therefore people can become custodians and sort of owners of their own health.

8:13They exercise more, they eat healthier. And over time, that solves a huge number of problems. First of all, that patient gets truly healthier. And if they come off the GLP-1, they can sustain the benefits of weight loss that they got. The patient then doesn't cost as much of the system. There's a lot less stress that's put on them and their family in terms of cost because they don't have to go in for these expensive surgeries with these large co-pays. You made the point about people going bankrupt over healthcare. I would say that we really dramatically underinvest in that in US healthcare. And yeah, we're trying to change that.

8:52So talk about healthy habits. You are an ultra marathoner, which, by the way, my knee hurts when I walk down the stairs. So I'm like negative 100 marathoner. Like I go like 10 feet. I don't know what that's considered, half marathon. And you climb mountains, which pretty badass, man. I want to climb a mountain one day. I've always wanted to climb a mountain. I would do like indoor climbing. Do you think that when you're an entrepreneur, that many times you kind of seek out these things or maybe people that were into like if you're into these things more like I don't want to say extreme sports or, you know, more extreme things that those people typically become entrepreneurs?

9:38there's a correlation right if you really want to uh start and and sustain a successful company or organization over a long period of time you're going to have very dark uh low moments and i can tell you from experience throughout the course of a hundred mile race you're going to have some of the lowest moments of your life uh you are also going to have some of the highest moments. So the, the roller coaster of emotions and, uh, this sort of just ability to continue to go forward, no matter what, uh, are very complimentary skills, I would say. Um, I haven't met a ton of other founders and entrepreneurs that are specifically ultra runners, but there's tons that are athletes for sure or you know either recreational um or like former collegiate athletes uh a lot of the skills are complementary i'm still trying to figure out why anyone wants to be an ultra runner i see like was it jesse itzler he's doing yeah the 100 miles up and down the hills i'm like i'm trying to figure out like what what's the feeling okay when you when you finish that race where you finish the the ultra marathon you is it 100 miles i believe yeah yeah so you finish a variety of differences but yeah call it 100 miles let's call it 100 a million miles not 100 miles you finish the 100 miles what is the feeling that you get in that moment when you're done like a combination of true exhilaration complete relief um and i would say just generally complete exhaustion i think that the feeling is that the thing that you seek in an ultra run isn't the feeling at the finish per se it's the feeling that you did something that uh you didn't really necessarily know that you could do when you started right it's the feeling of pushing your boundary further than it it's like the feeling of growth you know what i mean honestly i make an analogy between that and like what we're trying to do at carta and just anybody who's starting an exercise program that they you don't have to go run an ultra marathon no one's no one's five just if you're doing something more than you could do yesterday that's real progress right and when you start an ultra run and you don't know if you're going to make it to the finish and you do, that's a feeling of like, wow, I accomplished something meaningful.

12:18Right. So I think it's exploring your own limits. That's really the interest from my perspective. I think that's what motivates a lot of ultra runners too, is like, how much can I push this? How far can I go? I really don't want to continue. Can I continue? Sounds like business every day. I think that every day I go to LinkedIn and I look up jobs and I'm like, today I'm going to go apply for a job. And then all of a sudden they get a call deal closes. I'm like, I would never have a job. You know, the next day everything falls apart. I'm like, let me go, let me go find a job. What was that ultra running marathon finish feeling for you in business where like, you know, moment you're like, this is it, man.

12:59Why am I even doing this to the next moment? You're like, this is the greatest thing ever the lowest moment we've had at card is you know we've come within uh weeks of running out of money and going out of business so i've experienced that but i would say the the the the highest moments have been just honestly we hear from patients every day i can think of one who i spoke with on the phone um who you know he had he had served in world war ii wanted to go back to France where he had served, couldn't do so because of his heart disease. We put him through our program. He got healthier and he was able to go to France and enroll himself in kind of a French language course.

13:47This was a guy in his 80s at the time. We're enabling people to live lives that they want to live, right? That's really gratifying. and I find that incredibly motivating. It's worth all the pain and just kind of like chewing glass feeling that you inevitably run into as a founder and an entrepreneur. Yeah, I like your analogy of eating glass. That is entrepreneurship. I'm going to switch it to ultra marathon. I'm going to say, I ran 100 miles today in my business. That's how I'm going to look at things from now on. I like that. I'm going to set my goals. My goal today is to reach the 100 miles, which is X or Z, and I'm going to get there at the end of today.

14:32I'm going to enjoy the feeling because I don't think we do. You've landed a great partnership with Humana, which is obviously huge. Love to understand more about what that looks like. And at the same time, I'm wondering how many times companies like a Humana maybe didn't see the value in what you were doing yet. Humana is a major partnership for us. They are the second largest health plan when it comes to the Medicare space. I think folks that are 65 and older in the United States. and they are a very respected organization and they've been great partners to CARTA. The purpose of the partnership is to give access to their members, give their members access to CARTA's platform and to our programs and specifically at the moment around heart disease.

15:32The reason why they are interested in CARTA and programs like it is these patients and members typically end up going back to the hospital again and again and again because they don't get a lifestyle and behavior change intervention that puts them back on a path to health. And so they continue to be in this cycle of going to very expensive care, which Humana ultimately then has to pay for, right? So Humana is very interested in that from a cost savings perspective, as any health plan would be. And they're also interested in providing a good member experience to their members. I mean, they're competing for members out of the marketplace against their competitors, you know, Aetna and United and Blue Cross and all the other insurance companies that you know, and they want their members to have a good experience.

16:25And so the fact that Carta is, you know, we have an NPS of around 89, which is a super high NPS for any healthcare organization, just as context for your listeners, that's really beneficial for Humana, right? Patients love the fact that we can send them everything in the mail. They can do all their programs from home. It's kind of a slick interface. So those are really the two reasons that Humana, that that partnership exists. What did you implement within your organization to get to an NPS of 89? That is very, very hard. I remember when I was, we used to use the NPS for things. I don't know if we ever got past like 70 or 60 some.

17:07This is like a retail environment, but still, that's huge. That's really, really hard to get to. I think people are always very critically, they like to say things that they're critical about than necessarily the moments where they had a good experience. It's much better to say, I had a bad experience, something and air those. So for you, what change within the organization did you have to implement to get to that point? I don't know that there's a single change, but I think a couple of things that we've done that are really important. First, we place a huge emphasis on the convenience to our patients, right?

17:42So we ship them the care package. We explain to them clearly what's going to happen. We have a whole team dedicated to technology setup. Most of our patients are kind of of Medicare age or thereabouts, so technology can be a challenge for them. We have a whole team. We invest a ton of resources in getting patients comfortable with the technology. They have monitoring devices and everything. Then I would say the other thing that we do is that the patient stays with the same clinician the entire time that they are on Carta's platform. So they build a relationship with the clinician. And that relationship is what enables trust to sort of, you know, enables trust between CARTA and the patient.

18:25And the fact that they then feel listened to and heard and understood means that as they go through the program, you know, they feel completely supported. And as a result, that comes out in our NPS. Patients are really satisfied by that. And it's in contrast to what they normally feel in the healthcare system, which is one of, you know, they don't have any relationship necessarily. It's very hard to go see their physician. And they're just kind of left to their own devices, and they don't know how to navigate things. So that piece is crucially important. It's not just people getting back to their health.

19:02It's also how you're making them feel as your customers and as your patients. I would imagine in the healthcare industry, NPS scores are quite low. That's just my personal experience with things. I would rate most of my healthcare experiences as quite low experiences on an NPS score. But no, I mean, it's incredible what you all are doing to be able to really impact the world. I mean, this isn't just like impacting the US. This will impact the world, I'm sure everyone is always seeing what people are doing and how they can get better from a standpoint. So whatever Carta Health is doing, I'm sure other organizations will also want to copy, want to emulate.

19:47And the fact that you had such a passion from your experience, I think it always comes across. When you talk to someone in business who is not doing it just for money, who really had an experience that happened to them that changed their life, and they say, this is such a big problem, I want to solve it. You can tell when that passion comes out. But if people want to get in touch with you, Harry, they want to learn more about Carter Health, how can they do so? You can go on our website, carterhealth.com. I'm on LinkedIn. You can go find me on LinkedIn. You can shoot me an email, harry.carterhealth.com.

20:22I'm very responsive there. But yeah, it's great to talk. Thanks for your time. All right. Well, next time we talk, we're going to climb a mountain together. or we can walk 100 miles. It might take a long time. Either one. That could take a while. That could take a while. But I really appreciate your time today and thank you for all that you do. Likewise. Thanks. See ya. If you like the show, please take a moment to rate, review, and subscribe. It really does help the show to grow. Thank you for listening.