Michelle Carnahan, Arbiter CEO: From Eli Lilly to solving healthcare's $100B fragmentation crisis
Chrissy Farr sits down with Michelle Carnahan, who spent 26 years at Eli Lilly witnessing the development of breakthrough GLP-1 drugs before transitioning to direct-to-consumer healthcare (Thirty Madison) and then co-founding Arbiter, a startup that raised $52M at a $400M valuation. Michelle and Chrissy discuss the GLP-1 revolution, transformative shifts in health insurance, and how her company is using AI-powered care orchestration to solve healthcare's fragmentation crisis by connecting disconnected systems and improving patient access.—SPONSOR:This episode is brought to you by Arbiter. As Michelle says: "We don't need another instrument for the orchestra—we need to conduct the orchestra." Backed by one of the largest early funding rounds in health tech, Arbiter creates one real-time source of truth from fragmented healthcare systems, then routes referrals and handles prior auths so patients actually get to care. Learn more at Arbiter.AI.—LINKS: Chrissy Farr’s Website: https://www.chrissyfarr.com/ Subscribe to the Second Opinion Newsletter: https://secondopinion.media/ Chrissy’s Book: The Storyteller's Advantage: https://www.chrissyfarr.com/books Lifers with Christina Farr on YouTube: https://www.youtube.com/@LiferswithChristinaFarr —FOLLOW:
Michelle:https://www.linkedin.com/in/michelle-carnahan/ Chrissy:https://www.linkedin.com/in/christinafarr/ https://x.com/chrissyfarr—TIMESTAMPS:(00:00) Intro(02:49) The Lifers concept and healthcare dedication(04:19) Michelle's journey: from big pharma to startups(07:54) Addressing access and fragmentation in healthcare(13:43) The rise of GLP-1s and their impact(20:58) Future of GLP-1s: pricing and distribution(23:18) The role of health insurance in modern healthcare(25:09) Transformative shifts in health insurance(27:25) AI-powered care orchestration(32:17) Challenges and solutions in healthcare technology(34:55) The importance of collaboration in healthcare(40:21) Personal insights and recommendations
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Lantern's Dickon Waterfield on rising healthcare costs and how Medicaid cuts will impact businesses
In this episode of the Second Opinion, Christina Farr interviews Dickon Waterfield, president of Lantern to discuss the intricacies of U.S. healthcare costs, particularly the disparity between Medicare and commercial prices. They cover the unsustainable burden on employers to provide healthcare, the evolving nature of digital health solutions, and the market's reaction to recent IPOs in the sector.
—📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess
—LINKS: Lantern: https://lanterncare.com/
Christina Farr's Second Opinion Newsletter: https://secondopinion.media/
—SPONSOR: 👩⚕️ Hot flashes, insomnia, brain fog? You don't have to accept these as just another part of aging. Midi Health is the virtual care clinic for women navigating midlife hormonal transition, offering FDA-approved medications, supplements and lifestyle coaching - all covered by insurance. Visit https://joinmidi.com to book your virtual visit today.—FOLLOW:https://www.linkedin.com/in/dickonwaterfield https://www.linkedin.com/in/christinafarr/—HIGHLIGHTS FROM THE EPISODE: • The company was previously under the radar despite its size because it lacked traditional digital health investors and operated in the emerging "sensitive excellence" space • Lantern works by securing lower rates from select providers in exchange for steering patient volume to them, rather than contracting with all providers like traditional insurers • Commercial insurance pays dramatically more than Medicare for the same procedures - for example, a total knee replacement costs around $45,000 commercially versus $17,000 for Medicare • About 90% of surgical costs go to the facility, with only 10% split between surgeon and anesthesia fees • The company built scale over 14 years by starting with local networks and school districts before expanding to national employers • They typically contract with only one or two providers per market, offering them incremental volume and market share gains • By waiving patient cost-sharing (like $5,000 out-of-pocket maximums), they incentivize patients to travel to preferred providers • Proposed Medicaid cuts could affect 10% of Medicaid recipients, forcing more healthcare costs onto employers • When Medicaid funding decreases, hospitals typically increase commercial rates to compensate for uninsured patients • Employers are increasingly frustrated with being responsible for 60-70% of Americans' healthcare coverage • The current system originated post-WWII as a talent competition tool and became normalized as part of total compensation packages • Only a major economic downturn with high unemployment could potentially break this cycle, as tight labor markets force employers to maintain competitive benefits • Employers will likely narrow their coverage, offering less rich benefits and more selective networks and formularies • Cell and gene therapies costing $1-5 million per treatment pose existential threats to employer-sponsored health plans • There's a reckoning coming for point solutions that don't deliver measurable ROI, with increased scrutiny on clinical evidence and cost reduction • Digital health companies are held to higher standards than pharmaceuticals, which don't face the same outcome-based payment requirements • Forward-thinking employers are moving beyond simple cost savings to evaluate programs on multiple parameters including talent retention and clinical outcomes • A new generation of digital health companies is becoming in-network providers rather than selling directly to employers • This approach eliminates long sales cycles and complex billing arrangements that characterized earlier digital health companies • Successful healthcare sales requires understanding buyers' needs and solving their problems rather than just selling solutions • Founder-led sales remains crucial in early stages because founders can listen more acutely to feedback and pivot quickly
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Why is the longevity sector taking off? With Lifeforce CEO Dugal Bain-Kim
In this episode of Second Opinion, Christina Farr and Lifeforce CEO Dugal Bain-Kim dive into the billion-dollar longevity economy, examining why health optimization became a status symbol and how personal data drives better health decisions than population-level advice.
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📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess
—LINKS: Lifeforce: https://www.mylifeforce.com/
Christina Farr's Second Opinion Newsletter: https://secondopinion.media/
—FOLLOW:https://www.linkedin.com/in/dugal-bain https://www.linkedin.com/in/christinafarr/
—HIGHLIGHTS FROM THE EPISODE:• The "shadow healthcare system" refers to cash-pay healthcare alternatives where insured people seek services outside traditional insurance coverage.• This trend results from converging factors: post-COVID cultural shifts, health becoming aspirational/lifestyle status, and new technology enabling accessible longevity services.• Personalized data from wearables (like Aura rings showing sleep/alcohol impact) motivates behavior change more effectively than general medical advice.• "N of one" personalized data feels more relevant than population health guidance, though there's risk of "measuring the fun out of life."• Personal genetic risk (like Alzheimer's predisposition) transforms health behaviors from optional to urgent, particularly around sleep quality.• A paradox exists where physicians publicly skeptical of longevity medicine privately use interventions like GLP-1 microdosing and seek optimization partners.• Personal health testing reveals significant issues traditional healthcare misses, including PCOS, scoliosis, and device malfunctions.• Longevity medicine catches problems early - 26% of members are pre-diabetic, often undiagnosed despite regular annual physicals.• Continuous monitoring can discover serious conditions like pituitary brain tumors when primary care doctors aren't interested in investigating elevated biomarkers.• The equity challenge questions how expensive cash-pay services can reach populations who need them most.• Three customer types emerge: health optimizers, health-motivated people getting back on track, and people wanting complete health reinvention.• Solutions for broader access include insurance integration and AI-powered tools to reduce costs from $140 to $40 monthly.• The "dating app problem" asks whether longevity companies lose customers when they successfully improve health.• Solutions include maintenance vs. optimization modes, targeting 40-60 age demographic where significant bodily changes occur.• Despite male-focused industry branding, actual customer bases can be gender-balanced (45% female, 55% male).• Effective messaging balances performance-focused and wellness-focused approaches rather than targeting one gender.• Longevity medicine includes traditional prevention but adds quality-of-life interventions that create initial motivation and trust for broader health compliance.• The rebranding question asks whether longevity is simply primordial prevention made more engaging and actionable.• Supplement safety concerns arise from liver injuries and poor industry regulation, highlighting need for data-driven approaches.• Most people take too many unnecessary supplements; data-driven supplementation could improve both safety and efficacy.
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Meeting people where they are: Healthcare in America's laundromats with Fabric's Courtney Bragg
This week on Second Opinion, Christina Far interviews Courtney Bragg, CEO and co-founder of Fabric Health, about their innovative approach to delivering healthcare services in laundromats. They discuss the challenges and opportunities in the Medicaid system, the importance of building trust and relationships in healthcare, and the critical role of human elements alongside technology.—
📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess
—SPONSOR:🏥Thatch makes it easy to give your team great healthcare. Save ~$1620 per employee yearly while giving them customizable plans. Visit https://thatch.ai/HR for a demo and receive a $100 gift card.
—LINKS: Fabric Health: https://fabrichealth.org/
Christina Farr's Second Opinion Newsletter: https://secondopinion.media/
—FOLLOW:https://www.linkedin.com/in/cdebragg/ https://www.linkedin.com/in/christinafarr/
—HIGHLIGHTS FROM THE EPISODE:• Most healthcare startups chase the obvious markets, but Fabric Health found something different: 32 million Americans spending two hours weekly in laundromats, 70% of them women making healthcare decisions for their families.• Founder Courtney Bragg's counterintuitive insight: you need "muffins before mammograms" - build genuine relationships before pushing healthcare services on people who've been burned by scams.• The approach works because it's human-first with tech as an enabler, not the other way around - they integrate with laundromat systems but lead with offering someone a laundry cart.• After 837 days in laundromats, they learned the hard way that walking up and asking "do you have insurance?" is tone-deaf; real conversations start with Eagles football talk in Philly.• The results speak for themselves: 27,000 families enrolled, profitable before raising VC money, and hiring directly from the communities they serve.• The healthcare system is genuinely broken in absurd ways - like sending a blind woman a paper letter asking her to confirm she's still blind to keep her benefits.• System dysfunction runs deep: kids auto-assigned to different health plans (one mom juggling four), caseworker calls flagged as "scam likely," transportation benefits that stop 2 miles short of available care.• These aren't technology problems - they're human problems that require understanding real people's lives, not building apps in isolation.• The Medicaid opportunity is massive and misunderstood: 80 million Americans, nearly half of all births, but VCs avoid it because they think "poor people don't pay enough."• Political noise around Medicaid cuts is mostly theater - too many hospitals and jobs depend on it, plus "a lot of people who wear red MAGA hats are on Medicaid."• States are actually begging Fabric to expand because they see results, with Medicaid directors personally requesting their services.• The real opportunities ahead are in maternal and pediatric care, where states face real financial penalties for missed metrics.• Courtney's unconventional background in education taught her community organizing - skills most tech founders lack but healthcare desperately needs.• Her advice for mission-driven founders: "you've gotta be obsessed with what you're building because you care deeply about it" - most startup founders are just chasing trends.
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Are we all out of a job? Examining AI’s impact in health with Towerbrook’s Eric Larsen
This week on Second Opinion podcast, Christina Farr and Ash Zenooz interview Eric Jon Larsen about the the potential and challenges of AI in healthcare and various industries, debating its role, accuracy, impact on jobs, and future implications for human society.
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📰 Be notified early when Turpentine drops new publication: https://www.turpentine.co/exclusiveaccess
—SPONSOR:🏥Thatch makes it easy to give your team great healthcare. Save ~$1620 per employee yearly while giving them customizable plans. Visit https://thatch.ai/HR for a demo and receive a $100 gift card.
—LINKS: Eric Jon Larsen (Towerbrook): https://www.towerbrook.com/our-team/eric-jon-larsen/ The 'creepy Facebook AI' story that captivated the media: https://www.bbc.com/news/technology-40790258 Genesis: Artificial Intelligence, Hope, and the Human Spirit: https://www.amazon.com/Genesis-Artificial-Intelligence-Human-Spirit/dp/0316581291 John Maynard Keynes’s Economic Possibilities for our Grandchildren: https://www.econ.yale.edu/smith/econ116a/keynes1.pdf
Christina Farr's Second Opinion Newsletter: https://secondopinion.media/
—FOLLOW:https://www.linkedin.com/in/eric-larsen-a4a0461/ https://www.linkedin.com/in/ashzenooz/ https://www.linkedin.com/in/christinafarr/ —HIGHLIGHTS FROM THE EPISODE:• Christina Farr tested AI on financial filings - it produced 5-hour analysis in 2 minutes but with 5% inaccuracies requiring 2 hours to verify, raising the question of whether we should wait for 100% accuracy before relying on AI• Eric Larsen argues AI represents a "speciation event" - unlike previous technologies that augmented human capabilities, AI will replace cognitive work entirely as we create "non-biological intelligence" superior to humans• Healthcare faces a perfect storm: medical knowledge now doubles every 73 days (vs 50 years in 1950), 2.3 million biomedical studies published annually, and humans already exceed ability to process medical knowledge• AI shows superior empathy in healthcare - people tell truth to chatbots but lie to humans to avoid embarrassment, and chatbots provide infinite patience compared to overworked physicians• China announced first AI hospital with 26 specialties testing 10,000 synthetic patients with higher diagnostic accuracy than human doctors, while US regulatory barriers slow adoption• Counterintuitive prediction: high-cognition jobs (doctors, lawyers, consultants) will be disrupted before physical jobs due to "Moravec's Paradox" - algorithms mastered chess and Go but struggle with basic motor skills• The healthcare narrative that "AI won't replace doctors, but doctors using AI will replace those who don't" is a "bedtime story" - real trajectory points toward AI systems exceeding human diagnostic capabilities• Economic transformation ahead includes potential 30% annual productivity improvements, massive deflation as AI drives costs toward zero, and need for new social redistribution policies• Larsen advises next generation to "learn for agility" - study humanities plus STEM, become "cybernetic" human-machine collaborators, and develop AI proficiency as core mental operating system• Critical window exists to shape AI development before it achieves "escape velocity" through automated AI research, creating infinitely replicable researchers sharing a "hive mind" of knowledge
Veteran journalist, investor, and Second Opinion Media founder Chrissy Farr talks with the CEOs and founders who've been in the trenches long enough to know that healthcare doesn't move at startup speed. These aren't the entrepreneurs chasing quick exits—they're the "lifers" who understand that building in healthcare requires endless pivots, regulatory navigation, and decade-long timelines.
No hype, just honest conversations about what it really takes.
Each episode explores healthcare innovation, startup strategy, medical technology and AI, health system transformation, and investment insights from operators who've navigated regulatory challenges, clinical trials, reimbursement complexities, and the unique dynamics of the healthcare industry.
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