Behind every patient living with schizophrenia, Alzheimer’s, dementia, or a brain injury, there is usually a family member quietly holding the system together. In the U.S., more than 30 million of them are doing the work, often for years or decades, with little to no structured support.

StartUp Health community member Mitul Desai of The Care Hack knows this reality firsthand. He has helped care for his brother for more than 20 years. Together with co-founder Eli Shalenberg, MD, a community psychiatrist, he is building an app that gives these families what they were never given: training, coaching, community, and a seat on the care team. With a partnership with McLean Hospital and early pilots turning into multi-year provider contracts, The Care Hack is showing that when we support caregivers, everyone wins.

In this Health Transformer Spotlight Q&A, Mitul shares the story behind the company and the Health Moonshot driving it.

What is the challenge or problem that your company is addressing?

The U.S. healthcare system depends on over 30 million family members caring for loved ones with long-term cognitive conditions like mental illness, Alzheimer’s, dementia, brain injury, and more. We coined the term “cognitive caregivers" to describe these families. They keep people out of the hospital, manage medications, coordinate care, and fill in countless gaps that the formal system cannot. Without the work of these family caregivers, healthcare as we know it would collapse.

And yet, these caregivers receive little to no structured support, despite having to manage heavy responsibilities for years, often decades. The result? It’s what we saw in the recent Bradley Cooper documentary: widespread caregiver burnout, financial strain, worsening patient outcomes, and billions in preventable costs.

While some caregiver solutions focus on eldercare or broad, general support, we know that cognitive caregivers face a different reality: higher complexity, greater stress, and a uniquely long journey shaped by chronic conditions. Despite the high stakes, they often receive the least help.

What’s your mission and why did you start the company?

Our mission is to make family caregiving a core pillar of the healthcare system. Today it’s treated as an afterthought. We want to change that.

Do you have a personal connection with the problem you’re solving?

Absolutely. I’ve helped care for my brother for over 20 years. As a family caregiver myself, I’ve lived this. It has shaped my understanding of how the system fails families, and how much better it could be.

Can you tell us more?

Over twenty years ago, my brother came home from college almost unrecognizable. We eventually learned he had schizophrenia. We became his primary caregivers, which turned out to be the hardest job we’ve ever had. We didn’t realize it at the time, but that moment changed him – and my whole family – forever.

Even though some providers wanted to help us, there was no clear or easy way to do it, so we were left to piece things together ourselves. While my brother had nurses and doctors, we as caregivers had no one. Just endless google searches, and a few costly “experts” who we paid thousands of dollars to meet with us for a couple of hours. Our feeling of helplessness lasted for years. We made one wrong turn after another. My brother ended up living with my parents for over a decade, and we were in constant crisis.

What hit me hardest was this realization: despite taking care of my brother full time, families like mine were excluded from the care team. Left out of decisions. It was a massive missed opportunity.

What is your company origin story?

As I was grappling with this problem as a caregiver, my cofounder Eli was seeing the same thing from the other side, as a psychiatrist. Over and over, he watched the system leave families out of the equation, even when they were essential to the patient’s recovery.

We met through a mutual friend, and the moment we started talking, it was clear we shared the same urgency and had arrived at the same conclusion: if you want better outcomes, you have to support the family. And we’ve been building ever since.

Did you have an “aha moment” or inspiration to share?

Yes. After years of lived experience and research, we also came across a rigorous body of research spanning over three decades, showing how family education and support can improve treatment outcomes, reduce hospitalizations, and protect caregiver well-being. But all that evidence was trapped, stuck in research papers and small pilot programs.

That is why we’re able to say: We’re not guessing. We’re scaling what already works.

What differentiates your team and gives you an unfair advantage?

We have a rare combination of deep personal experience and cross-sector professional knowledge. In addition to being a caregiver, I’ve built a career at the intersection of healthcare and technology, leading cross-functional teams at Mastercard, working in healthcare finance and law at organizations like Merck, and advising Fountain House, the nation’s leading and most innovative provider of community-based support for serious mental illness for over 75 years. Eli is a community psychiatrist who works with families every day, and also has previously worked with a successful, Y-Combinator backed digital health startup.

Importantly, we’ve immersed ourselves in high-impact, non-medical interventions – like ACT teams and the clubhouse model – that few tech founders have direct experience with. We speak the language of clinicians, families, payers, and community organizations. That breadth lets us build something that works in the real world, not just on paper.

Have you had an inflection point where you realized your company really had the right ingredients to succeed?

Yes, after going through some hard moments early on, we realized we had built a high trust, resilient co-founder relationship. Each time we hit a challenge, we defined the problem, brought in an outside perspective when needed, and focused on solving, rather than spiraling. That has served us again and again, and it’s a great signal for the road ahead.

What are you building? How would you explain your product to a 5th grader?

Imagine one day being asked to take care of someone with a serious illness that they will have for the rest of their life… but no one shows you how to take care of them. You’d probably feel confused, worried, or even scared. That’s exactly what caregiving feels like for most families.

We built an app that treats caregiving like the hard job it is – by providing training, mentorship, tools, and a team to help you.

Walk us through the user experience.

We know caregivers are busy, so we’ve made our app incredibly simple. It takes two minutes to onboard. After that, caregivers get immediate access to:

We also have structured programs based on the specific challenge they’re facing, whether it’s medication refusal, navigating a new diagnosis, or preparing for discharge.

Everything is based on what caregivers told us they want, and what the clinical literature says works best.

How would doctors use your platform? 

All a provider has to do is recommend our app to the family. We handle everything else, including onboarding, engagement, and reporting to support billing.

It extends their care team, without adding to the provider’s workload, while enabling billing services most aren’t offering today.

What are you doing that the rest of the world doesn’t know is a big deal yet?

We’re unlocking the potential of 30+ million cognitive caregivers, people caring for loved ones with long-term brain and mental health conditions, such as mental illness and dementia, brain injury, or the effects of stroke. These conditions are complex, and the caregiving burden is uniquely high. Yet these caregivers get the least support. That’s in part because they’re already burnt out, and in part because there is still a lot of stigma around mental illness and dementia. We believe caregivers aren’t just people to be helped. They’re people who can help. If we give them the right tools, they become the highest-ROI force in health care, and the missing piece to delivering better outcomes at lower cost. And many health care providers don’t realize that supporting caregivers is already standard of care and billable. We make all of this happen, which is why large providers contract with us.

What stage of development are you in, and what’s coming next?

We’re turning early pilots into multi-year, paid provider contracts, and our pipeline now includes providers and payers who see caregiver support as the next frontier in behavioral health. We’re in advanced talks with a regional health plan that will help set the stage for population-level impact. We finalized a partnership with McLean Hospital, the top psychiatric hospital in the U.S. and a Harvard Medical School affiliate, to help us strengthen the clinical foundation of our platform. This partnership gives us a level of credibility that’s hard to replicate.

We’ll continue to build on our unique strengths – trusted family relationships, exclusive clinical partnerships, and purpose-built AI – to personalize our product, secure key provider and payer deals, and show what our early customers already know: when you support caregivers the right way, everyone wins.

How’s the world going to be different when you succeed?

Imagine a healthcare system that doesn’t just treat the patient, but equips the whole family to thrive. Where the people doing the hardest work, every day at home, are trained, supported, and valued.

When we succeed, no caregiver will feel alone. Families will have the skills to prevent crises, the confidence to handle them, and a community that has their back. Loved ones will spend less time in hospitals, more time at home, and the system will save billions. Patients will do better, families will be healthier, and healthcare will finally work the way it should.

What are key challenges to your journey that you’ll need to overcome to succeed?

Scaling without losing the warmth and trust that we’ve built with families. This is the thing that makes us special. And helping stakeholders, from providers to payers to investors, truly see caregivers as a lever, not a liability.

Anything else you think we should know?

This isn’t just a theory. It’s already working. The science backs it. We’re just enabling it to scale.

The most overlooked members of the care team may also be its greatest untapped force. By training, supporting, and valuing the families who do the hardest work at home, Mitul Desai and The Care Hack are helping us reimagine a system where caregivers are partners in care, not afterthoughts.

That progress is powered by community, too. As Mitul puts it, “We love being part of the [StartUp Health] moonshot community for a lot of reasons, including practical tips on fundraising and real connections with fellow founders so we can share lessons learned and avoid common mistakes.” It’s the kind of collaboration that turns hard-won lessons into faster progress for everyone building toward a Health Moonshot.

We’re proud to have Mitul Desai as a member of the StartUp Health community. Learn more about their work at The Care Hack, and join us in supporting the Health Transformers who are turning lived experience into lasting change.