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3
"Delusional" Enough to Build Something Real with Efriam Weinfeld
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48 min
What does it take to build a healthcare company from nothing in the aftermath of a once-in-a-century pandemic? For most people, the answer would be: probably more than you have.
Efraim had less than most. No pre-built portfolio. No safety net. Two facilities that nobody else wanted to touch. And a name for his new company rooted in the Hebrew word for "to ascend" -- because even before the first resident walked through the door, he had already decided this thing was going to rise.
In Episode 4 of CCC, Dan Brody sits down with Efraim, founder and CEO of Aliya Healthcare, for one of the most honest, wide-ranging conversations we've had on this show. They go from Efraim's earliest days as a 20-year-old pharmacy tech figuring out the industry, all the way to navigating million-dollar losses, crisis-level self-doubt, and the moment everything turned around because a pipe burst in a building across town.
This is not a polished success story. It's the real one.
He'll tell you himself: nepotism got him in the door. But what he does with that admission is more interesting than the admission itself.
Efraim came back from Israel with no particular plan, enrolled in a pharmacy tech job, and set his sights on working his way up the honest way. That lasted about a year -- until the owner's son walked in on day one and landed a $70K salary and a floor manager title without ever having seen the inside of a pharmacy. That was the moment Efraim picked up the phone and called his family in long-term care.
"Pride does not pay the bills," he says.
What happened next was the education that shaped everything. Because he was always the "extra person," Efraim got cycled through every department every time someone quit or got fired. HR, admissions, operations, finance. Not as an executive observer, but as someone who had to actually do the job, sometimes before he understood what the job was.
He calls it "baptism by fire." Dan draws a parallel to Zappos, which intentionally rotated employees through unrelated departments to build total operational understanding. The difference for Efraim is that his wasn't intentional. It was chaos. And he wouldn't trade it.
"I'm thankful for the chaotic style in which I learned. I don't know if I would have learned any other way."
Ask any long-term care operator what they learned from Covid and most will give you a policy answer. Efraim gives you a human one.
"No matter what the policy, procedure, or process is -- nothing beats showing up. Just actually being in the building. Being with people. Showing that you care."
During Covid, the gap between organizations that made it and organizations that didn't often came down to this. Leaders who stayed behind closed corporate doors saw their teams lose morale, their operations unravel, and their residents suffer for it. Leaders who got into the trenches -- even when they couldn't do everything the clinical staff could do -- changed how their people felt about coming to work every single day.
That lesson became the foundation for everything Efraim built next.
Post-Covid, Efraim found himself at a crossroads with his family's business. Succession planning got complicated. Family dynamics made the next chapter hard to see clearly. And the entire industry felt like it was still trudging through something heavy and unresolved.
So he left, and he started over.
The timing was fortuitous in one specific way: Manor Care (by then operating as ProMedica) was divesting its Illinois portfolio. Out of the available properties, Efraim and his partner Michael Erlich took the two that nobody else wanted. The runts of the litter. The ones with the worst reputations, the most ground to make up.
He named the company Aliya -- a Hebrew word meaning "to ascend, to rise up." The logo is a phoenix. Rising from the ashes. The color is purple, a regal and calming choice that would go on to become a rallying point for staff, residents, and eventually a Chicago Bulls sponsorship that landed a recovering patient courtside at a Bulls game.
The brand wasn't just aesthetic. It was a declaration of intent.
"It's not just a name. I think there's a lot of value in that. People can rally behind it. There's something to believe in."
One of the most counterintuitive things Efraim shares in this episode is his acquisition approach. He doesn't tour buildings before he buys them.
It sounds reckless until he explains the reasoning.
He does look at the market data: proximity, acuity mix, competitive landscape, reputation signals. But he deliberately avoids forming detailed operational impressions of a property before taking it over. His phrase for this approach is "zero budgeting" -- meaning he isn't inheriting the old identity of a building. He isn't looking at a facility that's been "a dialysis building" or "a short-term rehab building" and assuming that's what it will always be.
He goes in with the potential as limitless. That creates room to ask the team what they want to build, what capabilities they think they can develop, what the building could become. It also creates ownership.
"Being able to go in and have that open mind, and then asking the team -- what do you want to do? We want to do this, we want to do that. People are excited about it. They're invested. They're a part of it."
It's a philosophy built around possibility, not inherited limitations.
The success of the first two facilities came fast enough that when a second divestiture opportunity appeared -- four more buildings -- Efraim jumped. Why wouldn't he? The playbook was working.
It wasn't working for long.
Within four or five months of taking on those additional facilities, one building had lost over $1 million. Lines of credit were maxed. The internal monologue -- the one only Efraim could hear -- was spinning out. He was writing what he calls the "Death of a CEO" scenario in his head, replaying every voice that had told him he'd taken on too much, that he didn't know what he was doing.
Outside, he kept projecting confidence. His partner had no idea how badly shaken he was. It was only a year later, when Efraim finally told him, that his partner said: "I had no idea."
This is one of the most valuable moments in the episode -- not because of how it resolved, but because of what it reveals about the internal experience of leadership that almost nobody talks about honestly.
What happened next? A building nearby had a catastrophic pipe burst. It had to evacuate overnight. Efraim's facilities had the available beds. They filled fast. The numbers that had been hemorrhaging turned around within a quarter.
Was it right place, right time? Yes. Was it also the result of someone who kept doing the right things, kept showing up, kept believing when the spreadsheet was saying otherwise? Also yes.
"I was like, what did you do that turned it around? And I'm like -- nothing. You keep doing the right thing. You keep working hard. You don't forget who runs the world. Things work out."
Aliya's return-to-hospital rate sits at 16-17%. The national average is 22-23%.
Efraim describes this as his favorite metric in skilled nursing because it captures everything at once. It measures clinical quality -- are patients being treated effectively enough that they don't need to go back to a hospital? It measures customer service -- are residents and families confident enough in the care that they're not calling 911 out of fear? And it measures proactive care -- are teams catching and addressing issues before they escalate?
"It combines all of them. It means you're doing a good job of customer service, a good job of preventative care, proactive care, and actually treating whatever that issue is at hand."
He celebrates it with his teams. There are boat trip incentives for buildings that hit below 15% for a full quarter. He admits, with a grin, that he doesn't think they'll actually hit that threshold -- but the goal matters regardless.
Aliya's approach to culture is woven through this entire conversation, but it comes into sharpest focus when Efraim talks about transparency.
He shows his clinical teams the data. Not sanitized summaries that make everyone look good, but the actual numbers -- financials, labor metrics, clinical outcomes, hospital return rates. His reasoning is direct: if you want people to own their performance, you have to give them access to what their performance actually looks like.
"If you really want someone to own what they're doing and give them that sense of ownership, you have to give them the data."
This also extends to his approach to investment. He staffed up heavily at the corporate level when launching Aliya, investing in support infrastructure before the revenue fully justified it. His philosophy: investing in quality care brings in more residents, which drives more revenue. Squeezing operational costs at the expense of care quality is the wrong end of the problem to optimize.
"Maybe harder, but a little more front-end investment and making sure the quality of care is top notch -- that will pay off eventually."
As Aliya grew, Efraim promoted his VP of Operations and CFO into formalized leadership roles -- and "promoted" himself into a COO/CFO role that looks very different from what he'd been doing day to day.
For someone whose energy is built around being in the buildings, talking to residents, walking the halls with staff, and showing up as the visible face of the culture, this transition created something unexpected: an identity crisis.
"It's easier to show up when you're also the person fixing their problems all the time. You need to show up for other reasons now."
Learning to be present not because you're needed operationally, but because your presence sends a message -- that's a different discipline. He's still working through it. And the fact that he talks about it openly is part of what makes this episode worth watching.
Dan asks Efraim what he'd tell someone thinking about jumping into a new venture -- in any industry. The answer could have been generic. It isn't.
Efraim's core advice: don't build something you only think you can make money at. Build something you genuinely, completely believe in.
"If you don't really love it, people will know that."
He's not being abstract. He's watched operators come into this industry because their family was in it, or because they saw money in it, or because their friends were doing it. And he's watched those same operators struggle in ways that more passionate operators don't -- because passion is what gets you through the $1 million down months. It's what gets your team to dye their hair purple and tell their friends they work somewhere worth talking about.
"Find the thing you truly believe in 100%. People will rally around that."
He also talks about humility. He ate plenty of humble pie in the early days, made cocky mistakes, and was lucky to have the support to come back from them. His advice to younger operators: don't try to skip steps just because you think you're already at the finish line. Respect the people who are actually doing the work. They're the ones making you successful, not the other way around.
The conversation closes with a look forward.
On managed care: Efraim is blunt. He sees it as a leech on the industry -- a third-party system that manages Medicare dollars with incentives built around cost reduction rather than care quality. Length-of-stay targets and rate methodologies that don't account for the full complexity of a patient. "It erodes the quality of care. And then we get the blame for it." He hopes this model eventually fades in favor of the value-based care structures he sees gaining traction.
On value-based care and ACO programs: cautiously optimistic. Accountability connected to incentives for doing better is the right direction. Programs that reward outcomes rather than volume are where skilled nursing needs to go.
On AI and technology: he wants to believe in it more than he currently does. The hope is that robotics and automation reduce the monotonous administrative burden on nurses and aides -- freeing them to do the human work they came here to do. The reality, in his experience, is that most "AI for healthcare" solutions are boardroom products that real clinical staff find more annoying than useful.
"Nurses are just like, why do I have 700 more alerts."
Efraim is the founder and CEO of Aliya Healthcare, a skilled nursing and long-term care operator based in Illinois. Aliya's name comes from the Hebrew word meaning "to ascend and rise up" -- and the company's phoenix logo reflects its founding story: built in the aftermath of Covid, from facilities others passed on, by a team that chose to see the ash as a starting point rather than an ending.
Aliya's purple brand identity has become a rallying point for staff and residents alike, including a partnership with the Chicago Bulls that recently brought a fully recovered patient courtside to celebrate their discharge.
Care Code Capital is a podcast exploring the business, strategy, and leadership behind long-term care. Hosted by Dan Brody, each episode features candid conversations with the operators, investors, lawyers, and innovators shaping the future of healthcare.
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