They have successfully created a typical silicon valley she/he bro developer shop that is roughly akin to a hipster coffee shop with beards 'high-five'n each other for creating problems, then high five'n each other for monkey patching data in production. When you are high-five'n yourself for 'caching' data and then ask someone else to figure out why memcached is called 29000 times per request because you are too busy being awesome, that's when you have arrived into the hipster twilight zone of mediocre engineering that healthsherpa is neck deep into.
The spaghetti code is intertwined to everything and any suggestion to clean it up is cast to a side task that you shouldn't have last longer than a day. If you want to do software engineering, you won't be doing it here because the engineers that helped to create the mess use their 6 years of code muckery and experience in the code base to help perpetuate the myth of their awesomeness. No software engineering principals need apply, no encapsulation, modularization, separation of concerns, or polymorphism. But hey, if you are a hipster who likes to hive-five people into believing you are achieving something, they might give you a promotion! Look how many high five's today, oh you must be a sr developer! lol