We sat down with Elli Kaplan, co founder and CEO at Neurotrack to discuss how she and her team have built some of the most groundbreaking technology in the cognitive health space and where they see it going from here.
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Neurotrack website: www.neurotrack.com
Chris Hoyd 0:07
Welcome back to Product in Healthtech, a community for health tech product leaders by product leaders. I'm Chris Hoyd, the director of product management and Vynyl. Today I sat down with Elli Kaplan, co founder and CEO at Neurotrack to discuss how she and her team have built some of the most groundbreaking technology in the cognitive health space and where they see it going from here. Let's jump into the conversation. Welcome, Elli, thank you so much for joining us today, I'm really excited to get to kind of ask you a few questions about what you're up to with Neurotrack. I think maybe we can just jump right into it. I would love if you could just take a minute and maybe tell us a little bit about your story, maybe some of the background of how you got into your position and founding Neurotrack, and how were you kind of bringing, you know the that initial idea to fruition?
Elli Kaplan 0:52
Sure. And thanks so much for having me. So my company was really founded out of a personal challenge, I lost two of my grandparents one on either side, to Alzheimer's disease. And when we went through that experience, what I learned immediately was just first how hard it was to get a diagnosis for either of them. And they were separated by, you know, about five years or so. And when we first went through the experience with my grandfather, really hard to get a diagnosis, no treatment options. Five years or so later went through the exact same experience with my grandmother and nothing had changed. And what I very quickly learned, as I talked to more and more people about it was that I wasn't alone. And if you just look at the statistics today, one in 10 adults over the age of 65, have Alzheimer's disease, 20% or two in 10, have mild cognitive impairment or early Alzheimer's. And so it became very clear to me just given what the population looks like today, and where and how it was growing of the tremendous need, that there was for better tools to identify people who are at risk, or who had the disease, make it really easy and accessible for them to get access to that diagnosis. And then think about how we better manage care for them. And so as part of my journey, I went out looking for academics, researchers who were doing the most innovative work in this space. And I met my two co founders, then who were at the time at Emory University in Atlanta, and had developed technology that uses eye tracking to identify impairment in the part of the brain called the hippocampus that stores memory. And their theory or hypothesis was that if we can identify that impairment in that part of the brain earlier that we could then identify the actual disease earlier and with an earlier diagnosis comes opportunity to develop drugs and, and to better manage the disease. And they were really excited to have a way to take their tools out of the ivory tower and bring it to market and so that's that's where it started. My work and life before that I think all really led up to where I am now. And what's interesting, I think is I had a very varied career leading up to this, I worked in politics and in government. I come out of healthcare, I come out of a family of health care providers and spent my early childhood years actually living on Native American reservations were my dad was a pediatrician and worked for the Indian Health Service and so got a really sort of stark look at what health care means. And that definitely formed my views on on health care, then went into finance and, and then went back to business goal. And so all of those different things have played a role in helping to bring Neurotrack to where it is today.
Chris Hoyd 4:19
Incredibly cool. Thanks for sharing all that. Okay, so I wanted to touch on a couple of things there. You mentioned some, I think, really stark statistics about how prevalent this is and how devastating it can be. Can you touch a little more on how sort of ineffective or inaccessible kind of the old fashioned approaches to diagnosis and then maybe talk us through in a little more depth how you're using this kind of new approach through through Neurotrack?
Elli Kaplan 4:46
Yeah, absolutely. It's a really important question, Chris, because it, it is why we have so many problems around diagnosis today. So 2023 You can order food to your house through an app, you can order a car, you know, technology surrounds us in every aspect of our lives, except when it comes to measuring you arguably one of the most important functions of our health, which is our cognitive health care. Historically, the way cognition has been measured is with pen and paper tests. So you walk into your doctor's office, if your doctor is doing any testing at all, they will say, okay, sit down at a table in front of me, and I'm going to over the next anywhere from 15 to 45 minutes, ask you a series of questions, I ask you to do things like draw a picture of an analog clock, I think you go to any sort of 19 year old person today and ask them to draw a picture of a clock, an analog clock, and they would not know what you were talking about, right? That's grandfathered in a little bit with an older population, but that's going to change. And they take what you've written down and score it, and then give you some kind of subjective indication as to what's going on with your with your cognition. And so if we think about one like how archaic that process of xeroxing, you know, sheets of paper in a doctor's office, having the provider who, you know, the doctor has to do this test, we can't ask other, you know, medical assistants or PAs or anyone else to do it, scores have to be manually calculated, and then the that score has to be documented into the EMR system. All kinds of problems, hugely inefficient, subjective in nature. So you know, we find that when we go into a clinic that sometimes the providers are administering the test the right way, sometimes they aren't. So a lot of subjectivity that gets built into your score. And then I would say the other big issue is that those tests were designed and developed. And the data that is used to calculate the the end result was normed, on, you know, largely no offense to white men, but well educated white men, we think about the fact that Alzheimer's disease disproportionately affects women, black Americans, Hispanic Americans, we're not capturing accurate data on those individuals. So we're missing, you know, the majority of the population that that is actually affected by this disease, most of all, and so that's what we're replacing. Now, the good news about that is that you walk into any doctor's office, and if they are doing that testing, in fact, some are doing nothing. They say, Oh, thank God, you're here like this, it you know, it's very easy to start a conversation about how bad these tools work and talk about what, what the alternative is. And so, you know, I think that's part of it. That's very exciting to us. And then in terms of how we do it, I think that was the next part of your question is, first of all, it's all digital. But it's not just a digital version of those tests. And we think that that is a very important point. Those pen and paper tests have served some good purpose for a while, but they're not as accurate. They're not as specific and sensitive to subtle changes in cognition as we would like them to be. So we have alternative tests that outperform on specificity and sensitivity, and our digital and are much shorter. So we go into a provider's office, and that provider is typically a primary care physician. And that's an important point that we'll put a pin in for a minute. And we say, okay, we know that you are a really busy doctor, you've got a ton going on, you're on the hook for testing and understanding a whole host of medical conditions that your patient may have. We want to add cognition to it, you know, initially, they're like, Oh, you know, I've got enough going on. But the reality is that those are exactly the kinds of doctors that do need to be doing screening at scale for cognition. And in fact, CMS which is we know is the the body that governs Medicare has said cognition, and the the measurement of it or the testing of it is so important that we have they've gone in and so that it must take part as part of every it must be included as part of every annual wellness visit for any individual over the age of 65. And if you don't do that, we're not going to pay for that visit. And so PCPs have to start doing this testing. If they're not doing it. We make it easy for them to do it. So our screening test is just three minutes long. It lives on an iPad, it can be administered by the medical assistant as part of when vitals are collected. So patient comes in, they get their blood pressure taken and their weight and and everything else that's included as part of as part of that vital collection. And at the end, they get their cognition tested. And that score gets immediately uploaded into the EMR. And we, based on, you know, what the score tells us, then the provider has, with us the the clinical decision support tools in order to understand what they need to do next to properly care for that patient.
Chris Hoyd 10:43
Wow, that's, I mean, that's amazing. So I want to underscore, you just said, it's about a three minute test, right. So like comparing that to what before was up to 45 minutes, that was roughly what twice as long as your average sort of primary care visit. So it doesn't fit into the normal workflow of like scheduled visits, it has to be kind of its own thing, maybe the patient is having a good day or a bad day. So it's hard to standardize it. And you've you've delivered it, you know, in this now very, kind of it sounds like templated, but it can sort of personalize for the for the patient. And it does actually fit into the primary care window, which is such a huge improvement.
Elli Kaplan 11:25
The other thing that I should say is that the other thing that we've done, is we've tested it on just about every population that lives in the US. And so we know that our data is normed for, you know, the diversity that shows up in our clinics. So whether you're, you know, you're Filipino or African American, we're gonna capture your accurate score. And then on top of that, we can do it in multiple languages. So if English is not your first language, and you're not comfortable, taking a test in English will pop up a different, you know, whatever is your native language. So we're, we're really meeting the patient where they are and making them as comfortable as they possibly can be, when it comes to taking this test.
Chris Hoyd 12:11
Incredibly cool. I would love to talk now a little bit more about the process, or the evolution from maybe a product or design perspective of like, you know, you meet these researchers at Emory. And you guys, you know, sort of have this beautiful discussion about, you know, what could be someday. And now it's kind of someday. So how did you go from from that sort of kernel to now this scaling, you know, solution?
Elli Kaplan 12:38
That's a great question. So when I met Stuart Zola and Beth Buffalo who are the neuroscientists that I founded, the company with the technology that they had was a 30 minute test that uses eye tracking, to identify this memory loss, and that the foundation of that test is still part of our product suite. But it has changed dramatically. So you know, the eye tracking technology that they use was hardware, patient had to sit with their head and a chin rest for 30 minutes, and watch as images would float across their screen and the eye tracking tool would, or technology would capture where they were looking and how the patient was spending their time during over the course of the test. That test is now a five minute test that uses the camera on whatever, you know, whatever device you're using, so it could be a tablet, or a smartphone or a webcam. So in terms of the eye tracking technology that has has developed by, you know, orders of magnitude from when we first started the company, and you know, that speaks to other things, obviously, going on in the world around embedded cameras in tech and, and being able to access those cameras and capture really sensitive, you know, eye movement over the course of a period of time. So, you know, one hypothesis that we had early days was that that would happen. You know, it was very early days. I took our first capital in 2013 very early days in terms of eye tracking technology, smartphones and cameras and phones and you know, when when I started the company, most people were using that Logitech camera that would sort of hang over the side of your, of your monitor, which some people now use as a result of COVID and being in their offices and being on zoom all day or being in their home offices. But we made a bet that cameras would become ubiquitous and the camera technology would improve so much so that we could capture at a much faster frame per se for time period measurement. And then we also had a theory that people would be using technology in healthcare much more today, you know where we are today then the way that it was being used at the time, and that was also fortunately a good bet to make. And we've seen how, how tech - throughout healthcare - but also just in a doctor's office has evolved and the role of the EMR system and the role of iPads and tablets that are used to collect information and now deliver diagnostic tools. And so, you know, we have grown as that has evolved, and fortunately, it has grown in the way that we had initially hypothesized it might, and now, you know, sell software, essentially, into health systems so that they can access our tests and use them in the clinic. And then the other big way, well, there are a few other ways that our tech has evolved. I mean, one is we've built out the battery of testing tools from where we originally started. So when we started, we had this one 30 minute test, that test was shortened to a five minute tests really to make it much easier for people to sit there and take it. You know, when we first started commercializing, we were working with big pharma to help them better recruit patients for clinical trials for disease modifying drugs. And what we heard from pharma was, we get that your tasks this 30 minute test is a much better way of identifying people who are essentially pre symptomatic for Alzheimer's disease. And that's exactly the profile of a person that we want for our clinical trials. But even in a clinical trial setting, getting somebody to sit down and and watch a screen for 30 minutes was too much. And so we shortened it to five minutes, we were able to maintain the specificity and sensitivity by sort of reordering and reorganizing that tool. And it's it's a much more user friendly or patient friendly test. But the other thing that we've done quickly is that what we recognize is that diagnosis alone is not enough. We have to be able to give people an answer to the question of "so what do I do if I find out that I have early Alzheimer's or mild cognitive impairment or Alzheimer's disease"? and the unfortunate thing that we've been battling, I suppose, over the life of the companies that we haven't had a drug for Alzheimer's, we now do have one FDA approved drug, Lecanemab. That is on the market and being prescribed not at large scale, but I think that will change that has opened, I think the floodgates for other drugs and investment in drugs to happen. But in the meantime, what we've learned is that there that the role of lifestyle in terms of really being able to better manage Alzheimer's disease and slow progression for the disease has become extremely compelling. And there is now a very strong science, about the role of lifestyle and being able to do that. And so we developed a product that is now in a second, randomized controlled trials funded by the NIH. That will show I mean, we have early data that will get published in the next few months, that shows that, that if you follow a program that's based on the FINGER Protocol, which is a very established program for managing Alzheimer's disease, you can in fact, manage your future trajectory for it.
Chris Hoyd 19:26
Okay, well, I want to talk a little bit about just sort of, you know, organization leadership. So you, you've founded the company in those early days, you know, you mentioned a couple bets or hypotheses that that you took a little bit of a leap on where you thought things were heading. But as you, you know, kind of grew and realized that those bets, were sort of validating and you, you know, took more capital and scaled the team. How did you think about sort of the the product side of it and you know, sort Maybe from those early days as a sort of product focused CEO, what was that like for you to kind of grow that side of the business over the years?
Elli Kaplan 20:08
It's a great question. So there's, you know, there's obviously product development in pure tech, and then there's product development in healthcare. And digital health is a new, you know, relatively still new category market category. In those early days, I think there was not yet a clear understanding of what was important when it came to building products for a digital health market. And I think, unfortunately, there were a bunch of companies that thought of it more as pure tech, as opposed to what you would need to do if you were actually more like a biotech company, we took the view, and those companies, you know, kind of put these products out into the market, some got great adoption, others didn't. But they're, you know, there was uncertainty around them, we took the view that we we and we still maintain this view that we are a biotech company, maybe we're a tech bio company, and as a result, that the products that we bring to market need to be validated in the exact same way that you would validate any other product that you were bringing to market and healthcare, whether that is a drug or a medical device, or you name it. And so we spent, we spent a lot of resources, validating our tools, running clinical studies to show that they worked. And, you know, I will say, that's not always a hugely popular thing to do, particularly if you're a venture backed business, we're very fortunate and that we have deep alignment with our investors who got and, and understood the importance of that, you know, we spent years running clinical studies to show that our products work that they would work not just once, but many times over, you know, sort of the test, retest reliability, the testing in different populations testing in clinical settings versus like, out in the wild. We have, you know, people who, who have taken our tests on smartphones, in Japan in the back of a taxi cab, and we can get the exact same result from that individual as we can, if they took it, you know, sitting in with an MA in their doctor's office. And so being able to show how strong and secure our products are, was really important to me. And I think, you know, it really comes from having grown up in a family with doctors who would say to me, like, Oh, you're so you ran one study, that's great, go do the next five, and then come telling me that it works or go to the next ten. So now we have 23 peer reviewed publications that show just how valid our products are. And lo and behold, you know, when you go and try to sell to large health systems or to payers, that's where they start, you know, someone very early on said to me, and it couldn't have been better advice. There are two desks that you have to get across when you're selling into healthcare. The first is the chief medical officer. And so you've got to be able to show that you've got those 23 peer reviewed publications, and we're also FDA Class 2 medical device registered and we have 11 patents and so you know, we have a very deep, both moat but also dataset and validation that behind our products, but then you've got to be able to get past the CFOs desk and so you know, we focus first on that CMOs office and, and ensuring that all of our products were had what they needed to to instill confidence and then and then getting past the CFOs desk is is kind of where we are now as we commercialize.
Chris Hoyd 24:13
I didn't even realize the extent to which you're validated. That seems to be you know, there's kind of this landscape I you know, over the last like maybe 12 to 18 months as the macro winds have shifted, the companies that that didn't focus on that or maybe didn't find that kind of alignment that you mentioned with their investors. It's a rough time for them. So that's really cool. Okay, so maybe talking a little bit now about, you know, about the development team, the product team, just sort of what they're focused on, you know, over the recent term or near term, are there any like wins kind of that you know, something that shipped recently that you're excited or proud about and want to give a little shout out to the the team for getting done?
Elli Kaplan 24:56
First of all, I have to say we have a phenomenal product is an engineering team, people who are very mission oriented who are working at Neurotrack because they believe in the problem that we're trying to solve and have been impacted themselves. And designed for patients. And build for patients, you know, we sort of have two customers we have or end users, we have the doctor. And then we also have the patient and you have to sort of design for both of them. So the product team for its, you know, it's pretty small and mighty, it's working on a bunch of different products. But the one that I would give the shout out to now is a remote - And I don't want to get too far ahead of myself, because some of this is still under wraps - but is making it possible for people to test for remotely in a clinical environment. So you know, we have a bunch of doctors that we work with that just because of the situation, the sort of the market environment, or that or what health systems are facing today, which is high labor shortages, high burnout among providers, and patients who need to get seen. So we have, whether it's pure telehealth partners, or just doctors that want to be able to have people test at home, making sure that those tests have the clinical bells and whistles that they need in order to do that, from a regulatory perspective. And so it really is, that's one of the big things that that we're working on today that people are really excited about.
Chris Hoyd 26:43
That's incredible. So it'll be accessible through the App Store, or what do you think?
Elli Kaplan 26:49
it'll be accessible through your doctor. So if you are, you know, going to see you've got your annual wellness visit, very often, the doctor, as you may know, or the medical practice will send out kind of a often they call it like digital front doors or an appointment manager. And so we would sit in that appointment management system and then the patient could take the test before they come into the doctor's office at home, the result will be ported into the EMR such that when the patient shows up, the doctor is ready to go from a discussion perspective, to have whatever conversation is necessary and get ready to plan for it.
Chris Hoyd 27:36
Right. And that's no small thing in itself, right integration with however many EHRs there might be out there, you know, which they each have their own sort of custom configuration for the health system. So I like what you said about sort of the two desks to get across. And you're sort of focused on the CFO one right now, which seems to be the trickiest one. So it just seems like a solution. Like, you know, you're saving physicians time, you're clearly improving, you know, the patient sort of experience, you think to the extent, you know, ensures incentives are aligned with those things, they'd be excited about this, what are the struggles you guys are kind of working through helping CFOs understand, you know, why Neurotrack makes so much sense.
Elli Kaplan 28:16
So I should give a little context, layering on the foundation that you laid out, which I think is spot on, which is one that the the point that I mentioned earlier, which is that CMS is now requiring cognitive testing as part of every annual wellness visit. And so CFOs, and their regulatory folks are saying, Okay, we have to comply with this. And so they're looking they're at for the most part, they're out looking for better tools that they can use across their system in order to do this testing. But the other thing that CMS did is, at long last, they have attached some very meaningful payment systems, for health plans and providers to be able to get paid for doing this testing. And so in a fee for service model, they get paid, you know, they're there. Now CPT codes that will reimburse the provider for testing and then care planning and managing and even more so as we as a healthcare system shift towards value based care. There are now value based codes that incentivize providers for doing a better job of really accurately identifying the prevalence of Alzheimer's disease in their population and attaching incentives or or reimbursement for that type of system as well. So, you know, I think we have the right tailwinds, I suppose it to really give those conversations a big boost. And, and I think it's just a matter of CFOs now, you know, with the market the way it is, and the pressure that so many health systems are under from a provider burnout, cost of labor, cost of everything going up perspective, it's really just a matter of them having the bandwidth and the time to make space to review solutions like ours. And then once they do, which they they eventually do, because they know they have to, then it actually is a relatively easy conversation,
Chris Hoyd 30:42
I just want to touch on a couple sort of trends out in the healthcare health tech space right now and see what your reaction is or whether sort of Neurotrack has a stance on them. One, one positive, maybe one a little bit less positive. But so first, clearly, you know, AI is very buzzy right now, you know, I'd be interested to hear your sort of take on how AI might apply to a solution like neuro tract, is that sort of factor into your roadmap? How do you How are you thinking about that?
Elli Kaplan 31:12
Ai factors into everybody's roadmap, one way or another, at least from the perspective of like, is AI something that we should be figuring out how to incorporate? And so yes, it does. And so we think about it from a few different perspectives. One is, can we use AI to make any aspect of our product be more efficient? You know, can we help MAs get patient information into the, you know, registered into the iPad easier? And make it possible for the patient to start testing faster? Can we use AI to, to capture other data about the patient perhaps from the EMR, or perhaps from they're sitting and taking our tests, and, and then give us more insight into their overall cognitive health and or other things going on with their health that may be affecting their cognition? So we, we do think about it a lot. And we are actively trying to figure out what would be the best way to incorporate it into our product roadmap, and I think, you know, it's a, it's certainly a work in process, as you said, there's AI as an actually an effective mechanism, or set of algorithms that can improve your product, and then there's AI just because it's buzzy, and everybody, you know, everybody's using it. And so, you know, we were doing the work of really trying to understand whether it would be effective and helpful. And help us go faster and and get more insight into the patient, or, you know, is it just not necessary? So I would say that's kind of where we are with it.
Chris Hoyd 33:11
Okay, cool. And then so the other one, the maybe less positive one, the trend that I think we've seen a lot of this years, basically mishandling of patient data, maybe a lack of regard or understanding of how to protect that data, or maybe in you know, even worst cases sort of trying to profit from access to some really sensitive data. How do you know, you and the Neurtrack team? Make sure you you know, you handle that stuff carefully?
Elli Kaplan 33:39
That question goes to the heart of what are your values as a company and what drives your your sort of your daily work and the overarching culture of the company - how do you think about your customers? And who are your customers? Are your customers, the patients and the doctors? Or are they someone else? And for us, I think, you know, because every day, people on our team wake up and think about how can we do more to help people who are facing probably the scariest diagnosis of their life, get insight into their cognition, think about, you know, how it's going to impact their family and how a caregiver needs to be, you know, working with their loved one to help care for them. That is what drives us and as a result of having that as sort of the cultural ethos and core value of what we're doing means that we take patient data as the most important piece of information, you know, it's sort of gold in our company. From the point of what, you know, how it needs to be protected and And so, you know, we're very, very careful. You know, we're just completing SOC 2 compliance, we have very strict protocols around who gets access to patient data and who doesn't. I couldn't get in. And you know, if you came to our, if you took a test, and and I wanted to see oh, that was interesting, I just did this podcast with Chris, I wonder how he did on his cognitive score, there's no way I could get access to your data. And I think that having those protocols around who has access? How is the data itself protected within your tech? You know, is everything. And so I think, my view is that there's nothing that's more important, we're going to do whatever is necessary to make sure that it's protected.
Chris Hoyd 35:49
I love that answer. Yeah. So it's never just a kind of a one off approach from your, you know, GC or CTL, or whatever. It's like, the value is just imbued in how you guys make a product.
Elli Kaplan 36:03
If you think about how the stigma that still exists around Alzheimer's disease and cognition, that alone is a huge issue. People don't want to talk about this. And so if it got out, you know, it's hard enough to get people to think about, Okay, I'm gonna get a diagnosis, it's mixed, I would say some people are like, I want to know, and I see that that information is powerful. And I can and I can use it to, to both try to change my future trajectory, but also helped my family plan. And then there are other people like I really don't want to know. And so protecting that information is really, really important.
Chris Hoyd 36:41
Right, especially without a, you know, affordable, highly effective medication, I think. Yeah, okay. All right. Well, Elli, we are approaching time here. This has been a huge pleasure I, you know, could not respect more what you've built over the last, you know, decade or so. So thank you so much for for kind of talking to the Product in Healthtech community about it. If anyone does want to, you know, reach out, where can they find you?
Elli Kaplan 37:08
They can find me at elli@neurotrack.com. Just want to say thank you, Chris, for having me. It's really fun to talk about this. We're so proud of our products and proud of our product and engineering and design and content team and it's it's really fun to be able to shine a little light on that.
Chris Hoyd 37:25
Thanks so much for joining us. You can also connect with us on LinkedIn, YouTube, or on our website at productinhealthtech.com. If you have ideas or suggestions on what you'd like to hear on a future episode, or if you'd like to be a guest, please shoot us an email at info@productinhealthtech.com. Thanks.