Dr. Yael Katz of BrainCheck: 5 Things We Must Do To Improve the US Healthcare System
We could have a big impact if Medicare and private insurers would pay for long-term care. Right now, Medicare pays for a certain number of days in a nursing home. If a person needs more than that then they deplete their savings. For Medicare to be on the hook for from the time a person turns 65 until their end of life, that would do a lot to incentivize them to care about the patient’s outcomes.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Yael Katz, Ph.D.
Yael Katz, Ph.D., Co-Founder & Chief Executive Officer of BrainCheck®
Yael drives BrainCheck’s mission to democratize cognitive health by detecting cognitive impairment earlier which helps clinicians confidently assess and implement treatments that preserve brain health and functional independence.
Yael brings proven scientific and business leadership to BrainCheck, having raised $12 million in venture capital and managed the development and commercialization of the BrainCheck® CORTEX™ technology platform, and cultivated a top-notch team with offices in Houston and Austin.
As a serial entrepreneur, Yael also founded CountVision, a startup that provides software for cell counting and fluorescence quantification, which replaces expensive hardware or manual approaches in laboratories. She also was one of the first employees at JW Player, a creator of web video technology, where she helped grow the company’s footprint to over 6 billion monthly video plays on individual blogs and websites including ESPN, CNN, AT&T and Stanford University.
After earning a Ph.D. in biological sciences from Northwestern University, Yael completed postdoctoral research at Princeton University in biological informatics and collective behavior in biological systems. She holds bachelor’s degrees in physics and astronomy and Asian and Middle Eastern studies from the University of Pennsylvania. She currently resides in Houston.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
There really isn’t a story or a linear path that brought me to this point. Looking back, being an entrepreneur was not a conscious career choice. It’s more like a personality trait or something that I was compelled to do — to dream up big things, then go ahead and do them. I’ve been doing that my whole life — from a swimming lessons business that I started as a teenager that funded my college, to my Ph.D. and post-doctoral projects, which were multi-year multidisciplinary projects. These were similar to entrepreneurial ventures. I had to convince people to get on board and fund the mission, execute on it and bring it to completion.
With BrainCheck®, I chose to pursue this work because I evaluated the market and saw a problem that needed solving. I looked at my skill set and experience and along with some luck, I met my co-founder, Dr. David Eagleman. We developed a way to digitize cognitive health assessment, which was a pretty big unmet need.
If someone has a question about their brain health, we know they want insight into what the brain is doing. Functionally, it’s actually really difficult to get answers to that question, because it involves going to the doctor, getting referred to a specialist and then another specialist, which turns out to be a very long process that takes many hours to complete.
I thought that cognitive assessment was the right space for digitization and a place where I could really make an impact using my expertise in neuroscience and computational methods. I also spent some time consulting to the biotech and pharma industry. Putting all of that experience together, I was uniquely positioned to solve this problem of democratizing cognitive health — giving more people insight into how their brain is performing.
I didn’t plan for this, but I drew upon different experiences and skills that I developed over my life that made me a uniquely suited role to solve this problem.
Can you share the most interesting story that happened to you since you began leading your company?
Since starting BrainCheck five years ago, one of the most interesting shifts that I’ve seen is around the consumerization of healthcare. Early on, I had a very heated debate with a prospective customer, a healthcare executive, about taking control of your cognitive health, which used to be our tagline. This person said, “how dare we actually encourage people to take their health into their own hands?” He was implying that people should just leave everything to the doctors and healthcare providers.
Fast forward to today, patient empowerment is no longer a controversial matter. Patients and caregivers seek out health information with “Dr. Google” and that is encouraged. We ask patients to be partners in their care and it’s widely seen as a good thing. It’s very interesting how attitudes have shifted so much in a short period of time.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Early on in the company’s history, I was raising money from angel investors and most investors wanted to see the product, our interactive cognitive assessment. I was very excited to hand it to them to test out. These cognitive tests measure speed and accuracy on each test and the investor did not do very well.
The assessment should have compared him to data from people in his similar age group. Most of the people in the data set at that point were college kids. It was quite challenging to talk him down. It was a humbling experience for me and helped me realize some of the additional data we needed to include in the future product development.
What do you think makes your company stand out? Can you share a story?
What makes BrainCheck stand out is that we’re mission-driven and the people who we have working with us are people who really are willing to go above and beyond. Recently in Texas, we had a deep freeze and many of us lost electricity and Internet access. We had a product issue that wasn’t anything too serious and something that would be easily resolved in an hour under normal circumstances, but our entire development team had no access to the Internet. Members of our team drove very far to find wifi and solve this issue for a customer. Our people are really dedicated and that is what makes us stand out.
What advice would you give to other healthcare leaders to help their team to thrive?
My advice would be to take the time to get to know people. When you’re a small team, everybody’s got to pitch in. The upside is that you don’t need formal policies. You can be on the lookout for opportunities and perks that would be meaningful to specific people. Those things can go a long way, and they can be very valuable to them. When people know that you care about them and that you will have their back, then they’ll do the same for you.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
The U.S. healthcare system is the best for the privileged few and it’s the worst for everybody else. The challenge is whether and how we can have both.
In terms of accessibility, we have a very heterogeneous society and people have very wide-ranging priorities. As a result of that, it’s very difficult to formulate policies because you just don’t know what people are thinking and what conclusions they would draw, given their backgrounds and where they come from. When you look at the other countries that scored well on the survey, like the Netherlands or Canada, they are a lot more similar, more homogeneous than our society.
When I was in high school, I volunteered as an EMT. A woman comes into the ambulance with her son who is around seven or eight years old. The boy had a stomach ache and the mother told me she gave him “some” medicine. After more questions, I realized the mother had given the child the full medicine bottle to drink from. I was so astounded by that and it showed me early on that there is a lack of basic health knowledge.
When you look at our society, people are just so different through our varied education, cultures, etc. Because we’re so heterogeneous, it presents unique challenges in creating healthcare policies.
On the efficiency side, why are we inefficient? That I believe is by design. We have a competitive free market, and health systems and payers that are private. Many companies are trying to develop the best technologies. We don’t have universal guidelines or standards, which creates challenges with interoperability. There are pros and cons to having a competitive system, but we have to make sure that all the systems can “talk to each other”. You can have multiple versions of the same thing and the option to pick the best one. The downside of that is a lack of efficiency.
The issue about outcomes asks, why do we have bad outcomes? We incentivize with fee for service, which explicitly incentivizes services over outcomes. It’s a result of the competitive system and the fact that there’s no one party that’s on the hook for the patient’s care over their entire lifetime.
Patients are constantly, or at least every few years, switching providers or health insurance payers. As a result, it’s really difficult to incentivize any one party for their health outcomes. Most of the big expenses occur when a person gets older and they become sick or have health complications at the end of life. That’s usually a result of all of the accumulated decisions made over time. If the healthcare system could have done more to help the patient be healthier earlier on, there might be less healthcare costs later on. I think that’s an unintended consequence of our free market system.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
The first thing, I would invest in education. That’s probably the biggest thing that can impact health outcomes, specifically access and equity. Typically, income and education go hand in hand — usually households with higher economic status have higher levels of education. There are a few exceptions and I had first-hand experience of that. I gave birth to my daughter at the end of my Ph.D. program. At that time, I had low income, high education and no traditional health insurance.
The university had a hospitalization plan, but I didn’t have ordinary health insurance. As a result, my newborn daughter went on a government all kids insurance, Chicago’s version of Medicaid. It was a very interesting experience. They call and ask questions like, “do you plan to have your baby vaccinated?” or “do you need us to pick you up and take you to your doctor’s appointment?” It was a very eye-opening experience to know that vaccinations and regular appointments for a baby are not always priorities for some families. Education is the biggest barrier to people taking responsibility for themselves and their children’s health. Those who aren’t educated about health don’t really understand what they should be doing and the consequences of not making it a priority.
The second thing that I would do is implement more anti-poverty measures across the board. If we can elevate people out of poverty, we will have stronger health outcomes and they can prioritize making time to go to the doctor.
Another idea to improve outcomes is implementing an intermediate healthcare role for a patient, someone who is a healthcare coach or health optimizer and is aligned to help improve outcomes. If you look at the role of the doctor, the person really sees themselves being responsible for making sure that someone is not acutely ill. As an example with BrainCheck: if a person has a cognitive issue, when they go to the doctor, they don’t necessarily ask if they have major illness or injury or condition. Their question is, “Am I different than I was before? Did I lose 10 IQ points?” The doctor, in a lot of ways, is not concerned with answering a question like that, as long as the patient is not functionally impaired.
We can enable innovators to place bigger bets with less certainty on the regulatory side. We need to come up with pathways for new innovations, new devices, new pharmaceuticals, etc. to come to market with less certainty and expedite their path to market. If done carefully and ethically, we can improve outcomes.
Lastly, we could have a big impact if Medicare and private insurers would pay for long-term care. Right now, Medicare pays for a certain number of days in a nursing home. If a person needs more than that then they deplete their savings. For Medicare to be on the hook for from the time a person turns 65 until their end of life, that would do a lot to incentivize them to care about the patient’s outcomes.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities, and d) leaders do to help?
In terms of the things that I think need to change, many of them don’t, at first glance, appear to be directly focused on the healthcare system. As I mentioned before, we need to be investing in education and anti-poverty efforts more broadly.
For individuals, we should reach out and make a friend who is not like us. When communities are segregated, then outcomes are segregated. Make an effort to get to know and befriend people who are different than you are. Corporations should also make an effort and seek out diverse candidates who come from many socio-economic and cultural backgrounds.
Regarding communities, schools and other community spaces should be outfitted so that people can go there in a crisis. In Texas, when we had the deep freeze in February, I was surprised that schools were closed. People could have gone to schools for basic needs like electricity and water and healthcare as well.
For leaders, I would like to see them depoliticizing healthcare issues. We can all agree that improving outcomes for children is a good idea. Let’s not get hung up on politics.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health, and general health. What are your thoughts about this status quo? What would you suggest to improve this?
A big problem is that if a person has a serious mental health issue, it’s difficult to access the services they need. This needs to be addressed. More broadly, there is a role beyond the doctor, similar to a health coach that would benefit somebody with a mental health diagnosis. We need to integrate the health coach role within the healthcare system.
When doctors are in medical school and beyond, we need to teach them that it is their responsibility to interface with and oversee the health coaches and to ensure that they are the best intermediaries between patients and doctors.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider helps patients achieve their goals, which could mean helping them feel better short term, manage a chronic illness or extend their survival with a terminal illness or work to develop end of life plans.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Richard Fineman said, “The first principle is that you must not fool yourself and you are the easiest person to fool.” In running a business that has come up time and again. You have a great new theory of everything and you have to be very honest in assessing what you believe to be true.
Are you working on any exciting new projects now? How do you think that will help people?
The BrainCheck platform also helps give individuals insight into how their brain is performing, which allows them the ability to take control of their cognitive health. This is such an important mission for us: we’re empowering individuals to take control of their cognitive health with this information which allows patients to have meaningful conversations with their doctors.
We are working on adding new modalities to the BrainCheck CORTEX™ technology platform. We’re making it more powerful to detect patient changes earlier and more effectively, which will help doctors to make a better diagnosis and guide patients to treatments that lessen the burden of the disease.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
MobiHealthNews is a newsletter for digital health. I enjoy receiving their “up-to-the-minute”, simple, and accessible daily updates in my inbox. It has also been cool for me to watch this publication, but really the industry as a whole to evolve. When I started reading their newsletter five years ago, there wasn’t a “digital health” category. Seeing that space grow has been unique to watch. I’m impressed that the publication covers this emerging category now on a daily basis.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
Oftentimes, you look at a very large issue, like poverty, and you want to do something, but where do you even start? Giving money to an organization seems like a drop in the ocean.
When I take my child to first grade, it’s astounding to me that there are kids in her class that are living in poverty. It would be interesting to make a medium sized project or goal, something that is much more manageable, to help lift the kids in that class out of poverty.
I would like to come up with a way to pool resources at that level to find a meaningful level of intervention with a community-based approach that could ultimately help five people.
How can our readers follow you online?
LinkedIn — Yael: https://www.linkedin.com/in/yael-katz-98909825
LinkedIn — BrainCheck: https://www.linkedin.com/company/braincheck
BrainCheck’s website: www.braincheck.com
Thank you so much for these insights! This was so inspiring!