HIStalk Interviews David Bates, CEO, Linus Health

David Bates, MS, PhD is co-founder and CEO of Linus Health of Boston, MA.

Tell me about yourself and the company.

I have a PhD in chemical and materials engineering. I was in life sciences — applied biology, genetics, microbiology and biochemistry – and got into venture capital and new venture startups in 2009. I’ve done both the investment side and the operation side, especially bringing impactful technologies to market and trying to do paradigm shifts. Venture capital is about taking big risks to make a better future. 

Linus Health uses artificial intelligence to turn the sensor array of IPads and smartphones into high-quality medical devices that are capable of detecting and understanding brain function and giving primary care physicians and other providers the information they need to act on it in a timely fashion. We are looking to expedite neuroscience in the standard of care.

How would a primary care practice implement cognitive screening?

Right now, 76% do not do anything, or they ask the simple question, “Are you worried about your memory?” Those who do something use paper-based assessments. Those take a lot of time, require some training, are not very sensitive, and are subjective. Our tools allow them  do something remotely before they even come into the office, or in the office, where a medical assistant or even a secretary with a very little bit of training can administer our assessment. It takes about three minutes or less and the patient usually enjoys it. 

We get an incredible amount of insights, thousands of data points about their brain function that are processed through algorithms. It gives the provider an understanding of what’s going on with the individual, what their risks are, and what actions can be taken. We also provide the patient with a personalized brain health action plan so they can take agency over their own brain health and begin to make those lifestyle modifications that optimize their brain health trajectory. It needs to be very quick and it needs to be in the workflows of primary care. That’s what we focus on.

Can the screening be performed via telehealth or in settings outside the PCP’s office?

Our mission is to help bring brain health into its rightful place in the standard of care, making a brain assessment a standard like blood pressure and heart rate. All biology rolls up into the brain, but it is often neglected. Healthcare should start with brain health and brain function, and out from there, everything else. Any touchpoint in healthcare delivery, including remotely through telehealth, is an ideal setting to make sure that the brain is functioning as it should. If there’s any kind of wobble starting to occur, it gets addressed immediately.

Accumulated results for the same person allow you to detect both immediate problems as well as unexpected degradation over time?

That’s correct. The ones we use in the clinic are cross-sectional, because we have amassed enough data and understandings and there’s over 100 years of science behind it. But you’re precise in that with sensitive enough tools and using the individual as their own baseline, you can more easily pick up any kind of dysfunction or dysregulation that’s starting to occur and address it for that individual. That is certainly where we want to take things, to be more preventative so that someone has themselves as their own baseline. It’s very personal into what they are dealing with and their own personal situation.

Has interest in early detection increased as treatment options become available?

Absolutely. There’s a huge gap in information and understanding of brain health disorders, but that gap is closing. People thought, well, there’s nothing I can do about diseases like Alzheimer’s. It’s the number one feared disease for people over 55,  but most people think there’s nothing they can do about it.

But in fact, there’s a lot that can be done about it. At least 40% can be put off by just changing lifestyle, getting hearing aids, making sure your eyes are functioning correctly, nutrition, socialization, exercise, and all these kinds of things. They really work and contribute to optimize brain health. Giving every individual agency over their brain health, which is both information — that there’s something they can do about it, what matters, and how to optimize brain health — and giving them the tools to monitor it so that they know that, OK, I’m starting to experience something and I need to go take care of this right away. Maybe I need hearing aids, because 8% of dementia could be avoided just by using hearing aids. That’s just one example.

We want to partner and ally ourselves with these busy providers and enable them with tools to better serve their patients without increasing their burden. In fact, we want to remove some of their burden, lower the cost of the system, and empower patients under their care to have agency over their brain health. Patients want this, they want the information, they want to know. They are afraid of this disease. They are afraid of brain health ailments because they are so debilitating.

Now is the time. The science is advanced enough. There’s a lot of movement in the industry, and it’s time to take action. These digital tools are real. They are here to stay. We need to let go of the horse and pick up the car. I hope that we can work together on that in a new era of healthcare that incorporates the brain and puts it into its rightful place in the standard of care.

The recently published study that showed a strong correlation between untreated hearing loss and dementia was fascinating. How could the audiology component be tied into PCP dementia screening?

I typically lump it into two buckets. It’s all the people that have situations today. One in two over 45 will experience some kind of debilitating brain health situation in their lifetime. One in three over 65 will have at least mild cognitive impairment. So there is the population that is of age where there is a chronic illness, either detected or under the surface that has not yet manifested. What do we do with those folks? In the younger population, how do we work with those folks so they don’t get a severe neurodegenerative disease? Those two buckets are important. 

Primary care is the quarterback of healthcare. They manage care. Diabetes used to be treated only by endocrinologists, and hypertension was treated only by cardiologists. Both now are managed in primary care. We believe some of these very standard neurogenerative diseases and their causes will be managed in primary care.

But primary care is already overwhelmed. We need artificial intelligence. We need better tools and information to equip them, and even take care outside of the clinic into the daily lives of folks. 

That’s why I’m super excited about chronic care management opportunities, where health coaches are engaged to carry out the orders of the doctors and help people live their best life, their best self. That includes hearing, vision, and all those other things, making sure that it’s all coordinated and that information is tracked so that they can have that agency and optimize their brain health trajectory and overall health trajectory.

Will the company expand its offerings into other forms of testing or brain exercises?

We start with where we’re going and first enabling the patient to define what matters most to them in life. That is what we tie everything back to. Not just indefinitely — it’s what matters to you now. Is it playing with your granddaughter? Is it following a conversation? Is it driving your car? Is it playing golf? What matters to you? 

Then assessing their health, their lifestyle, what’s going on in their life, giving it some context and then bringing some objective assessment. We have those things in our platform. If there’s a reason to screen in primary care or to assess, they can use our IPad based tool to gain a clear understanding across multiple domains of what’s going on with this individual very early. That is then tied to recommendations and clinical decision support so that a primary care doc has specialist-level insights at their fingertips that were collected in three minutes. They know how to direct that patient next.That ultimately helps to generate a personalized care plan that can be implemented by the patient with help of their family.

But also I’m excited, as I mentioned, about chronic care management, where health coaches are engaged on a platform with asynchronous communication, rooting these patients on to implement the care plan and optimize their brain health trajectory. Then ongoing with the monitoring with our remote tools, being able to say, “The stuff that you are doing has stabilized or improved your brain health.” This is not just cognition, which is the highest-order function, but also mood. Do they need CBT for depression or anxiety? What are those other things that are happening? How can we equip them with the information, skills, even medications to optimize their health trajectory?

What is the company’s business model?

CMS has taken a good position. They reimburse our assessments for anyone over 65. I hope that goes downstream for the risk-based capitated plans, being able to identify people and what’s going on with them. That saves a lot of cost in running test after test and scans when all that was needed was a medication change. Or they had depression, or they were the worried well. Being able to have objective, concrete, and clear understanding of what’s going on with the individual and what to do next in a very short period of time optimizes the total cost of care and gets rid of a lot of wasteful spending in those risk-based plans. 

We have pricing models for both. We are much focused on return on investment of the practice, the healthcare system, or the payer network. We have dialed that all in because it’s important that we build not only fantastic products for providers and patients, but that we also have a sustainable business model that drives value to the entire system and every stakeholder in the healthcare.

What will drive the company’s strategy? 

Important to the company’s strategy is the acceptance of real, validated, artificial intelligence-enabled tooling that boosts the provider’s understanding, adoption, and necessary behavioral change to incorporate brain health in its rightful place in the standard of care. Younger doctors are more digitally savvy, but all doctors are savvy enough that if it is explained to them clearly, they will get it, adopt it, and their patients will love it. Getting more adoption, more openness, and that necessary behavioral change to bring it into the standard of care is the most critical thing for our success.