Healthcare Innovation: Could we start with describing Isaac Health’s origin story and the business model that you're fine-tuning?

Bruch: I started off as a medical doctor, started training in neurology, did my Ph.D. in research in this space, and I've always been very passionate about the dementia space. I had a grandmother who went through that journey as I was growing up, and that definitely left an impression on me about the dire need to improve the experience. 

I was working at McKinsey, the management consulting company, during COVID, helping develop a digital health strategy for a national payer. As part of that work, we were looking for a dementia solution, and at the time there was absolutely nothing. We were thinking about virtual care models during that time. I reached out to different specialists in this field. And that's how I met Joel Salinas, who works in the Memory Clinic of NYU Langone. He eventually became our chief medical officer and my co-founder. The goal for the company was always: how do we close this access challenge? How do we get a much bigger proportion of the population into this care? 

I think our experiences have come together in a really nice way to build this platform that allows us to scale specialty care better. Isaac Health is essentially a platform that enables the entire care pathway, starting from screening and early identification through to the diagnosis and then the treatment and long-term care management to support these patients need. 

HCI: Is your business model that people are going to be sent your way from health systems like NYU Langone or from their managed care plan? Or are patients and caregivers going to find it themselves online?

Bruch: I think a little bit of all three. We have primarily specialized in payers as a way to reach this population, primarily because it's so under-diagnosed and under-recognized. I think the incentives align really well with payers. They have this population and have an interest in getting them diagnosed and identified. They have an interest in keeping them out of acute-care settings and safe in their homes. Most important, they have the data. We've developed AI algorithms that I think are the industry-leading model for identifying undiagnosed dementia, and it's also patented technology now. We are able to help a payer identify which members we should probably reach out to. We then reach out to them, get them diagnosed and get them in touch with the right care. That's the primary model of how we work, but I think health systems struggle with capacity, so their channel problem is a little different. It's more like they just can't handle the volume, and they are losing patients from their health system. That's how the NYU Langone partnership has started, and how we are now partnering with a few other health systems. 

HCI: Is part of your goal to do more partnerships with health systems, as well as with more managed care plans?

Bruch: Yes, both.

HCI: With the health systems, do you have to tie the clinical records of the patient between their EHR system and yours so that their clinicians know what's happening to patients in your system and vice versa?

Bruch: Exactly. That kind of integration is definitely important, because obviously we don't want to fragment care. We want to make sure that there's one consistent record. And it does take a bit of time to get that right, so it is a key part of making this program successful.

HCI: Last year your company announced a partnership with the Caregiver Action Network and Carallel, which provides training, educating and care navigation for family caregivers, to work on the GUIDE model, an 8-year CMS initiative to improve dementia care by providing comprehensive, coordinated services to beneficiaries and their caregivers. Is that work already underway?

Bruch: Yes, that's been underway for a bit. Essentially, we partner wherever the dementia population is, because our goal as a company is to reach as many dementia lives as possible. Carallel and the Caregiver Action Network is one such channel — they have a phone line for caregivers. Obviously, many caregivers have a loved one with dementia, so if they call this the Caregiver Action Network support line, they talk to someone from Carallel. We provide more of the clinical care, and Carallel provides more of the care management. That model works very well.

HCI: We have seen some consolidation or exits from companies in the dementia care space. Most recently Rippl was acquired by Harbor Health. Do you have some thoughts on why? 

Bruch: My view on this market is that we were the only ones doing dementia management. Then the GUIDE model came out, and lots of people pivoted into dementia and/or started new businesses because it seemed like an approachable market. There was an established revenue model through this care model. But then people realized two things. First of all, it's not easy to recruit traditional Medicare lives, in Part B Medicare, because they are not part of a payer. They're more or less free-floating, unless they're part of an ACO. The other thing is that it’s operationally really hard to manage this population. I mean, they have cognitive decline, so that obviously makes it challenging. But they also need a very multi-disciplinary care team, and they need specialist care. So I think a lot of these models that were created on a whim to address the GUIDE model ultimately failed to address specialist care need. 

At Isaac Health, we have neurologists, we have speech language therapists, we have geriatricians, we have neuropsychologists. It's a complex operation that we've managed to automate well and effectively. That's how we're able to deliver this model, and why we keep attracting more investment and more partnerships, because we are able to scale and cover a population of over 800,000 Medicare Advantage lives.

HCI: Is recruiting a significant challenge for you if there is a tight supply of some of these specialists such as neurologists?

Bruch: We set out to solve for that from the beginning. Our model is very much primary care, geriatrics or nurse practitioners with a neurology background doing the frontline work, but being supervised and enabled by a team of behavioral neurologists, as well as our AI platform that makes recommendations on the diagnosis, on the next questions to ask. If you can imagine, it is like holding the hands of the frontline provider to enable them to essentially deliver care at the level of a behavioral neurologist. That's how we are able to scale this model.

HCI: Is the AI platform of today considerably different from what you initially envisioned a few years ago?

Bruch: It's definitely smarter. I think we'd initially envisioned this more algorithmically driven. But obviously the world has moved on quite significantly, and it wouldn't make much sense to do this algorithmically driven anymore.

HCI: Anything else about the partnerships or the company’s future that I haven't asked about that you'd want to stress?

Bruch: NYU is a new kind of partnership that we're very excited about, because it really creates a blueprint for an academic health system. Now that that exists, there's a lot of interest from different health systems.

We’ve also just announced a partnership with national insurance company Wellabe. One thing I like is that they have a rewards program that provides bonus points that people can claim benefits against if they do healthy behaviors. And one of those incentivized behaviors is doing a memory screening. I think it is a great way to encourage healthy behaviors and a brain-healthy lifestyle.